My husband needs to be in a rehab but no one will take him without hospital referral. Advice?

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My husband has several different ailments: dementia, guilliam barre.

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I agree with moondance. If a person starts falling, that qualifies them for a home health care evaluation under Medicare Part A. You can find the information on the Medicare website. A nurse will come to your home and determine your husband needs such as physical therapy however, you have to be insistent that it will help him. I have been struggling with getting my husband around for over a year. Fortunately or unfortunately, my husband stumbled and messed up his knee. I convinced the primary care physician that he needed home health physical therapy because his knee prevented me from taking him to a PT facility. It was not easy to get approved. The most valuable service is that I finally had a resource to show me how to transfer him from place to place. If I had known some of this information a year ago, I could have prevented my husband's stumble and knee problem. I should have told the doctor he fell the first time I had to catch him.
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I hope you are getting the answer you seek. Is there a council on aging that can help you. It maybe difficult to even get the time to make these phone calls or lawyer visits. You need some in home help. Just to be able to get a lot of these suggested fixes in place. Please keep us posted on your progress.
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How is your husband's physicians assisting you? Ask the rehab unit to specify the information they need. See if you can find out if this a common practice of this rehab facility. Find out if finances or Medicare are playing a role in their reluctance.
Sounds like being more assertive is something you need to consider. Being an advocate is tough work.
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My heart goes out to you. This is truly one of the situations that falls squarely on the shoulders of care givers. You didn't mention insurance coverage so I'll approach this from a Medicare perspective. Other insurances will have different requirements.

Medicare will only cover temporary rehab after a qualifying 3-day inpatient stay at a hospital (that's what Sueber48 was referring to when indicating that you sometimes need to force the Admit.) Forcing the admit is sometimes necessary, but it's stressful for the patient. And you can't really count on the rehab lasting more than a few days.

The first 20 days of rehab (under Medicare) are with no copay and percentage co-pays after that, but the patient can (and will) be discharged from rehab if/when they no longer show signs of improvement. So - you have to go with your gut. If you think he'll get Released after a few days; it's not worth the angst all 'round.

Respite care is only covered under Medicare if the patient is under Hospice and authorized by the hospice provider. Medicaid is different & I'm not familiar with their requirements and they can differ from state-to-state.

If he's a veteran, he may be eligible for additional benefits through TriCare, but they can take a while to get implemented. See - 'Aid and Attendance' benefits.

If his physician will sign an Order for Home Health (due to being home bound etc.) you may be able to get someone in from a Medicare approved Home Health provider. It can be a bit of buggle the first few visits until you get it organized, but if you schedule the more difficult tasks for those days - it can help. Wishing you the best. Stay in touch.
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The hospital has to call the NH #1 for approval and #2 to see if they have an available bed.
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The best way is to have him admitted to the mental health unit at a hopsital for dementia. There are several criteria there, including being combative, changes in thought process, not sleeping, etc. While there inform the social worker you would like to have him placed in a nursing home, because you are unable to care for him at home any longer. This happens at mental health facilities in the midwest everyday. Good luck.
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If he can't gain admission to a rehab facility, he may still qualify for home rehab services. Doc has to order evaluation from VNA or other home care agency. Eventually may be able to be admitted to facility. In meantime there is some help from homecare.
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Do you want rehab for one of the conditions specifically, or for multiple conditions? Have you contacted his treating physicians?
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Are you looking for long-term placement, or just temporary? Rehab is usually a temporary thing after a hospital stay, though, they can provide what is called "Respite Care" short term, to give caregivers a break. How that gets paid for depends on your insurance, and you'd have to check because daily rates can run from around $400-$800.

If you're looking for long-term care, then what you want is long-term nursing care, or assisted living (not rehab). If you have been asking about rehab, but really want long-term care, you should call them back and ask about that instead. They will have different information for you.

Whatever you do, DO NOT sign any admissions agreement without having a lawyer look at it. They often have tricky wording in them which will make you liable for any bills your loved one cannot pay. You don't want to be stuck with one of these bills, which can get into the tens of thousands of dollars.
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I have found that getting a doctor's order for therapy for a person with advanced dementia is difficult. The doctors I have dealt with say that Medicare and Medicaid have requirements regarding whether the physical therapy will be beneficial. Apparently, with advanced dementia, when a person is wheelchair bound, they don't feel it will help.
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