Need some advice about leaving a skilled nursing facility and home health care.

1. Yes, you can leave a facility before the responsible person (physician who treats at the facility) releases her, and go to another facility providing that your mother's "regular" (non nursing home) doctor provides a letter, indicating you want to transfer but still want rehab, just in case Medicare challenges the move.

We did this, with no problem at all. I did make sure to get a letter, but Medicare never challenged.

2. If she leaves and you indicate the reason is dissatisfaction, the facility admins and/or doctor might not be very happy, and might not be flexible in scripting for home health care. If one of her regular physicians scripts for home health care, you can get it and Medicare will pay.

Just to "hedge your bets", you could indicate that there are issues with Mom being away from home (traumatized, confused, etc.), you have trouble visiting her, or some legitimate sounding excuse.

3. If you leave the current facility, get home health care and it "does not work out", I rather doubt that the same facility you've left would be amenable to take you back. "No Medicare beds" would probably be the justification.

I sense there's a lot of uncertainty about what to do, including what will happen with home health care. Have you been through this sequence before with your mother? Why are you concerned that "home health care does not work out?"

I think that would be one of the issues to address first.

Why is your mother in a facility for rehab now?

It's also a good idea to do some thorough research on home health companies so that you select one in which you have confidence. Not all of them are that good.

How severely are you "not happy with her care"? Is there something that could be improved with her care that would make you less unhappy? Do you want to take her directly home, or to a different rehab facility?

The rehab facilities are much better than home therapies, per my experience.

We did find ONE pt home therapy that was very thorough, yet it is very rare to find such dedication.

I would have a meeting where she is now and provide concrete examples of what could improve for her there.

Tough it out at rehab for awhile unless there's clear signs of something really bad going on there
With an infection, she has a long road to recovery
If she's bedridden, how will she be cared for 24/7 at home?

I agree with Jeanne (again!) that tackling the problems you're having at this centre - which otherwise sounds pretty good, given how conscientious they're being about her rehab schedule - might be a better way forward; until you can get a formal plan in place, at least.

Also, who is unhappy, and with what? Are we talking about specific incidents or deficits in standards that you or other family members have noticed, or is it more that your mother is expressing that she hates it there and wants to go home, in a more generalised way?

Dear answerplease; If your mom has an infection, and has been in bed for 3 weeks ,sounds like she Needs a nursing rehab facility ...Before you move her ,spend a few days at your mom's nursing home with her to see actually what has to be done for moms care...they maybe doing more than you think.NOBODY ever wants to be in a nurseing home rehab unit.and they are not pleasant because it's sad to be surrounded by sick people.If she doesn't have long to go maybe just let her stay or transfer to a different rehab unit close to home...It sounds like your mom is a sick lady please think hard before you make any rash decisions ...the nursing home staff is trained to deal with the infection and everything else that goes...GOOD LUCK 

Thank you for responding. My mother is in rehab because after two hospital stays for two different infections, she is very weak. She was not very mobile before the hospitalizations, but now she has been bedridden for almost three weeks. They are giving her PT and OT at the rehab facility. She would like to go home, but we don't know if the therapy provided by home health care will be enough to help her recover. She was getting PT through home healthcare before the hospitalizations, which was fine. But now we are concerned that she may leave rehab and discover that the therapy provided by home healthcare is not enough, and in that case, she would need to go back to rehab, which may be closed to her if she leaves rehab before being released.

GardenArtist offers the correct answers, as always! Thank you, GardenArtist.

I live with my elderly grandmother. And it’s just us for the past 3 years. So I have been taking care of her full time for like 2 years. After I started working, I was not able to be there for her all the time. That’s when I decided to hire a  24 hour home care in Toronto from C-Care (https://www.c-care.ca/about/why-choose-c-care/) 
For me, it was very helpful. The main thing was coverage. Even when I was not with grandma, she was never unattended, which gained me peace of mind.
The best thing about hiring a home care is that:
You can be sure that your loved ones are always around you and they are being looked after properly.
The nurses come to you on a regular basis and assist you with feeding, bathing, grooming and all the other needs.
The hours are flexible too.
Your loved one can maintain their dignity and independence.
Plus they will always feel safe with you around.
The residential care can be sometimes overwhelming for them.
Due to dietary restrictions of the residents, meals may be bland.
You may not be able to meet them, since the residential homes can be far away from home.
The home care I hired, also did a criminal background check on all their staffs. So it was pretty safe.
I felt safe leaving my grandma with the nurse.
Hope this could help you make up your mind.

GardenArtist: You're very welcome! Your advice is always spot on.