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My husband recently fell and broke his hip (upper part of femur) and had a half hip replacement. Is currently in hospital but they are trying to get him into inpatient rehab. He also has Parkinsons and radiculopathy (nerve damage) in the same leg resulting from shingles, so recovery is not as simple. We aren't at all familiar with how rehab services (OT, PT) operate in skilled nursing facilities, nor who decides when enough function has been restored to allow a person to go home. With outpatient PT and OT, my husband's doctor has written a general order and then the PT and OT take over from there, and they do periodic evaluations to determine if their services are still needed (based on Medicare or insurance guidelines I'm sure). In a SNF, I presume there a doctor who writes the orders and oversees the patients medically? And would this doctor coordinate care with the patient's other doctor(s)? The hospital will be providing detailed notes to the SNF, including notes from the PTs who have seen my husband. How does the SNF know that a patient is safe to discharge to home? I know hospitals are bound by regulation to make sure it's a safe discharge. Does the SNF have a process to do a home evaluation to make sure it's safe? We are fortunate that my husband does have LTC insurance and we are already getting some home care aide services from an agency, so can get more when he's discharged as needed. We also have grab bars, shower chair, bed rail, and a lift chair, so I think home is pretty ready physically.

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My story was my mother was all set in the rehab unit of the SNF and we expected her to transition to the long term care unit of same SNF. She was previously living alone in her own home many, many states away from me and my brother. They had a family meeting, including my mother and they said to her "Ma'am, you're too well to stay here." WRONG ANSWER! Less than 48 hours later there, my late mother suffered a stroke there. She did not live. Prayers sent to you.
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Reply to Llamalover47
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Well, hubby is all settled at a nursing home with snf beds where he's goi g to get pt, ot, etc. Our insurance company denied the need for inpt services, which both the hospital and the receiving facility find impossible to believe. We fortunately have ltc insurance and they're agreeable to paying room and board, and the Medicare advantage company should hopefully cover the therapy services as if they were outpatient services. Hospital arranged transport in a wheelchair can as my husband had been sitting up readily in the hospital and they thought it was safe to travel that way. We had to pay transport as Medicare doesn't cover that. I think the facility will provide transport to outside appointments included in the room and board package. Ot. Pt, speech, and doctor have all been in today, so I think we have a better idea of how things will go. Thanks to all for your input and advice!
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Reply to newbiewife
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While he is still in the hospital, ask to talk to the case manager if that person has not already reached out to you. They can arrange the move from hospital to facility in an ambulance when certain criteria met. With his medical issues, be sure to emphasize the need to move via ambulance because he cannot sit upright in a car (or medical van) to make the move. They need medical necessity documentation to get the ambulance transport - otherwise, there's a good chance they are going to ask you to put him in your car or call a medical van. Insist that he must lay down for the transport.

Also, ask his current doctor if he is affiliated with any facilities to continue oversight of his care. If he's not, he may know a dr that does this sort of thing and is helpful in maintaining communication between current dr and the one who will see him at the facility.
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Reply to my2cents
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Newbiewife, the SNF should have transportation that is included as part of their services. Please ask before you pay for that service that is typically provided when it is from the hospital. My dad was moved from a SNF to another one and he didn't pay for any transport.

From what I was told the therapists are the ones that provide the information that gets your rehab extended or you go home. I stayed in touch with them to find out the real progress, because the doctor is only reading notes not seeing the progress.

I know that being separated is difficult, but use this time for some self care and rest. Statics show that the better a person is on discharge the less likely they will have a recurrence. So trust the pros and encourage hubby to stay in rehab until they say he is ready to go home.

Our occupational therapist was the one that walked through the house and made suggestions about what to do for safety. The hardest thing for me was NO throw rugs. I have almost white carpet and throw rugs save my sanity, so be prepared for some changes that you might not like.

Be sure and ask for in home therapies, that will help your husband know how and what to do in his environment versus a facility setting.

May God give him a speedy recovery and you some self care and rest while the pros care for your hubby.
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Reply to Isthisrealyreal
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Be aware that PT is not a cure. Alot of posters feel, my LO needs more therapy because they can't walk on their own. Thing is, therapy can do no more for them. No amt of therapy is going to solve the problem.

There are plateaus that people meet and no amt of therapy is going to make them better. Sometimes the legs just give out. Once a plateau is met PT stops. Then the decision of bring them home has to be considered. Can a family member physically take care of the person. Can they afford aides to come in. Is the house safe. Does the caregiver have support?

If no to these questions, then LTC maybe needed. Private pay, if u can, Medicaid if u can't.
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Reply to JoAnn29
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Every client's care is under the authority of his/her doctor that is associated with facility. The doctor can coordinate care with your husband's other doctors. Before he goes to SNF, make sure that all his medications are prescribed for the SNF. The nursing staff can only give medications that are prescribed. The benefit of SNF is that your husband will receive more OT and PT than in a hospital. The OT and PT staff will keep good records of your husband's progress and the doctor will review these notes. Most patients will have weekly or bi-weekly care conferences to discuss how the patent is progressing and suggest changes to care. You can and should be present at your husband's care conference. OT and PT can let you know if he will need more or different assistance when he is ready to go home. Social work can help arrange for community resources as needed. The doctor is the one who will decide when your husband is ready to go home.
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Reply to Taarna
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Where I live our rehabs and LTC are in the same building. Rehab is in a section by itself and the therapy room is in that wing. This is how it maybe with the poster.

Medicare determines how long a person stays in rehab from what the therapist reports. If they hit a plateau, they are usually discharged. Therapy can continue at home. The first 20 days is fully paid by Medicare. The next 21 to 100 only 50%. Some suppliments may pick up the rest. With my Mom she pd $150 a day. This can mount up. So, if you can't afford it tell them. U may be able to get help from Medicaid.
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Reply to JoAnn29
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I'm a little confused here. I have had inpatient rehab twice for myself, but it was in a rehab facility, not a SNF. My understanding was that I would go to a SNF for rehab only if I did not progress in rehab in the rehab facility. In general, rehab in a rehab facility is more efficent than rehab in a SNF, because in a rehab facility you usually have rehab for a few hours 2x/day, often including at least 1/2 day on Saturday. Why are they planning on sending your husband to a SNF for his rehab?
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Reply to caroli1
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worriedinCali Oct 30, 2019
Caroli, in many places there are no actual rehab facilties, “rehab” is done in a skilled nursing facility. My county for example, has one “acute” rehab facility. All other rehabs are located within and run by skilled nursing facilities.
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Thanks very much for the information. I sure hope my husband doesn't have to spend 21+ days in the SNF, but if it prepares him better to be safely at home I guess we'll have to live with it. The PT at the hospital was talking about 1-2 weeks for rehab. He's very motivated and is happy to exercise, so if they give him the tools he'll push himself. Transport wise, he's in better shape than your mother was as he's already able to transfer from bed to chair, is walking with rollator a little (5 days post surgery). He possibly could transfer to a car, but the discharge folks at the hospital think the easiest way for him to get to the rehab will be by wheelchair van, which we'll just pay out of pocket. I'm still not sure if there's a doctor in charge at a SNF, or if the treatment plan is a team effort and likewise the discharge decision is a team process. I'm sure we'll find out when we get there, but I like to be prepared!
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Reply to newbiewife
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It sounds like you are pretty well prepared. You will have a pre discharge meeting a couple of days prior to discharge somewhere around 21 days. You should have PT, OT, and social work be present as you prepare.

One thing to watch for is post discharge and specialists orders to see them within the first 2 weeks of rehab. Medicare will not pay for routine ambulance transport to doctors offices. My mom had a hip replacement and her renal doctor insisted on seeing her in his office which ended up as a conversation. No labs were done in the office but labs certainly could be done in rehab. Mom was was not able yet to transfer to a car and needed transport by stretcher. The rehab reqiured special permission and it still cost several hundred out of pocket after arrangements were made. I met up with her at the doctors office which was more than an hour hanging around. What a waste of time and effort. I m recommending delay in these specialist appointments. Mom's special issues were certainly being managed by the APRNs in rehab.
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Reply to MACinCT
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