This s liikely the paperwork that rehab gives to you or to your elder when Medicare has announced that they can no longer pay for their care. It simply acknowleges that medicare will not cover more time. There may be many reasons. Perhaps the 21 days is up. Perhaps the person is making no progress and the staff, PT, Doctor acknowledge that they are unlikely to make more progress. At that point Medicare send a letter that a further stay will be self pay if there is no supplemental to cover or help to cover. In rehab it doesn't matter at all if the patient is having problems and doesn't feel "ready" or the family isn't ready. What matters is whether or not the time is up, the progress is at a standstill, the senior can no longer participate. You can send a response to Medicare to attempt to get more time. It usually does not work. Usually the report is in. So you will have to send the senior to other Long Term Care or home. A social worker at the facility can explain ALL OF THIS to you, and help you file an appeal. More concerning to me is that you feel that your elder has new memory issues. You need a discharge plan and should have been a part of the discharge planning if you are the POA or next of kin. So check on all of that. Call the Social Worker today. The sooner the better. In our case my bro got another 7 days from his doctor filing an appeal and saying that while the original intake was for PT rehab, he has a non healing wound that required more care. So sometime you can pull some strings; it is rare to have success getting more time. Wish you luck. Hope you'll update us.
As said, if therapy feels that Mom has hit a plateau or is not progressing, Medicare will not pay so the patient is discharged. Rehab does not mean the person will be taken back to the way they were before the hospital stay. Hospitalizations are hard on someone the age of your Mom. There is something called Hospital Delirium where they suffer Dementia like symptoms. Did Mom have anesthesia? This will cause memory problems. Memory problems does not mean Mom does not understand what she is signing. Unless you have a POA that is in effect, Mom is considered competent until a doctor says otherwise.
You can appeal but I would talk to the physical therapist first. There maybe nothing more they can do. We hear on the forum all the time "My 90+ Mom was cleaning her own house and doing her ADLs until she fell and needed to go to the hospital" Thats what happens. A fall, broken bone especially the hip is traumatic for the body. Elderly do not bounce back like they did when they were younger. A hospital stay without getting out of bed weakens the body. Sometimes to the point they never come back.
This may be the time decisions need to be made. If Mom was living on her own, she may not be able to anymore. So, she moves in with a child or you find a nice Assisted Living if she can afford it.
The can be a big gap between *finished with acute care or rehab* & *recovered*.
*Finished with acute care or rehab* can be (as others said) when the Rehab says so, when the patient has plateoed, when finding runs out. This may not match when the patient has *recovered*.
Which leads to what is *recovered*? Is it completely back to normal? Is it weaker, but nearly normal? Is it when a hip has been replaced, despite mobility now much reduced? Is it after a stroke blood clot has been dislodged but permanent disability exists? What if delerium is still present? What if the delerium is dementia & the new normal?
Sometimes a type of transitional care is required before getting home or to wait & see what further recovery is possible.
Request that occupational therapy evaluate then home for safety. You could refuse to bring her home saying it is an unsafe discharge, then they would have to find a place for her.
Do you not want her to return home at all? Do you lived with her or she with you?
Not much ..I do sympathize though - it is run by insurance telling how much or how long they will pay, and the facility doing enough not to lose money , plus if it is a good one the bed will not be empty and may have someone waiting for it that will be paid one of my moms hospitalizations - she was acting confused and unsteady ..we weren’t sure if it was stroke related or from her calcium levels being too high ( hypoparathyroidism ) …well her levels were high but she was still acting confused once they stabilized PLUS they had never done the MRI that had been ordered on admission. They said they were releasing her ( to a SnF despite having been at home with some assistance ) since she was so weak and out of it still. I tried going up the chain - from nurse and social worker, to hospitalist and finally to neurologist through attending hospitalist . That doc said the neurologists felt ‘comfortable ‘ releasing her snd that there was no need for MRI at that point. I said ..with history of two prior strokes ?! And her family is telling you that this is not her normal mentality nor physical ability ( granted that this was impaired severely by second stroke with hemiplegia) . Nope they released her ..and actually very quickly with transport arriving and leaving before I did . Anyway ..she was in the SNF for about twelve hours before being sent to hospital , a different one but same system. There they were also thinking she was okay, and talking about release but more accepting of our concerns . They finally did an MRI and lo and behold — it showed multiple small strokes which were causing her issues!! I think it is a main issue with medical personnel that when someone is old and especially if after a stroke — they assume the person being physically impaired and mentally insufficient is their normal and worse they don’t listen when the family tells them otherwise.
You can do nothing, most likely. Medicare will only pay for a certain amount of days in rehab and only IF the patient is making 'progress' according to their guidelines of what progress entails. If your mother has dementia at play, then she may not be able to rehab properly; follow instructions for PT/OT and make the required 'progress' to stay longer. You can speak to the social worker at the SNF and see what they have to say on the matter, but it's likely having to do with a Medicare decision rather than anything else. And, like I said, if dementia is involved, it's probably hard for your mom to make the required amount of 'progress' Medicare wants to see in order for her to stay there longer. Normally, 20 days is what they pay for. Of course, Medicare decisions can be appealed, but it all depends on what's going on here, which you're not giving details about in the first place.
There may be many reasons. Perhaps the 21 days is up. Perhaps the person is making no progress and the staff, PT, Doctor acknowledge that they are unlikely to make more progress.
At that point Medicare send a letter that a further stay will be self pay if there is no supplemental to cover or help to cover.
In rehab it doesn't matter at all if the patient is having problems and doesn't feel "ready" or the family isn't ready. What matters is whether or not the time is up, the progress is at a standstill, the senior can no longer participate.
You can send a response to Medicare to attempt to get more time. It usually does not work. Usually the report is in. So you will have to send the senior to other Long Term Care or home.
A social worker at the facility can explain ALL OF THIS to you, and help you file an appeal.
More concerning to me is that you feel that your elder has new memory issues. You need a discharge plan and should have been a part of the discharge planning if you are the POA or next of kin. So check on all of that. Call the Social Worker today. The sooner the better.
In our case my bro got another 7 days from his doctor filing an appeal and saying that while the original intake was for PT rehab, he has a non healing wound that required more care. So sometime you can pull some strings; it is rare to have success getting more time. Wish you luck. Hope you'll update us.
You can appeal but I would talk to the physical therapist first. There maybe nothing more they can do. We hear on the forum all the time "My 90+ Mom was cleaning her own house and doing her ADLs until she fell and needed to go to the hospital" Thats what happens. A fall, broken bone especially the hip is traumatic for the body. Elderly do not bounce back like they did when they were younger. A hospital stay without getting out of bed weakens the body. Sometimes to the point they never come back.
This may be the time decisions need to be made. If Mom was living on her own, she may not be able to anymore. So, she moves in with a child or you find a nice Assisted Living if she can afford it.
*Finished with acute care or rehab* can be (as others said) when the Rehab says so, when the patient has plateoed, when finding runs out. This may not match when the patient has *recovered*.
Which leads to what is *recovered*? Is it completely back to normal? Is it weaker, but nearly normal? Is it when a hip has been replaced, despite mobility now much reduced? Is it after a stroke blood clot has been dislodged but permanent disability exists? What if delerium is still present? What if the delerium is dementia & the new normal?
Sometimes a type of transitional care is required before getting home or to wait & see what further recovery is possible.
Do you not want her to return home at all? Do you lived with her or she with you?
one of my moms hospitalizations - she was acting confused and unsteady ..we weren’t sure if it was stroke related or from her calcium levels being too high ( hypoparathyroidism ) …well her levels were high but she was still acting confused once they stabilized PLUS they had never done the MRI that had been ordered on admission. They said they were releasing her ( to a SnF despite having been at home with some assistance ) since she was so weak and out of it still. I tried going up the chain - from nurse and social worker, to hospitalist and finally to neurologist through attending hospitalist . That doc said the neurologists felt ‘comfortable ‘ releasing her snd that there was no need for MRI at that point. I said ..with history of two prior strokes ?! And her family is telling you that this is not her normal mentality nor physical ability ( granted that this was impaired severely by second stroke with hemiplegia) . Nope they released her ..and actually very quickly with transport arriving and leaving before I did . Anyway ..she was in the SNF for about twelve hours before being sent to hospital , a different one but same system. There they were also thinking she was okay, and talking about release but more accepting of our concerns . They finally did an MRI and lo and behold — it showed multiple small strokes which were causing her issues!!
I think it is a main issue with medical personnel that when someone is old and especially if after a stroke — they assume the person being physically impaired and mentally insufficient is their normal and worse they don’t listen when the family tells them otherwise.
Good luck!