My wife is at a rehab facility after having suffered an intracerebral hemorrhage 5 weeks ago. They say she must be transferred to a skilled nursing home. She's 69 years old and in excellent physical shape. I want to take her home. She will be getting skilled care (OT, PT, and speech therapy) at home. Our home is completely set up to care for her. Though we have a basement, our house is a patio home with everything located on the ground floor. We have LTC so it will pay for unskilled care people. So we have both skilled and unskilled care coming in. My wife is barely begining to take steps, can swallow, and needs no medical intervention other than high blood pressure meds and perhaps anti-anxiety pills which I can easily provide for her. I'm the same age - 69 and in excellent health as well.
IF she goes into a nursing home, there's the threat of institutional disease, there's isolation, visiting limited to one person on any given day, there's a good chance of future lock downs with no visitation by loved ones. A nursing home is the last place on Earth my wife would want to be in. Hospitals, rehabs, nursing facilities look like a lost episode of the Twilight Zone with everyone's faces covered up - can't possibly be good for a person recovering from a brain injury.
At home, unlimited social interaction, safety, familiar surroundings, unlimited visitors, she'll get the same amount of OT, PT, and speech therapy and the skilled people won't have to wear masks in our home. Given this, could a rehab facility still force my wife to live in a nursing home against my wishes, with me serving as her medical power of attorney?
I've heard about the threat of Medicare not covering skilled rehab at home if there's a written document from the rehab facility that she needs a nursing home? Is there financial incentive for the medical world to look out for each other and force people to be in institutions to keep the income coming in? Do many people retain an attorney when something like this comes up? In my view there's absolutely no reason my wife should be going to a nursing home. But can a rehab facility say to Medicare that my wife must be institutionalized regardless of how ridiculous it might be? Who can overrule the rehab people?
My experience with my mom after her stroke was that she went from a 3 day hospital stay to acute rehab (I am assuming that's where she is now) getting therapies twice a day. She then " stepped down" to sub-acute rehab where therapy was less frequent, but still quite intense.
I'm curious if her current rehab is recommended going to a long term care facility for more rehab or if they think she needs to become a long term care resident there because her medical needs argue for her being someplace with 24/7 medical staff.
In my mom's case we were fortunate that she transferred to a setting for further rehab that had medically trained staff as she developed some pretty severe low blood pressure issues the first time she got out of bed. She would quite possibly have died had they not been there to intervene--I have a colleague whose post stroke mom DID die in just such an incident when medical intervention was not on site fast enough. It was also quite useful to have a geriatric psychiatrist on staff to deal with my mom's new emotional liability and what was eventually diagnosed as Vascular Dementia.
I don't v think that anyone can force a person who has not been declared incompetent to reside someplace against their will.
I would check out several subacute rehabs (not all are in skilled nursing facilities--my mom's was not) and get clarity from the staff at the current setting exactly what they think her needs are.
We were blessed with good discharge planners who were able to explain clearly what Mom needed and why. Consider taking another person with you to listen to the plan and formulate questions--I imagine that doing this for a spouse is a much more emotionally fraught process.
From your profile
I'm worried the rehab place thinks I'm a danger to my wife since she is mortified of me when I go see her. Ever since she was admitted to rehab she has progressively become afraid of me. I have medical power of attorney for my wife's care. I went to see my wife as I stayed away for six days and thought I'd try again today. My wife is now terrified of me.
It will certainly not be beneficial to your wife's recovery if she is terrified of you. She needs calm so she can work towards recovery.
More of the situation.
https://www.agingcare.com/questions/do-cerebral-hemorrhage-survivors-begin-to-fear-and-hate-their-spouses-471555.htm?orderby=oldest
Have you discussed it with them?