She went to the ER for a dislocated hip that required surgery. From there, she was sent to a *****facility. She was not being cared for and was found 3x completely dehydrated! She then fell out of bed-ending up back to ER. We moved to a new place-again with all kinds of promises. She has fallen out of bed 2x there, just this week (2 more trips to ER) she has Alzheimer's & has basically become a real nuisance to the whole staff (the label has been set!) She does display many of the usual symptoms (of ALZ) but in no way is a danger to anyone (but herself). She can’t walk, go to the bathroom or anything by herself yet...there hasn’t been a chance for the rehab she needs. Can they just send her off or home in this condition!??????

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What support does your mother have at home?

If the set up there, before she dislocated her hip I mean, was a good one, it may be that she will do better in her familiar environment and you can bring the PT to her?

They certainly can't kick her out with a proper plan in place, so Ahmijoy's instructions should see you through that nicely. I just wouldn't assume that rehab is the only or best option; but it does depend on what she's going home to.

And on who's doing the work, of course. Hope it's not all on you!
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Reply to Countrymouse

What is likely happening is she is being considered “non compliant” for rehab. Insurers - whether it’s MediCARE e or BCBS or Humana, etc. - are very strict and it’s a time sensitive type of strictness as to rehab benefit which has a specific script & is based on the various ICD-10 codes she was discharged from the hospital with. If she won’t get on the timetable, she’s toast for rehab as considered non compliant and Insurance won’t pay.

Like for broken hip / hip replacement surgery, they will probably be expected to get up, get dressed with assistance and get their butt down via a wheelchair to the rehab room or wing to see the PT & or OT, the day after or 2 days after surgery for an in hospital evaluation. This will be used to do the discharge report from the hospitalization. Once they leave the hospital & go to the rehab NH, likely if they get there midday, the initial PT / OT intake may be that afternoon & they look at the info in the discharge report. If not, it will be the next day. Any lollygagging or maybe manana attitude will be written into her chart. And after a set # of noncompliance days, rehab stopped so insurance coverage stops.

Really if it means you or other family members need to be her own little cheer squad (or threat squad) to get her to do this, then form one.

MiL broke her hip walking dog ( classic scenario) and had preexisting heart condition (CHD). After surgery, she clearly expected to lay in her hospital bed, carping about lack of options on the TV and limitations on menu check off and be waited on. Well she was taken to hospital transitional rehab unit for PT evaluation day after surgery with first mild session set for the next day. Between the hospital SW and family, we had to make it clear that either she went along with going to rehab at the hospital or going directly into a NH with no possible option of ever going back to her apt to live solo. Being genteel wouldn’t work with her. So give some thoughts go as to how to approach getting her compliant. Btw talk with SW and the therapist, they’ve been through all this numerous time and pretty spot on as to how to best convince her type of personality to do rehab.

Please be aware that if non compliant, insurance stops paying.
So either she stays private pay, moves back home or with family or if no resources applies for LTC Medicaid to become a resident of the NH. The vast majority of NH admits come from a post rehab situation..... they get hospitalization (Medicare) followed by post hospitalization rehab in a
NH (Medicare up to 100 days), then it’s determined they for their own safety and security & health care needs cannot return home end up staying in the NH and becoming a long term care resident (private pay, LTC insurance or Medicaid).
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Reply to igloo572

I haven’t dealt with a loved with ALZ, so I’m not sure if this helps/applies. Both my in-laws were in NH only for therapy this past year. If a patient is on medi-care in NH for therapy only and they *refuse* for three days, they are discharged because Medi-care won’t pay. I’m not saying she’s actually refusing, just stating the rule. Also, it is very easy for a patient to fall out of bed because NH can’t use any kind of restraints, even raising bed rails is frowned upon. I’m not making excuses for the NH, just stating what bit I know. An administrator told me that they “have to get creative” when it comes to keeping patients from falling out of beds/wheelchairs. I didn’t ask what that meant.
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Reply to mollymoose

If she is there for therapy, Medicare requires they start in a certain time,
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Reply to JoAnn29

Wherever she is now, you need to call a Care Conference to find out what’s going on. Every staff person who has anything to do with her should be there. It is your right to call this meeting. The meeting should be held within a few days, a week at most. Write notes on what you’ve observed and what questions you want answers to and bring them along. Be patient and firm. Let them have their say and then you have yours.
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Reply to Ahmijoy

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