This was after his stroke and 3 weeks of rehab. He needs 2 people to help with transfers and we want him to improve so he can live at home with his wife.

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My husband is in the same position as yours. Medicare Advantage paid for 21 days of rehab after he fell and broke his hip. He hadn't made hardly any progress during that period so I had to contact an Elder Law Attorney and he has set up a Miller Trust Account and has filed for Medicaid for my husband. They use the Hoyer lift to transfer him from bed to wheel chair etc. There is no way he can come home because I am 75 years old and can't handle that responsibility. We miss being together, but I have no other choice. We don't have any money to hire help here in the home since he would require 24 hour care. My only consolation in this is that he is in a very nice NH and it's less than a mile from my house so I can visit every day, even twice a day when I can. It's true that Medicaid is using more than half of his pension to help with the cost of his stay there and it's put me on a very tight budget which I'm working on still. Had to cancel lots of things that I couldn't afford any more but it has to be done. He would do the same for me if our situations were reversed.
Helpful Answer (16)

Is he trying? Or is he not trying and continues to be "dead weight". Three weeks of rehab should have already shown much improvement--they are not going to keep him forever. It sounds like he's on the road to a nursing home.  Hiring a caregiver is extremely expensive and Medicare will not pay for any of that and a caregiver will not be able to handle "dead weight" and will have to use a Hoyer lift for any kind of transfers. A Hoyer lift will do nothing for strength. It is simply a lift for dead weight.   If you hire a caregiver off the street and not from an agency--the caregiver hurts their back on your property they can sue the estate due to lack of insurance.
Helpful Answer (11)

Appeal it w Medicare. If they feel he didn't make progress though (by asking nursing home), then they won't pay.
You can private-pay for it indefinitely, yet it's expensive.
A 2-person transfer is difficult to care for at home. Is he incontinent? Then even more so.

As soon as my dad couldn't walk and incontinent, it was over. He had to live in a facility.
It was twice as expensive to have 24-hr home-care at the house (heavy-wetter at night).

Praying for the best for you and your family.
Helpful Answer (10)

You really need to talk to the therapists about whether there is still progress in therapy. Have you had a care meeting? Do they believe that dad can live at home with substantial assistance?
Helpful Answer (9)

If he still requires two people MAXIMUM assistance after three weeks he may not be able to improve..and if he has not been trying but been a total burden to staff, he just bought himself a ticket to the nursing home. Face it he won't get any better at home if he can't get better at a rehab center. Dead weight is dead weight.
Helpful Answer (8)

Is his wife in a position to care for him? Even with equipment that will help him to stand can she do what needs to be done.
Is the house accessible for someone is a wheelchair or using a walker?
Grab bars in the bathroom? Carpeting that is a trip hazard? Stairs into the house or a 2 story house? Bathrooms large enough for a walker or wheelchair? ADA height toilets?
There are a lot of things to think about getting someone home.
How is the rehab going? Is he participating fully? Is he improving? Do the therapists think he will continue to improve?
And will you be hiring a caregiver to come in to help out? is it possible that someone could come in in the morning to help him get up, showered, dressed then return in the evening to help get him to bed. But this also leaves changes during the day that either he will have to do or his wife.
Depending on the situation is a move to Assisted living for both of them a possibility? They will get help with ADL as needed. But this would work only if he is able to transfer himself. Most Assisted living will not permit the use of equipment for transfers equipment like that is used in Nursing Homes.
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Countrymouse, did that and no help. In the state I live in, if the person is essentially on medicaid through a help at home program, the state will okay an extended short term stay, but the level of physical therapy leaves a lot to be desired. It is a slippery slope when you are at advanced age. If you aren't on the program already, it is more likely that you are discharged and put into a dangerous situation. I experienced that with my other parent; he ended up sustaining injuries because he truly wasn't well enough for a safe discharge. Little by little the program is being whittled down. For example, they used to allow the diagnosis of failure to thrive to qualify one for hospice (some very old people die with that diagnosis, they are really ill, their bodies are just worn out). That has been taken away. I have to wonder what of medicare will be left when I am at the age to require their service.
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Three weeks seems a bit quick off the mark to decide he can't make meaningful progress at rehab. How well has he recovered so far? - can you point to significant improvements since the stroke? If so, Savitaa's advice to contact Medicare seems the way to go; but if the reality is that he's unlikely to recover well enough to be cared for at home, maybe it would be better to concentrate on finding the best possible choice of facility.
Helpful Answer (2)

I should have mentioned that a person with only one usable arm/leg (such as with stroke) or no leg strength at all (advanced MS, paraplegia, leg neuropathies, etc.) can still be very independent if they have the right assistive products to help them. Not sure why a two person assist (for transfers) is needed- would it be possible to provide a bit more information?
Helpful Answer (2)

Medicare will pay 100% for the first 20 days. Medicare pays all but a daily co-insurance for days 21 -100.  Does he have a secondary insurance?   They will pick up the remaining costs through day 100.  

All this is moot if he is not showing measurable progress. He may not show progress due to physical inability or an unwillingness to do the work. Either way Medicare requires measurable progress or they will no longer pay. So you need to confirm WHY they are discharging him. If they feel he has reached his maximum capability, you may want to find a NH for him to reside in. Around the clock care at home is terribly expensive. And it is doubtful that his wife could care for him on her own given his inability to help in his care.  She would need to turn him multiple times a day to avoid bedsores and change bed linens multiple times on some days and nights when his bed becomes soiled.

I know, you probably do not even want to think about a NH. If he was fairly healthy before the stroke this is all coming at you too quickly. We have all faced these same fears and emotions. You are on a tough, demanding path, and you have no choice but to rise to the occasion.

Have a care meeting with his rehab team and discuss his progress and the motivation behind their recommendation for discharge. If it is solely due to reaching the maximum of Medicares full coverage he can pay the remainder out of pocket or use secondary insurance if he has it.  If they simply feel his physical ability will not improve further, you need to consider a nursing home as the possible best option for him.
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