How do I get a family member discharged from 100 day rehab into a nursing home?


My wife’s uncle had a stroke and was hospitalized for one month. After the month was up he was sent to a 100 day rehab. Medicare is covering 80% of the cost with AARP handling the remaining cost. My wife’s uncle is now wheelchair-bound and cannot be left alone anymore. We are going to talk to him today at the rehab about having him go into a nursing home because my wife and I both work full-time jobs and we have a special needs son to take care of. Not to mention our own personal medical issues one of us has a weak heart the other one has a bad back that we can’t really help them out and we live in a three-story townhouse. How difficult would it be to get my wife’s uncle from the 100 day rehab to the nursing home? Especially if he doesn’t want to go because he feels that we can take care of him even though we really can’t. Also before he had a stroke and he was at my house there were times I would come home from work and the stove was left on in the kitchen and he was upstairs on the second floor in his bedroom. He would be the only one home and he would deny that he did it.

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First, not sure who told you Medicare pays 80%. Unless that's an average. The first 20 days is 100%. 21 to 100 is 50%. My Moms UHealth Medical with Medigap did not pick up the balance leaving Mom to pay $152 a day. He may not be there 100 days if he doesn't keep improving or reaches a plateau. Is there a NH attached to the rehab. If so, ask them to evaluate Uncle for LTC. Leaving a stove on is a good sign he shouldn't be alone. I assume your wife is his only relative? If so, explain to the Social Worker that he cannot live with you and why. Hope someone has POA over him. He probably can still be evaluated if not attached to NH and  the SW can help find a LTC for him.
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Good answers. Whether Uncle’s mind is sharp or not ( and it sounds like he has some issues at least), bottom line is that even if he did stay with you for a while, he can’t anymore. You learned that. To take him back into your house would be very problematic and you know that, too. Call a Care Meeting, if even with only the Social Worker and tell them Uncle can’t come back to your home. Period. Don’t let them tell you they’ll arrange for Home Heslth Care, Nursing visits, Therapy, etc. These only last for a short while; for us only a few months. And then, you’re on your own. Don’t feel obligated or guilty. Not your problem.
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How is it your responsibility to decide on and implement your wife's uncle's care plan?

You and your wife might take some reassurance from the fact that where and how he is to live now is Uncle's problem, not yours.

He can choose to return home and hire care. He can look at a range of options from retirement communities to various facilities to nursing homes or whatever. It's up to him.

What he can't do, happily, is decide that he is going to move into somebody else's house (yours) and demand that the residents (you and your wife) provide him with full-time care. Any more than he can just pick a family at random and decide he'll move in with them. You and your wife decide who lives in your house. Not uncle.

So when you have this discussion, and he says that you can take care of him, to coin a phrase... Just Say No.

If that feels too harsh, just say "we'll see" instead, don't explain, don't continue the discussion, and ask the rehab's discharge planners to deal with it. It is their job, and they will do it just fine.
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Nursing home may not be needed. Doctor would have to prescribe it. Assisted living may better fill his needs, maybe memory care. You can refuse to take him home and rehab would have to find him suitable housing.
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