Can someone shed some light on short term rehabs that are in a nursing home environment? I heard a regular rehab is better. My dad is 92.

"We do not want him in a nursing home as we heard their terrible. Not enough staff and subpar care."

What was your father's living situation prior to hospitalization? Did he live alone? With you?

Can your father afford 24/7/365 care? If not, then can he qualify for Medicaid in a LTC facility? I know you don't want a NH, but what do you think the alternative could be?

Accept rehab. We made the mistake of opting for outpatient and it was a tremendous mistake. My husband’s motivation to PT home exercise program was very disappointing, which resulted in significant mobility problems. If offered inpatient rehab placement again, we will grab it with both hands.

I have been in three different nursing homes over the last two years for rehab from serious falls. I had a good experience in all three facilities. Didn't like the food in one of them. Rehab is only as good as the amount of work you do and the number of rehab hours your insurance allows. My insurance allows two hours per day. I took all of the hours allowed and I cooperated fully. I met all goals for my case. It's a nursing home - not a prison. They cannot "make" him a resident.

At his age and with all of the assistance he needs, it may be time for NH care. But that would be a family decision. If you can't lift him that is a major issue with the amount of help he needs.

The condition he was in prior to going in the hospital was that he still had use of his legs with help from the walker, but still very shaky. He also had a UTI infection that we didn't know he had. The reason he entered the hospital was because he couldn't get himself out of bed.

Lovely, the difference in rehabs is between acute and subacute. Acute provides therapy several hours a day, but one must qualify.
Where I live, there are freestanding rehab facilities, those connected to NHs and some connected to ALs.

Some rehabs cater to a younger crowd (think 40-50 year old marathoners getting knee or hip replacements) vs 90 stroke patients.

Look at several places. Why do you think it would be a bad idea for him to become a longterm resident?

Sure, short term rehab in NH, they'll subtly try to suggest he be a permanent resident.

If the hospital is recommending rehab they must think he can improve with it, if they are recommending ding a rehab facility over home PT they must think he can benefit from that. When my mom had her stroke Acute Rehab was recommended and that’s where we sent her, then once she didn’t qualify for “acute” anymore we had the option of taking her home with either out patient or home PT/ST as well as sending her the level down rehab from “acute” which is the normal rehab often connected in some way to a nursing home facility. I can tell you that she progressed much further much quicker in the facility than she did at home, though we opted to take her into ST so she could get more specialized sessions more often instead of a therapist not necessarily specializing in speech (which is what she needed) coming in as little as once a week. As soon as the intensity let up she started not working as hard so from our experience I would recommend rehab facility with the most sessions you can get. For one you get more sessions as well as nurses that are familiar with what they need to be working on and less distractions than the patient has at home. The other benefit for us was she wanted to go home so she was willing to work toward that once she was back in her own home (went “home” to my brothers first) she stopped concentrating on any of her therapy tools or exercises.

I'm not sure what you mean by "regular" rehab vs. "short term rehab in a nursing home environment"...

My mother did 3 stints of rehab in a facility that was attached to a nursing home, but it was an entirely different building, staff, kitchens, etc. The PT staff used the same space for both rehab and NH residents, but with different therapists and at different times of the day.

As far as "making" dad a resident, they can't keep him there against his will - or the family's will, should he not be able to make that decision for himself. My mom had the same concern when she first entered. I just told her "If they force you into the nursing home, just don't pay the bill. They'll kick you out in short order."

I think it's more important to find a good rehab facility rather than worry about where it's located. And the one my mom was in was excellent.

As far as whether he can successfully do therapy, you'll never know unless you try. The staff members where my mom was were excellent and she progressed far more that I had thought she would have been able. The battle was after she left, having her keep up with the exercises, which she immediately stopped as soon as she was home, and subsequently lost strength, but that had nothing to do with the rehab's staff members.

Look at it this way - if your dad doesn't try rehab PT, you KNOW you're going to have to arrange for 24/7 care one way or the other; but if he tries, maybe he can get back some of his mobility.

Good luck.

Lovely244, with regular rehab do you mean bringing Dad to their place via appointment?

I remember my Dad [in his 80's at the time] tried rehab at home with the physical therapist coming to the house. It did not work very well as Dad rarely did his exercises. Next time Dad decided to stay at the rehab facility [it had a nursing home] for the required number of days, and he did quite well, so for him it was a good choice, he was able to come home.

My Mom [now in her 90's], after a terrible fall at my parents' house, moved into a Rehab which had a nursing home. It was a good decision, as Mom could not learn how to walk or even stand. She was moved within the facility to the nursing home section. She needed a village to help her daily.

I agree, send him to Rehab and one that LTC is part of. Of course he is weak, the need for Rehab to get him stronger. Medicare pays the first 20 days 100%. 21 to 100-50%. The other 50% will be paid by Dad or his supplimental insurance fully or partially.

Dad needs to do the therapy. His stay there depends on how he progresses and if he hits a plateau, meaning he will not get better. Medicare will stop paying if he shows no improvement. This is where you will need to make a decision. You take him home or place him. IMO, 90 yr olds start having leg problems if they have not had them before. I would not look to him getting back to 100%. If he does then good for him.

Whether Medicare pays for 1 week or up to the customary 21 days, rehab will buy some time to educate yourself. Work with the social workers early, but do not wait till the health care meeting set up 24 to 48 hours before discharge. They will tell you point blank that he is ready to go home, but needs 24 hour care. You need to figure out about this long term care stuff. It is very expensive out of pocket at about $350 per day (basic answer) or if you will be helping set up Medicaid at a SNF for which he will be transfered to. Care at these SNFs really vary from decent to poor. If places are not up to par when you do a site visit, you might be able to ask for a little more time while he sits in rehab but the costs will increase to $180 per day per Medicare rules.
As far a s rehabs that have a step up to SNFs they are more of an advantage since you go to the top of the wait list for a bed. My mom was in one of those 5 stage places that I was lucky to get her into. But she was on a 3 week wait list just to get in to MC. The reason I put her in that place was because I researched it as a great choice. You are fortunate to be close to Boston.

Lovely, I think it depends on his overall health, what his life long activity level has been and what you are looking for as the end result.

When my dad was in rehab they were able to tell me what he could and could not do. Because of that and a needs assessment done by the NP that was treating my dad, I was able to determine what type of facility would best meet his needs. Home care wasn't an option for multiple reasons.

I, highly, recommend that you meet with his PT and OT team upon admission, stay in touch regularly and let them guide you. Tell them what he needs to be able to do and they can customize his therapy to get him as good as it gets. Then you will have some idea of what is coming when he is released from rehab and can start making plans sooner then later.

I have a 91 year old friend that "lost her legs" as she puts it and now she is in and out of my 4x4, walking through stores, going to the gym and blowing my socks off. So, yes, I do believe that someone in their 90s can rehabilitate. But, they also fail quickly.

I would definitely get him rehab, if nothing else, it gives you time to get things set up.

Look, whether the rehab works or not, he will be somewhere that can provide 247 for 21 days.

A true rehabilitation only facility will require like 6 hours a day to be there. None in my city would take someone your dads age. My dad was 74 and couldn't meet the criteria to be admitted.

My dad was in a continuing care facility for rehab that focused on getting him back on his feet. They didn't try to keep him down so he could become a resident.

Find one that has a separate rehabilitation wing that allows him to utilize all the activities at the facility. These tend to be better rehabs then the ones that integrate rehab patients with long term care residents.