My dad is 73 years old. He had surgery about 11 days ago and he had it on his foot which is a foot that is on a paralyzed leg. He uses a brace on that leg. His other leg is a little bit weak but as long as he has the brace on he usually can be mobile and very independent. Since the surgery he's unable to be weight-bearing therefore he is very unsteady. The surgery was outpatient. He's been home and has fallen several times and been taken by rescue squad on two occasions admitted into the hospital for 24 hours and then released. My mom is 72 years old and although healthy she's unable to physically meet all of his needs. Due to medication trauma surgery and the overall situation he's had some big issues with memory and forgetfulness and confusion. We believe he needs to have physical therapy on an inpatient basis but every time he's in the hospital they release him after 24 hours & we go home and it all happens again. What are our options? We live in Omaha Nebraska. He has Medicare and supplemental insurance. My mom and dad do not have any legal documentation such as power of attorney. My dad is very mobile and independent normally so this is not a situation we've ever had to deal with. I basically want to know if he has to be in the hospital for three days in order to go to rehab or can he be admitted to rehab the other doctor or are there other options?
Thanks for sharing all of your knowledge.
Medicare rules can be tricky. A 3 night admission to a hospital is the best way to go if you want Medicare to pay. Traditional medicare will pay fully for up to 20 days of skilled nursing (g-tube, wound vac, etc) and/or rehab. If those services are needed after 20 days, there is a co pay of approximately $170/day which should be met by your supplemental insurance. The original rehab stay can be cut shorter than 21 days if Dad won't participate or if it appears that he has reached a plateau in his rehab. You can probably make arrangement to private pay if you want him to stay longer but I'm not sure what the benefit would be as he could still fall in the rehab facility - they would just have the staff there that could pick him up.
The only exception to the 3 midnight rule that I've been able to find is for joint replacement (knee, hip, shoulder) and it took me 40 minutes on the 1800medicare hotline to get this information (blessings upon the CSR who answered my call; she wouldn't give up even though she had to go two levels up in the hierarchy to get the answer!!)- and this surgery can qualify for acute rehab.
Call the Medicare number and see if your Dad's doctor knows any of the admitting staff at the hospital you take Dad to for his er visits. They can be key players in the recommendation for rehab but they have to get on board the train. Good luck.
Please do tell the assigned nurse all health issues because the head nurse (RN) is the one who has the authority to order needed services.
If you can push for a home health aid to help you with bathing as well. This will also be included in Medicare coverage. Any other items needed for care such as a walker, shower seat, raised toilet seat, etc. can be sent to your home either free or at a significantly reduced rate. Take advantage of it if you meet the criteria. Caregiving can become quite expensive. So every little bit helps.
Council on Aging can provide a certain number of respite hours (4 hour shifts) per month if you qualify and their caregivers provide bathing, preparation of meals and light housekeeping for the patient such as laundering and changing bed sheets, vacuuming, dusting, cleaning mirrors, etc. (general light cleaning).
This service is free to those who qualify.
Last year ,my 90-year-old mother had knee replacement surgery. She was planning to do rehab at home; I think that home rehab is the default and is strongly encouraged by the physicians and hospital and insurance companies. Surgery went well, she was discharged the next day with my siblings ready to take care of her, but she ended up back in the hospital, via the ER, that evening, because her pain pump came out. She said she wanted to do rehab at a facility instead of at home. The hospital insisted on discharging her after two nights (I'm sure because of the three-nights rule), but my mom was willing to be self-pay if her supplemental insurer wouldn't cover the stay. (The insurer's first answer was ambiguous, then it said no, then it changed to yes.)
I am not sure dad would be ordered PT as he is non weight bearing on that leg. His rehab sessions should be saved until he can bear weight. They should have instructed him on how to stand and pivot on the good leg to get out of bed & assist himself to perform ADL’s.
I would contact your father’s surgeon if you haven’t already and discuss your father’s care plan going forward. Let the surgeon know that you feel dad would benefit from in patient rehab.
Rehab may depend on his foot being able to weight bear which can take a long time depending on your dad’s co-morbid conditions (diabetes, PVD, HTN).
After this rehab stay, he can be eligible for home care paid by Medicare if a need persists and the patient is home bound. Realize that once he begins any rehab out patient (which he definitely should) he is no longer considered homebound and HC stops.
I don't even know where to tell you to go with this except the 1 800 Medicare number to see what the rules are. Explain it just as you did here.