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He was discharged from hospital on Wednesday and it is 3 am Saturday now.
He acts like a great patient with therapist or nurse who we've just met, but is a terrible patient for me and does very few of things needed for complete knee replacement therapy. My mental health is at risk.

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I haven't read through all the answers but this is what I found out recently for my dad and regarding Medicare payment for rehab. If he has been home at least 3 days from the hospital AND a maximum of 30? days since he was inpatient (need to double check that maximum) and I believe if he was in the hospital for at least a few days, then you can sign up for any acute rehab hospital and/or nursing home with rehab and Medicare will pay for several days worth of rehab. (you can have up to 100 days I think of rehab if the person is making progress).

My dad just had 21 at acute rehab and I wanted him to do more acute rehab because the first 2 weeks were worthless and he was asleep the whole time. The facility wanted to discharge him. I called another acute rehab and they said they would assess him and bring him to their facility after he had had 3 midnights at home (or at a nursing home or other place... just not the hospital)

This made little sense to me but as I dug into it, I found out its because of how Medicare reimburses. If they transfer from one acute rehab to the other they must share the reimbursement 50/50 because it's considered one "visit"...even if one facility had him for 90% of the days/time. So I guess they need him discharged and allow 3 days/nights for the paperwork to be processed and off one facilities roles at Medicare before a new one will take him. This I THINK is true for any transfer of similar level facilities. Acute to Acute or Nursing Home to Nursing home.

After the 100 days, however, nothing is covered until there is new hospitalization.

I hope that helps.
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Reply to marydys
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Bad mistake to take him home. I don't know the answer but talk to the doctor and the rehab at once. He CANNOT stay with you with his behavior (which is no good for his healing) but most important because it is beginning to have a terrible effect on YOU. Do not let him harm you - he has to go - somewhere - at once. I don't know what a caretaker could do with him - I suggest he must go back to rehab.
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Reply to Riley2166
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Yes, it is possible to go to rehab now. I don't know if insurance would cover it.

After my mom's knee replacement, she did pretty well in rehab and listened to the therapists most of the time. With me, she was a complete whiny uncooperative pain. "I'm tired" "Maybe later" "I'll do ONE exercise" and on and on. Maddening! And PT is SOOO important to get their range of motion back. I made her go after her second one which wasn't a real rehab facility but rehab in a nursing home which is not nearly as good but better than nothing.

Call some rehab facilities and see what they say.
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Reply to againx100
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Imho, inform his physician of your quandary.
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Reply to Llamalover47
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I know exactly what you are saying! My mom is the same way! She fights my husband and I on everything, but acts all sweet and agreeable with everyone else! We've wondered the same thing! Maybe you can get a caregiver to come in! God bless you and I hope it works out for you!
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Reply to purplebadger
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againx100 May 4, 2021
Common but so annoying!
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Sounds like there is more going on in your relationship than a simple knee replacement. Remember YOU cant make another person do ANYTHING they dont want to do. Let him take responsibility for his own healing. You take care of you.
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Reply to cinna60
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First speak with his doctor and explain what is happening and have the doctor write a script out for therapy at a rehab place. Then the insurance should cover some of it but only IF he goes to a certified rehab place. IF not, then you might have to pay privately for the therapy. Secondly, tell your hubby that IF he doesn't do what he is supposed to be doing both for YOU and the therapist.......he is going to end up in crutches, wheelchair possibly forever so that means.......money spent on having someone build a ramp for your house, and possibly if that can't be done, he will go into a NH "permanently" since YOU won't be able to care for him. So either "he does the work and gets better"..........OR " he does NOT do the work and he goes into NH".................(now not knowing how old he is, but guessing he is retired, yes working on rehab can be a little painful, but the rewards will be better)......I sure wish you luck on this. sounds like he is stubborn.
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Reply to wolflover451
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RedVanAnnie May 4, 2021
If husband is being stubborn and defiant, warnings will probably only reinforce his resistance. He will deny the negative possibilities or say he doesn't care.
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Is your question whether your husband can go to a rehab facility or whether Medicare will pay for it? If his doctor recommends rehab or in-home thetapy, Medicate may pay. If the doctor does not feel rehab is necessary, you can still arrange either rehab situation, but you will have to pay out of pocket.
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Reply to RedVanAnnie
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Don't worry about it. He has a knee problem not a mental problem.

If he doesn't to the therapy, it will be him not walking.

Call his Dr and let it be known it's not working out and husband needs to work with a Therapist or you might see if he can have in home therapy.
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Reply to bevthegreat
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caroli1 May 4, 2021
He's already having home therapy. He's not doing the exercises much when the therapist is not there. This is a commonproblem!
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It is not too late! Talk with his orthopedic surgeon and/or regular doctor. Explain that he needs a more structured environment in order to participate fully in his recovery. Get him enrolled in a rehab facility asap. When my Mom fell and broke her hip, the surgeon spoke with myself and my sister and we all agreed that she would be better off at a rehab facility as at home she would not have been able to focus just on her recovery. It worked!
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Reply to Stilltired
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There is one thing that's unclear to= me. Are you hoping to send your husband to a rehab facility or to a SNF? A rehab facility might be located in a SNF, but therapy in rehab is different from therapy in a SNF. When I had a total lknee replacement, we had 2-1/2 days of therapy in the hospital. If we had progressed satisfactorily, then we were sent home. If not--and there was only one person in our group who wasn't, and she was already a resident of a SNF you were sent to a nursing home. There was therapy in the nursing home, but not with the intensity of a rehab program. I believe it was 2 hr/day for 3 days/week. At the end of 10 days you were sent home (or sooner, if progress was good). In a rehab facility/program, you get therapy at least 2-3 hours 2x/day. I've been in rehab programs for things much more serious than a knee replacement; for example, after fractured hip surgery. In any case, subsequently you have home therapy, and then, therapy at an outside therapy facility. The home therapy is usually 2 days/week for around 1- -1- 1/2 hours. The point is, if your husband goes to an NH for reb, he's going to get more therapy than at home, but much less than in a rehab facility. He's still going to need to spend time doing the exercises himself at the SNF. I don't know if it's very common to go to a rehab facility after being discharged for home therapy following a knee replacement and in-patient therapy in the hospital. Whether you are sent home for home PT or are sent to a SNF for more therapy, part of the responsibility is on the patient. If your husband is non-compliant at home, he may not be a good candidate for therapy in a SNF. I'm not sure Medicare is going to want to send him to a SNF when he was already deemed physically ready for discharge from the hospital. The chances of an actual rehab program seem even less. I know that non-compliance with therapy can be a terrible problem, but whether he would be compliant in a nursing home for a short time period and then compliant AFTER that when he returns home seems uncertain. Medicare may decide they are not going to approve his going to a SNF primarily because he's not complying with therapy at home, and it's at home that he was assigned to have therapy. A better route may be to determine what can be done to increase his compliance at home. Whether sooner or later, that's where he's going to be doing the bulk of his exercises. Perhaps his surgeon could talk to him about the consequences of not doing his exercises. The surgeon may have more credibility than anyone else!
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Reply to caroli1
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Following a link found in an older query and then a link within that page, I found this:

"Refusing care
If you refuse your daily skilled care or therapy, you may lose your Medicare SNF coverage. If your condition won't allow you to get skilled care (like if you get the flu), you may be able to continue to get Medicare coverage temporarily.

Stopping care or leaving
If you stop getting skilled care in the SNF, or leave the SNF altogether, your SNF coverage may be affected depending on how long your break in SNF care lasts.

If your break in skilled care lasts more than 30 days, you need a new 3-day hospital stay to qualify for additional SNF care. The new hospital stay doesn’t need to be for the same condition that you were treated for during your previous stay.

If your break in skilled care lasts for at least 60 days in a row, this ends your current benefit period and renews your SNF benefits. This means that the maximum coverage available would be up to 100 days of SNF benefits."

Most of that applies to a break in care, as in went to facility, but chose to leave. It would likely be best to contact Medicare to ask directly if he can still go, since it's only been a few days.

On that note, however, there are several issues to consider:
1) will he even agree to go?
2) if yes to #1, once there will he cooperate and participate?

The PT sessions are instructional, to provide various exercises and demonstrate how they are done. It is up to the patient to then "practice" these throughout the day, for the # of times recommended, between visits.

If he isn't cooperating with you between visits, who is going to stay on his butt in the facility, with a bull whip, to make sure he continues?

If you can determine he can go back to the SNF, then I would be up his behind with the usual threats:

If you DON'T do these exercises EVERY day, there is a chance the replacement can fail or never work correctly, and you WILL end up in a NH. There was no point to getting a knee replacement if you aren't willing to put in the minimal effort to ensure your knee/leg works properly and you can get around. I won't be signing up for pushing your wheelchair around, not when YOU have the ability to take steps to avoid that!!! USE IT OR LOSE IT!
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Reply to disgustedtoo
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caroli1 May 4, 2021
Those are the Medicare rules for admission to a SNF. An in-patient rehab program may be located in a SNF, but often an in-patient rehab program is in a separate rehab facility or in a wing of a hospital. I've had rehab in both a stand-lone rehab facility and in a dedicated wing of a hospital. The rules for rehab may be different than those for admission to a SNF.
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Following a qualifying hospital stay (usually 3 consecutive inpatient hospital days), a patient must enter the skilled nursing facility within a short period.
If your husband is under Medicare he has 30 to 60 days from the hospital discharge date to initiate physical therapy in an approved rehab facility up to 100 days benefit with a doctor’s order. However, if he does not want to go that is another problem for both of you to figure out.
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Reply to Ricky6
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JoAnn29 May 2, 2021
Medicare only pays 100% the first 20 days. The next 80 are 50%. The other 50% maybe paid by a secondary insurance, if not its the patients responsibility.
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Don't walk, run back to his doctor. Failing to do the therapy consistently on a joint repair is not going to go well. Tell dr, he is uncooperative with you and now you see you bit off more than you can chew. Dr should be able to arrange a move to rehab. Don't delay.
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Reply to my2cents
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I agree, there is a window.
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Reply to JoAnn29
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Call the discharge unit at the hospital today. The window of opportunity to revert to rehab is limited, so don't wait.
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Reply to BarbBrooklyn
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Yes I believe he could still go to rehab. I think you need to call the hospital to help you arrange.
Sorry it’s been so difficult.
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Reply to 97yroldmom
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Many people have that 'showtime' good behaviour for professionals only.. sigh.

Many people also think 30 mins with a PT twice a week is all they need to do, when ongoing daily exercises is actually required for recovery. PTs must see this all the time!

Can you speak to the PT about this?

PT may then get a bit more tough 🤔 & explain HIS recovery can be great or not - it will depend on HIM. Hopefully they can help him to find his own motivation.

It may be hard to transfer into rehab facility now but ask the PT about this too.

Anyhow, you will know for next time! (How's his other knee? 🙃)
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Reply to Beatty
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My dad is the same.

He had his 2nd stroke in 2015. My mom made him do rehab, said she would visit everyday if he cooperated. He recovered to 70% from bed to wheelchair to walker to cane.

He continued with one of the PTs afterwards 3 days a week. They even renovated to add an exercise room.

Then COVID hit and he stopped the PT. Then both my parents were hospitalized due to complications due COVID. My mom had to have rehab for 3 months.

My dad was released in a couple of days. He was very difficult to care for and he had a knack for when I would finally catch a bit of shuteye. Would call me, say he was hungry, then not eat. Had to spoon feed him, wouldn’t get out of bed, and give his medicines one at a time and search his bed to make sure he swallowed them, etc.

A week later, had to take him back to the hospital. Diagnosed with acute Kidney failure (20% function). Would not pick up the phone. Mom was in ICU. Had get my Aunt (his side) to call repeatedly until he answered. Returned home and we started 24/7 home health.

He was very uncooperative with the agency people. My mom had been released and was at my late Uncle’s old house. I was a gopher. Groceries, breakfast, lunch and snacks in the day, then visit my mom when the night shift arrived.

One night I was with my Mom, the agency person for my dad called the agency person for my mom and said his blood sugar was 480. Drove back to the house, blood sugar 590, called my cousin in law who works for the hospital my Mom was admitted to meet us at the drop off because he would be more comfortable with a family member.

My mom’s friend is a CNA (they used to work at the same hospital and she took care of my grandmother before she passed in 2005) and she took over the day shift for my dad when he was released.

After a month, kidney function returned. We made him use a walker because he is a fall risk from the stroke. Did very little with the home health PT in comparison to the sessions before COVID.

I took him to my doctor where he said he was in good health and did not want the home health and requested the paperwork not be filed.

Frustrated and ‘the saga continues...’

Hope you find clarity and peace!
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Reply to BL1982
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ravensdottir May 1, 2021
Wow. Kudos for all you're doing and have done. At what stage does a doctor disregard the patient's "I'm FINE" proclamation and direct their care according to their true need?

I was wondering if Adult Protective Services could give you some idea of what can be done since Dad is definitely a risk to himself.

Would he tolerate a candid talk, be able to appreciate that declining home health may be a fast-track to getting placed in a facility? That happened to a friend's uncle. He kept firing home aides and turned out relatives who came to care for him. Then one day he went to VA hospital for a health crisis and when that was resolved - definitely against his wishes - was sent right over to their LTC ward where he stayed until his death the following year.

Here's hoping for clarity and peace for you and yours!
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