What if I don’t feel comfortable bringing my parent home after acute rehab?

DO NOT let them guilt you into taking him home! He sounds like he will need 24/7 care. Especially if are having health issues. He needs to go into a SNF and then possibly an AL or even a nursing home. Prayers to you. My mom recently suffered a stoke and was living with me and at 93 was still very independent. Could cook, bath herself, dress herself - she even colored and roller her hair!. She didn't drive anymore but all that changed within a day. We are waiting to place her in AL - she will have her own bed/room but with assistance. I work F/T and cannot take care of her. Good luck to you!

Action is required ASAP. If you are the POA, you need to make the decision with his best interest in mind. Sending him home W/O 24 hr care would be seen as abuse. He did live alone, but he's not even qualifying to extend rehab more than 2 weeks, that shows lack of progress. He requires more care than you're able to provide. Check with your siblings to see if they are willing to take him home & care for him 24 hours a day. That means providing physical care such as bathing, cleaning him throughout the day & night, turning & repositioning him every 2 hrs. while in bed, getting him out of bed to a chair or BSC, passive & active exercises, watching for aspiration, inspecting his skin for pressure & bed sores, monitoring his nutritional status, etc. Without someone providing the required care that is needed for his current status, his health will suffer. If the answer from other siblings is NO then speak with the case manager & inform them that you & your siblings are unable to take him & they will have to find placement for him. The best time to place a person is while they are in the hospital or rehab. Good luck & I pray that your dad will get better! 🙏

Imho, your father may need an Assisted Living Facility. Prayers and good luck.

Leave him there...speak to Social Worker & Medicaid office to apply for long term care...don’t even think about taking him home . He have long term care insurance? Was he a Vet? Also make appointment with Elder law Atty. Hugs 🤗

If your insistent sibling isn't capable of handling the care alone, ignore him/her.

What your father needs is exactly what Assisted Living provides. If you think there will be resistance, there already is from your sibling, explain to both sibling and dad that dad has just fought a substantial battle with his health and two weeks of SNF isn't going to get him back to independence.
Do your homework ahead of time. Find an AL in a community that also has IL. Explain to the sales person that your dad would likely start out in AL (or in IL with homeware, whichever is suitable and is most economically sensible) with a goal to get to IL as he recovers. You can start as a 'respite stay' (committing only a month at a time) and see how it goes.
Don't be bullied into sacrificing your own health to yield to your sibling's irrational preferences.

All I can do is side with the others here who say if you do not feel you would be a good caregiver, do not force yourself into that role. It would be terrible for you and terrible for your father.

You are NOT cut out to be a caretaker and it will destroy you and your w ay of life if you bring him home. He needs the type of care that is best handled by a facility. Simply be strong and do NOT allow him to come home with you. Tell your sibling no and that the sibling should care for him. But YOU DO NOT BRING HIM HOME.

My uncle was doing rehab in a nursing home and was all set to go back to his apartment with care from an agency set up for him. While final arrangements were being made he contracted covid-19. He spent a month in the hospital and went from walking, talking, eating, and using the bathroom on his own to being bedridden (need to use a hoyer lift to get him into a chair), unable to swallow, and on a feeding tube. They say he will never return to his baseline prior to getting the virus. The virus often causes delirium in the elderly damaging the brain thus the inability to swallow. His level of care is too much for the care agency and he can not go home with a feeding tube. He is now in diapers because the liquid feeding results in diarrhea. He will be in the nursing home until he dies. They will not release him so Medicaid is the only option. This really stinks if you have a home or other assets to deal with. They will start charging and the bill will add up fast if he does not qualify for title 19. It's a no win situation and tough spot to be in for you and your siblings. Find out what his prognosis is. Usually if they are going to get better it happens sooner rather than later. Im not sure you could get aides because usually you would need a nurse because they can still choke and get pneumonia with a tube. It's expensive and will consume your life caring for someone so sick. On the other hand if you don't take him in you will lose any inheritance and he will have no life to go back to if he does happen to get better. I'm sorry you are dealing with this. I've been through these tough decisions with my dad and it's not easy but at least you have siblings to share the burden with. I wish you well.

After acute rehab, im assuming he can go to regular rehab ie check with medicare and or social worker at acute rehab. Typically, post hospital, medicare pays for 100 days of rehab(dont quote me on this).You would have to take him home with a catheter, feeding tube, etc? He wont be ambulatory with all these tubes and will need assistance with everything and would be a huge fall risk.its amazing he survived ICU etc.....does he have any bedsores, etc? How old is he? I remember with my dad ie he had mrsa and it infected his heart etc.....he stopped eating and drinking....he was bedridden with a catheter and IV for antibiotics....we actually chose hospice since we felt he was in so much physical and mental anguish that being in his condition for another 8 weeks in a facility to see if antibiotics would work for his heart infection seemed like torture....he died in 3 days in hospice - probably due to meds.....i have tremendous guilt about this.....and then other days, i feel i avoided needless suffering for what have been perhaps a painful existance. These decisions are horrible - i feel for you.

It does not need to be an express train from Acute Rehab direct to Home. Ask about other stops. Find out what the hospital calls them.

I had no idea there were things called slow stream rehab, transitional care, intermediate care, or respite when my sister was originally discharged home (to fall multi times). Wish I knew then what I know now.

What a scary ordeal you have had. I hope your Dad continues to get the care & time he really needs for recovery.

While you still have some time, check on your father's Financial situation. What kind of long-term care can he afford? Has anyone been appointed POA? Does he have a will? If his mind is still competent, get these things in place NOW if they are not already. Unless he has millions in the bank, get with an elder-care attorney to discuss his financial situation and how to prepare financially for Medicaid. Talk with the staff at rehab about whether he will be well enough for assisted living or need a nursing home.

I would ask what is needed to extend his rehab time until he can transfer from a wheelchair to the toilet. Extended PT, OT and speech therapies can be done in home each week from a home health agency. The social worker at rehab now should be able to help schedule this. For my dad in a similar situation we paid out of pocket for additional time in the rehab facility. It was well worth it.

If you can not do the level of care your father needs, please let your siblings know this now in very direct and simple terms. Maybe one of them can take dad in while he recovers. If none of you can handle this level of care, he may need placement in a residential facility that will provide daily rehab. Discuss with the social worker a placement for him. Then, discuss with your siblings and the facility the level of independence dad will need to come back home. Consider that your father needs extended rehab not permanent nursing home placement.

Agree with cetude in that he will be discharged with no improvement. I would encourage him to really work hard in rehab as well. Or to a NH he will go. Inform the DC planner of this so they can assist in finding a SNF for him now.

He was diagnosed with Covid thus his care is based on what would be expected for a Covid diagnosis. Meaning he is expected to get better. How old is he?
I too would see how well he does for 2 weeks in rehab. The difficulty swallowing is no doubt from having a breathing tube and being on a vent for so long and should improve. If not he can be discharged on a puréed diet and advance up to soft then regular.

Are you expecting him not to recover? He may do very well but of course is weak now because of being inactive for so long.

If he is a commercial pay vs Medicare the rehab center will probably keep him as long as his insurance pays as commercial pay rates are higher (contrary to another poster who alluded he may get discharged faster on commercial pay vs Medicare).

I say give him a chance to work at rehab. You may be pleasantly surprised to find he recovers quickly due to your statement of how independent he was prior to Covid and Covid being his only health issue.

I myself don’t foresee gov’t insurance nor commercial carriers approving routine long term care or extended rehab for Covid patients as the majority are expected to recover quite nicely, elderly or not. I am a RN case mgr and it is a struggle to get post Covid patients homecare services due to the 10 day quarantine after hospital DC and the availability of homecare staff as we speak. It’s crazy out there. We are working on “Covid 19 time”. Staff are here today and gone tomorrow.

Thus it may be a struggle to get insurance to pay for extended rehab as it’s just not part of the Covid algorithm for treatment/payment.

But your father was in an acute setting for 60 days and that has to account for something. Unless HIS insurance is dictating the number of paid rehab days. Is that the case? I would call his insurance carrier and ask how many days of rehab are paid for according to his policy and use this info as a tool in your box to push for more days.

If you father is not showing improvement they WILL discharge him. You should have been telling your father to work HARD on rehab, or he will be going to a nursing home. Medicare does NOT pay for nursing home care other than rehab up to 100 days, and they have to show improvement--they can eject them, called "no progress" discharge.

Your choices are either learn how to do basic care and get over your reluctance to "clean up his mess" -- or straight to the nursing home he goes. I took care of my mom with end-stage Alzheimer's for decades and in the end I had to bathe, clean and even make certain she has a bowel movement a few times a week, which often involved enemas and lactulose. If you really love someone you do what you have to do.

If you can't, or won't--then you can't--then get him placed in a nursing home, and you better tell your father that. GET WITH A SOCIAL WORKER.

Discharge in two weeks is out of the question because they are “crystal-balling his care based upon their needs, not his, not yours. By law, the rehab facility CANNOT release him without a realistic “plan of care.” This sounds like an “insurance release” because your dad isn’t on Medicare. He is potentially eligible for 90 days of care on Medicare rehab. It’s amazing how incentive changes when there is good insurance or private pay cash money available. I know because of what our family experienced with our mother, who lived to be 101.

Simply refuse to take him home on the grounds that he is not sufficiently recovered for you to be able to meet his needs within the time and resource constraints you have available and can afford. But if insurance is the issue, they will start charging you.

Dont let rehabilitation facilities and nursing homes push you around. If you have a question, google it and you might get an answer that makes sense. Negotiating your way through this morass of government, health care and insurance regulation is an absurd challenge that literally requires expert legal advice to negotiate and even attorneys who specialize in issues related to health care for the elderly don’t necessarily have the right answers. Flatly refusing to take the loved one home until YOU are ready usually gets their attention.

My sister and I are going through this right now with my mom. A year ago she fell and since then has been back and forth to rehab/ assisted living and hospital. Three weeks ago she was discharged from rehab. Medicare wouldn’t pay any longer even after we appealed their decision twice. We knew that her walking was limited but rehab said that she was able to walk enough to get to the bathroom, etc. She couldn’t live alone so my sister brought her to her home to live. What a disaster. It turns out she no longer walks and her muscle atrophy had gotten to the point where she has no strength in her body whatsoever. She is unable to help transfer to the commode or anything. She is “dead weight” when we try to lift her or roll her over on the hospital bed to give her a bath Or change sheets. We realized we just couldn’t do it. She started getting bed sores because we couldn’t move her. We never imagined having to place my mom in a facility but we physically cannot take care of her. We thought Of everything we could to keep her at home. She needs 24 hr care and is at least a 2 person lift. It was financially not possible. We found a wonderful group home down the road from us and brought her there Tuesday. Within 3 weeks, we have brought my mom home, scrambled to clean out and sell my childhood home to pay for her care and placed her in a group home. We are heartbroken but know that it’s best for my mom. We never should have brought her home but we felt guilty. You have to think of the future if you bring him home. Can you physically take care of him if he declines further? I’m sorry your family is going through this. It’s an impossible situation

If your sibling is insistent that he come home then she should take him.

What does your father say about all this? Is he able to communicate?

Please listen to Barb and Alva. Do not listen to those who imply that it is your duty to take on his care. You know what your limits are as far as what you can do. Make sure all of the others , siblings and health care workers, are fully aware of those limits too. Be firm.

You should do what you would want done for you.

See what he can do in the 2 weeks of rehab, it may surprise you. You can always ask if he can stay a couple weeks longer if he needs it.
You won't have to pick your Dad up. You may have a walker for your Dad to get around with when needing to go to the bathroom.

His Cathiter can be taken out as soon as he's able to walk.

Juse because he can't walk well, doesn't mean he can't wipe himself after a poop.

There are Shower/Tub Chairs tgat he can use snd he'll be able to wash himself.

Im sure if you asked him, he would let you know he wants to go home asap.

His Insurance will pay for Home Health Care, Therapy to be done at home, will send a Nurse to check on him and do his Monthly Cathiter change and Aides to come 2 times a wedk to help with bathing him.

You could always pay for a Caregiver yo come 2-4 hrs a day to help out.

First I want to say Praise The Lord that your dad survived.

Do you know of a good skilled nursing facility? Do you know anyone that has been through needing skilled nursing recently?

I would start looking for a different rehabilitation facility that is committed to rehabilitation for your dad.

I had to move my dad from a facility that said he could go home because he could transfer to and from the wheelchair and bed. WHAT?!? No way! He needs to be rehabilitated to pre hospital stay or at least as close as possible.

He went to another facility, rehabilitation took place multiple times daily, 6 days a week for 3 weeks and he walked out. This after 2 weeks in the 1st facility and a 9 day hospital stay.

He needs more than 2 weeks of rehabilitation after being in the hospital and everything that he has gone through.

Please advocate for him to get the care that will let him be able to safely go home at some point.

Also very important- please be ready to say no if you re pressured to give dad a “trial” at home. A “trial” actually means “Dad is coming home you will be responsible for his care I’m busy this works so well he’s happy with you this should be permanent”.

Covid rehab is not yet cut and dried. Problems can arise during recuperation, and with his swallowing/feeding issues ALONE, caregiverS will need careful training.

Please impress upon your family that you need alternative choices for care management and lots and lots of support and help with decision making BEFORE he comes home.

Granted, it sounds like your family has been stressed of late. But, if it feels wrong to become his in-home caregiver..... then it's probably wrong. I'm glad the staff is giving you some idea of what care your dad needs. However, for every one thing they are telling you about, there are probably TWO things they are not telling you about in terms of things your dad will need or things you must be willing/able to do for him. Rehab staff will smile and ask if you have any questions prior to releasing your dad to go home. They will say you can call if you have questions once you're home and you realize the magnitude of what you've agreed to, but don't be surprised if you have trouble reaching them.... Just my experience talking.

Tell the one sibling that  you think dad belongs in an institution, but if he/she wants to take dad home, go for it, but you are not going to help.

Tell the discharge planner they have it wrong. You are a long haul truck driver who lives in Alaska.

I joke right? But what if you were? What if there were no adult children?

Alvadeer is correct. They will try anything to 'close case' & move on to the next case. They are crazy busy I know. But Dad is in their care so the *duty of care* is theirs.

Tell them you are your Dad's advocate to enable him to receive the care he needs. But his care is beyond what you (as one person, or as one of three sibs) can do.

Stand firm, be polite & professional. Stay strong.

"No, my father cannot possibly be discharged to my home".

That, my dear lady, is a complete sentence.

Tell them you will not be taking him into your home.
First question is that you say your Dad was completely competent. Was he living with you? What was your understanding moving forward? Or was he in his own home.
Know that SNF is covered for at least 21 days especially after Covid. But in almost all cases in which patient is on medicare.
Let them know NOW, at once, that your father was self care, and that you will not be caring for him. That, if he requires care then he requires placement. This is much easier, esp in these times, for the Social Worker there to handle than for you. The important thing to tell them is that you are neither mentally nor physically able to accept him into your care; they will try EVERYTHING. I have been there as a nurse seeing it. They will tell you that they will get you help and together you will all make it work. They won't and and it won't work and then you are stuck, having no answer but an ER dump to get him back into care. It will be almost impossible for you to find.
Your Dad will require four negative tests (in most CA facilities, at least) to get into care; they know that. It is a pain for them and they want him in your home.
TOMORROW, ask to speak to the Social Worker. Tell her that you will not be accepting your father into (or BACK into) your home, and that he was self care, and you are not prepared mentally or physically to care for him. Tell them that he will require placement, and they will need to find placement for him, as you cannot go in "covid-19 times" to check out facilities. They will then ask you for his assets, and you should be ready, if you can, to tell them as approximately as you are able.
Good luck. You are going to have to STAND STRONG against them to accomplish this. It is no time to be a shrinking violet. The truth is that your Dad may never fully recover from this; many younger than him have been unable to, and there may still be complications of blood vessels, strokes, no lung capacity on the horizon.
I am so sorry this happened to your Dad, but do not allow them now to use you and make it clear it will not happen. They cannot do a discharge to someone not accepting a patient and they cannot do an "unsafe discharge".
Time to kick it into high gear tomorrow, and I am so very sorry your family is going through this.