My mom is at an acute inpatient rehab because she recently received spinal fusion surgery at two locations in her neck. She was prescribed a medication a few months ago that had a rare side effect that messed with her ability to walk and balance which caused her to suffer a lot of falls which Dr thinks caused her spinal cord to get pinched which then caused her to not be able to walk. The signals to her legs were no longer getting through. She was stuck in a wheelchair for over two months before her surgery.
The surgery was a "success" and she has been at rehab for a week and a half. Rehab says she "is making progress" but she still can't walk without an overhead harness and two spotters while using a walker. She can't stand up without special equipment and not for long.
Before all this happened, she was able to walk, go on hikes, drive a car. Even though she's 87, she's very healthy otherwise.
She can't walk or stand without significant help and she's having many problems with incontinence. She had some issues before, but it's much much worse since all this happened.
In my mind, she's not rehabilitated yet. Not to where she was before (walking, independent).
Rehab is going to discharge her in one week, making her stay there at 19 days which is suspiciously close to the standard 20 days that Medicare covers. Are they discharging just because of insurance and not because of her actual rehabilitation? It just seems to me that she is making progress, but nowhere near where she was before and definitely not somewhere where she's gained any of her independence back or her ability to care for herself. It seems like the rehab thinks she's going to be in a wheelchair and we need to hire the help to continue her recovery, at least that seems to be the plan.
I know I can appeal to Medicare to get a longer stay, but nobody at rehab has mentioned anything about insurance coverage and if it affecting their decision to discharge. They just say "she's doing great" and I'm really wondering if they even know what her baseline was before coming to them. The goal of all this was to regain her ability to walk, not get her so she's in a wheelchair and her home is transformed into a nursing home.
TIA for any suggestions/insights/experience.
-Art
We are in the process of obtaining recommended equipment and we already did our best in getting the home suitable for a wheelchair because of those two months she needed one.
So she does have a relatively adequate environment and support when she comes home. I guess I was expecting a more advanced recovery at the rehab.
Going there now for caregiver training. Will update later. And thank you for your replies. It's definitely helping me better understand this whole thing.
-Art
We do have in-home care lined up with Home Health and PT a couple times per week, but she wouldn't be benefitting from the intensive PT she can get at the rehab, especially if she's unable to walk without the help of an overhead harness. I spoke with the case manager briefly yesterday and she acknowledged my mom isn't at the level of self-reliance they want her yet (with standing, walking and continence/ability to make it to the bathroom). I don't know how much she'll improve over the next 5 or so days.
I just want to make sure the discharge decision isn't being influenced by coverage alone. We can offset if that's needed and additional time at rehab is beneficial.
I'll update after our time at the rehab this coming week.
Thanks for your help so far 🤞
-Art
I think it is time for an individual assessment now with the MD and all the team to let you know what they are seeing, and what the future looks like for your Mom. She may be wheelchair bound with ability to transfer only. She may be able to get inhome PT. Any falls would mean further injury and set back.
Sadly these sorts of things are often the beginning of the end. Struggles for an elder who is already suffering the vagaries of an aging body can lead to further falls, bedsores, loss of appetite and a general failure to thrive. This is a day at a time. You need to beg, borrow and steal all the rehab time you can get covered, but do understand it may never be enough. What you really need is the HONEST assessment of those currently treating mom.