What might the hospital do if patient refuses rehab?

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A recent fall put my dad in the hospital for a few days. Thankfully, nothing was seriously damaged, but he did wrench a knee pretty badly, so they transferred him to in-patient rehab to strengthen it before sending him home (he lives alone).

Dad is NOT happy about this, and is threatening to refuse to participate in the therapy. He's already refused to wear the braces that have been ordered. I think he'd leave against-medical-advice (AMA) if he had a car on the premises. Right now he needs me to take him home, and I think he's in the right place :)

My question is this -- what might the hospital do about this? I'm concerned that refusing necessary care might lead to someone trying argue to a judge that he is a danger to himself or that he's incapable of making decisions in his own interests. I hold medical POA, so a declaration of incompetency or the like would make it my problem. :(

Anyone have experience with this? What might I expect, if he continues to refuse to cooperate?

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When my dad had a mild stroke a few years ago, he refused to do therapy because it hurts. He also refused to take the meds. He just wanted to come home. The doctor told him that if he wants to come home, he needs to take his medications And do the therapy. He did. Before he was released, they tried to send him to rehab but he refused. So they told me in a very serious tone that I must try to get dad to see his primary doctor and that they would prescribe home physical therapy. I was told that he Must see his doctor within 6 weeks from being released from the hospital - if we want Medicare to cover his medical cost.

Oh my goodness, we spent weeks trying to get him to go see the doctor. But we made it within the deadline. He refused to do the home PT, so that was discontinued. So was their home care services.

It's very good that the medical staff explained this to you about coverage.
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If he continues to refuse, they will discharge him under "failure to progress" and if the Social Worker or Discharge Planner suggests they will go to a Judge, cooperate with them and seek full Guardianship. Just a note: the pain meds can often make a patient unreasonable and uncooperative but the MD may be able to prescribe Tramadol instead of Oxycodone, which has an antidepressant /anxiolytic effect. After knee replacement, I found Tramadol would relieve the pain without making me dopey.
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Just a comment on the Durable Power of Attorney's activation clauses. My father's DPOA allows me to make decisions if he's incapacitated, which I did when he had to be intubated. It's a broader power than just making decisions in the event of mental insufficiency.
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Don't do anything. If he isn't incompetent per doctors than you don't have POA and can't make decisions for him without his consent. Don't drive him home. Just do tough love and repeat "dad, this is necessary to keep you mobile and prevent more serious balance problems, I'm not taking you home." He can always call cab and discharge himself and that is on him. Don't make it easy on him. See how it plays out....likely if you don't play into it and support medical team, he will stick it out. Don't concede to in home PT either and let him out of this.

Hang Tough!
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How old is your father? Is he a military man? Is the kind of man who feels that he's invulnerable and that therapy is only for "old folks" or the "infirm"?

Sounds like he doesn't realize he needs therapy to recover, and isn't recognizing that his life at home will be much more difficult if he doesn't get therapy.

Has he had any therapy at the hospital? In my experience, therapists come in to assess and start limited therapy while a patient is still in the hospital. If he has, perhaps he didn't like the therapists or the exercises. If he hasn't, perhaps the doctor could order it and he can see how much it will help him.

Who does he think will take care of him at home if he refuses to get therapy? Perhaps some talk of bringing in home care might help - you can get a feel for whether he's opposed to therapy in general or just a rehab facility in particular.

Or perhaps the orthopedic physican can tell him bluntly what his recovery will be like, and the chances of regaining full use of his knee, if he continues to refuse therapy. Sometimes a wake-up call from the doctors as to the dire consequences is more effective than anything a family can do.

Good luck and hope this works out better for you.
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Yep, Medicare won't pay if he leaves AMA. If he continues to refuse I don't think you have to worry about legal proceedings but they'll discharge him and wish him luck and then you take him home.
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Yes , the part about not paying is absolutely true. It happened to my mother in law.
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I hold a durable POA for health care now, and a durable general POA that becomes active once he's been deemed incompetent by two doctors, but he passed the rehab facility's cognitive assessment with flying colors, so *that* isn't going to happen any time soon.

Yesterday he threatened to walk out directly to the doctor - who informed him that if he left AMA that Medicare wouldn't pay for any part of his stay. I don't know if that is strictly true, but it shut down that argument pretty quickly :) He's still arguing about participating in the therapy program -- but I hadn't taken into account the fact that the rehab folks clearly have plenty of experience dealing with patients like him :) Waiting to watch the next round.
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Right now, if he's "threatening" to refuse, let it play out and see what he does . Why would he refuse therapy? But some advice, this is the time to go see an elder care attorney, who can explain what you need in terms of documents. Get this underway before your father deteriorates further.
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