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My 85-year-old mother-in-law has been in rehab since heart failure and pacemaker surgery in May and has had two more hospitalizations since then, and then returning to the rehab wing of a nursing home. She's very difficult to deal with and started out refusing daily PT sessions, not eating for days and even refusing her meds. The recent addition of an anti-anxiety med has at least made her more cooperative than she was. However, I don't see much difference in her physical condition and I'm worried she'll be released - there's no way my husband and I can care for her at home in her current condition. Truthfully, before her hospital admission, she was already completely incontinent and couldn't safely walk more than a few feet with her walker. She's had a few bad falls, including a broken shoulder. Her doctor has said he will re-evaluate her at each appointment and so she keeps saying that she's 'going home' after her next appointment with him, going so far as to packing her bag when we last picked her up for an appt.

We have our first 'care planning meeting' next week and I'm holding my breath. What standards will they go by? They rarely put her on her walker in PT anymore, mostly have her do leg lifts while in the wheelchair and throw a ball back and forth. She's still not strong enough to transfer herself from her bed to the wheelchair or the wheelchair to the toilet, just extremely weak.

One of the administrators asked us today if we planned on using their facility for SN 'if she didn't progress' enough to go home. We were startled as both the therapists and her doctor have all said that they think she will be able to go home at some point - is that said commonly to keep the patient positive, or am I not seeing the same 'progress' they are?

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To update, we had our meeting with the re-hab staff. Their report was that they had taken mil as far as they believe she can go. She is still too weak and unable to stand up on her own or remain standing without help, so she can't use a walker to get around on her own. Her doctor has said his own criteria to allow her to go home was to be able to get around her home on her walker - that's most likely not going to happen now. The staff also said she'd need 24-hour medical home care to be safe at her house, which is about $20.00-$25.00 in our area - no way she can afford that and we are unable to care for her ourselves.

Today, hubby told the social worker that we would not be taking her home as we had orginally considered. She didn't seem surprised and gave us their prices for level three care, whatever that includes.

This may not be the place for this question, but how do you tell someone they're not going home?? She has some Alz and dementia but when she's moved to another room in a different section and the therapists are no longer coming for her three times a day, she will catch on and there'll be he** to pay - it will definitely be hubby's fault, even though the rest of the family agrees that this is best for her and all concerned.

What do you say to them???
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Thanks, Jeanne, for your helpful response.

Our care planning meeting has been moved up a few days, so it's before she sees her doctor again. We're interested to hear what they have to say and will definitely make it known up front (if not before - not even sure who the DON is at the place, to be honest...) that not enough progress has been made for us to care for her at home. Thanks for right words!

No, she's way past AL and has been for awhile. I guess you could say that the past 4-5 years that she's been able to stay home has been her 'assisted living' time. She has a live-in companion (boyfriend) that is very helpful with meds and food, but he's 88 and in poor health himself. Together they have muddled through, with me and hubby going over a few times a week and paying bills, doing the grocery shopping, taking out the trash, doing laundry, etc. Luckily she lives only a mile away.

Her insurance and savings will keep her going for some time, so that's not an issue at the moment. She's nearly impossible to deal with at the NH, and will be far worse at home. While recovering from the broken shoulder, she let the PT's and aide come twice, then fired them all, saying that they were stealing her things (not true). She went straight back to bed and stayed there, losing all she'd gained during the re-hab at the hospital. She would quickly fire any help again, so the best thing for her would be to stay in re-hab as long as possible, then have in-home care, at least for several hours a day. She 'may' allow help if her doctor orders it and she doesn't know the cost.

She also suffers from hydrocephalus (sp?) and refused a shunt, so for the last year, she's done the tiny, mincing, Tim Conway shuffling steps. Several small strokes and two heart attacks have weakened her further and taken her energy and balance - not a good candidate to be home alone at all, really, and possibly not with professional help. That'll be another set of questions for the PT team that we'll add to our list.

We're very satisfied with the NH, though it's a few towns away from home. I wish she'd join in more, but she refuses to eat in the dining hall ('crazy people') and won't participate in any activity, never leaving her room. I know she thinks she won't be there long enough to make friends but there's a little arrogance involved, too. There's only one other NH that we'd consider, much more expensive than where she is, but my thought is that she won't be satisfied anyplace and won't involve herself with any of the added amenities there anyway, so why uproot her from one place to another or spend the extra money? Any thoughts on that? I hope I don't sound too crass, I'm already very thankful for this forum and all the help and input I've read so far...
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The goal of rehab is to get people back to where ever they came from -- home, assisted living, etc. So I expect that is what the therapists and doctors assume, until proven otherwise. And for a doctor to say "I'll re-evaulate you each time I see you," makes far more sense than saying, "I know right now you'll never go home," don't you think?

Once she has made as much progress as seems likely, then she can't stay in rehab.

Be prepared to be frank at the care planning meeting. You cannot care for her at home. She did not make enough progress for that to happen. In fact, if I were you I would get that message to the DON (and to her doctor) before the meeting, so that only viable options are discussed.

If she can't live on her own (certainly not!) and she can't live with you, what are her other options? It sounds like she needs way more care than Assisted Living. So the choices are proably going to be between the facility she is in now (the regular NH wing, not the rehab unit) or some other similar facility. Have you researched others in your area? Do you have a preference? Do they all have openings or are there waiting lists?

How will skilled nursing be paid for? Is MIL on Medicaid? Will she need that kind of assistance? WIll the NH you prefer take her on Medicaid-pending basis?

You have a lot to research and think about, and maybe it won't all happen in the week before the care planning meeting, but get as much done as you can.

Good luck to you all!
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