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My mom recently fell and broke her leg and after surgery she went to a rehabilitation center to get to where she could walk again. She has had numerous complications while she has been there and has missed around 7 days of therapy and only has a few days left. She hasn’t had an appetite and barely ate anything for 4-5 days and when she did she would throw it up. She also had to go back to the hospital to have a blood transfusion due to her red blood cel count being down. Her blood pressure was extremely low during all of this and she would get dizzy and feel like she was going to pass out when she tried to get up. After the transfusion she was able to eat and was able to go to therapy like normal. Her red cell count was down when she initially got to the hospital after falling so they did a transfusion and they had to do another one the day after her surgery, so this is the 3rd transfusion she’s had in about 25 days. I was told that if a doctor requests or tells Medicare that she needs more time for therapy that they would pay for additional days but I can’t seem to find anything online about it.

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Medicare relented in 2019, will now cover therapy as long as a doctor says it's medically necessary.
https://www.medicare.gov/coverage/physical-therapy
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geddyupgo Jul 2021
You are quite correct but that change in regulations was for "outpatient" therapy. Inpatient short term is still 20 days at 100% ; if rehab is still required and the patient is able to participate they will pay 185.50/ day (or this amount may be picked up by their secondary insurance if they have one) from day 21-100 per benefit period. This is true for original (sometimes called traditional Medicare only). Medicare Advantage programs are totally different and have their own individual timelines and requirements.
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The # of days are not fixed and firm. When she was discharged from the hospital to rehab, she was sent with a diagnostic code which has a usual # of sessions based on the code. But it can be less or can be more dependent on her progress or other issues that arise.

I’d be concerned that she is not progressing and her health is such that she will not progress. So if that has been recorded in her chart, then MediCARE will stop covering rehab. You should speak with the PT & OT this week as to how she is doing. Missing sessions as she was out due to transfusions can be “credited forward”. Therapists have some leeway in how they record stuff in the patients chart. But sometimes, no amount of therapy is going to take them back to where they were before their fall.
If that is the situation, decisions need to be made as to if she is best off staying there & becoming a LTC resident as she will have 24/7 oversight.
If she is still telling nursing staff that you & your brother will be her caregivers on call for her back at her home & that is in no way going to happen, you have got to make it clear with the nursing staff, the SW and her doctors that is NOT happening. That she cannot return home as it is an unsafe discharge.

Low RBC, high BP and vomiting after meals isn’t normal. What was her health like b 4 the fall?
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https://www.agingcare.com/questions/can-i-be-held-responsible-for-taking-care-of-my-mom-if-she-goes-home-from-rehab-from-a-broken-leg-468454.htm

Medicare pays 20 days 100%, 21 to 100 days 50%. Mom will be responsible for the other 50% unless her secondary pays full or part of it.

Her doctor may ask but he doesn't determine how long she is in Rehab. The therapist does and reports to Medicare. If Mom is making no progress or plateaus, Medicare will have her discharged.

I read ur other post and answered it. I suggest you call the SW at rehab. You seem to have a lot of questions that she maybe able to answer. You main problem is going to be when they discharge her. They need to understand that there is no one who can be with her 24/7. Stand firm on that. Do not allow yourself to be intimidated.

The part about her missing 7 days. I think that is taken in consideration. So she has 20 days, and has used 5 of them before going to the hospital. She goes back to rehab and still has 15. Something u can ask the SW. Your Mom is allowed more than 20 days in rehab if the Therapist feel more therapy is need. Just means that over 20, she maybe paying out of pocket.
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