How can I get help in navigating the healthcare system to insure that the patient remains in a hospital or similar facility?

Shane, when a person has increased intercranial pressure we often remove part of the skull to allow the pressure to build up with out causing more trauma to the brain. We call it a "bone flap",, and once things stabilize the bone is replaced,, but this can take some time to happen. Normally the pt gets a helmet to wear to protect the brain during this time. The skin is resewn over the brain so it's not exposed to the air and such. I work in a neuro ICU.. The bone flap is either stored in a lab, or (believe it or not) placed in the pts abdomen for safe keeping! Freaky but true!!

My stepbrother had that procedure last fall post stroke. He spent his time post hospital in a skilled nursing facility on VA and Medicaid coverage. Helmet was white with donated Harley stickers.

Talk to the social worker at the facility that the patient is currently in - they have to ensure that a patient is discharged to a "safe environment". On the other hand, hospitals and rehabs cannot keep patients in the facility indefinitely with insurance paying for the daily care. Depending on the level of care needs, you may need to explore a Skilled Nursing Facility for the care until next surgery can be done. And if that is considered a "residential" placement, you'll need to coordinate with social worker about getting Medicare, long term care insurance, or private pay set up. With long term treatments like stroke, you can't just leave patients awaiting the next stage of treatment in the hospital bed being billed at hospital acute care rates. The social worker can discuss other discharge options.

I am assuming that you are a an employee at said hospital. Thank you for being a caring person but hospitals Don't work that way. Medicare has to be shown why the person remains in the hospital. Medicare determines the hospital stay. My daughter, RN, has worked rehabs for 20 yrs and says they get a number of hospital patients that are not ready for rehab. Rehabs are not equipped like hospitals. Pharmacy and X rays are provided offsight. Where is the family in all of this? If none, then patient needs an advocate.

Part of his skull replaced? I’ve never heard of that condition & I am a RN. What is the diagnosis and what level of care do they need? Ventilator? Hydrocephalus? Cerebral edema? 
This depends on what insurance the person has as well.
I am thinking the person needs either rehab or skilled nursing home care.
JoAnn is correct, hospitals don’t work that way anymore.
If you can provide details we can better help you.

Has anyone suggested a long term care hospital, such as Select Specialty Hospital? I believe its focus is on respiratory issues, but there may be others. When my father was discharged to SSH, it was the first I was aware of a "long term care hospital."

Thanks Pam for clarifying that! I did not know this.
I knew it had to be something to relieve the IC pressure but wasn’t aware of this procedure.

I appreciate your comments and suggestions. The course so far has been 1) the OR and CCU of a hospital; 2) a long term acute care facility; 3) a skilled nursing facility; and 4) a rehab facility. Insurance has been the driver in his movement from one place to another. The kicker has been trying to locate a suitable facility that would accept him with part of the skull missing--even with the helmet he wears whenever out of the bed. I will follow up on the social worker. How doe sone locate a patient advocate who is familiar with the healthcare system?

First, I've never used a patient advocate in the sense of selecting long term care, so I have no suggestions on that other than to ask the SW at the existing hospital. I do have a few other thoughts though:

1. Find out if the hospital he's in now actually has any Patient Advocates to provide inter-facility coordination. In my area, one hospital has what it calls a Nurse Navigator to help guide patients with options and decisions. Someone in this capacity would have an overview of what's available in that hospital chain but I'm assuming with other short and long term care hospital facilities as well.

This is a big Catholic chain of hospitals. I think you might try nonprofits, especially Catholic hospitals, as in my experience, they're more caring and more likely to have a broader perspective on options.

2. Check out long term acute care facilities; I think this is probably the closest to what he needs. There would be an insurance coverage issue here as well.

3. If you're not familiar with his insurance coverage, you or someone else will have to be as it may be that he'll need more care than insurance will cover.

Does he have any Medigap or supplemental insurance? If not, does he have the resources for long term care?

4. The MediLodge chain has segued into specialties at the various sites. One seems to focus on rehab for knee replacements. Another focuses solely on respiratory related issues. I was told by an Admin staffer that most of their patients will never leave there until they pass. So this particular branch of the chain focuses on long term care, vs. the other with short term care patients.

You might try contacting the corporate HQ of Medilodge to find out if there are any that specifically will take someone with the head injury he has.

5. I would think the surgeon(s) who performed the operation would know what kind of care would be best, so they could help identify his next placement as they would know what's needed now and in the future. And they should be able to make recommendations; some of them work at different facilities, short and long term, and have a better idea of what's available.

Good luck; this sounds like a real challenge to find the right facility.

The Social worker should know how to work the system. If she doesn't there is a problem. There are only certain facilities that will take patients with trachs. Would think this would be the same for this person. He needs more care than most facilities are willing to do. That may be the proboe here.