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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

I’m in agreement with AlvaDeer. The fact that your mom was wheelchair bound for two months prior to the surgery has greatly impacted her ability to achieve her prior level of mobility. I would imagine that a current PT goal is for her to be able to transfer safely with the assistance of one person in order to go home. If that goal hasn’t been met and is feasible, you should be able to get a little additional time. What type of Medicare plan does your mom have?Also, where will she be returning and who will her caregiver(s) be?
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amain55 43 min ago
Not sure which Medicare she has, but she will be returning home and I will be the primary caregiver, along with my dad, Home Health (nurse and PT couple times a week provided by insurance) and a couple hired caregivers plus family and friends to fill in.

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
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Thank you for your responses. I realize at her age, recovery would be slow and her mobility might be permanently altered. We're going to be doing in-home care training next week at the rehab, so I'll have all day with the PT and staff to converse about everything. I just want to make sure her discharge isn't happening just because of insurance alone. They keep telling me she is making progress so lack of progress I'm being made to believe isn't the factor for the discharge. We're very willing to pay for additional time if additional time is needed.

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
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We just can't guess about an individual, but the sad truth is that your mother may never fully recover to be able to walk independently. I think that rehab has a pretty good idea at this time of where this is all going. The truth is that a month of rehab for an 87 year old with this level of spinal injury and surgery is probably not going to put her back where she was.

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.
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Reply to AlvaDeer
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I watched my dad experience the progressive loss of abilities in increments with each stay in a bed, hospitalization, each setback. A few days without movement of regular walking caused a permanent change in walking ability. We are truly “use it or lose it” bodies, and advanced age really shows this exponentially. Rehab cannot, using Medicare, continue providing therapies without being able to document progress. It’s sadly often reaches this point. Talk to the PT about what their perspective is, if lack of progress is occurring, and advice for next plans. I’m sorry this is going on, it’s definitely hard to watch. Wishing you and mom much peace
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At 87 your Mom may never walk again. They are good until they aren't. You really need to talk to the physical therapist. Medicare will pay past 20 days but only 50%, Mom will be responsible for the other 50% either out of pocket or insurance may pay.
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