Surgeon and physical therapist okay'd release from rehab. Rehab says no. Can they truly keep her?

Sunshiney, whatever you do, do not move away from that town.... it is truly amazing that a town of 400 has a hospital plus 3 rehab facilities.

The small town my Dad grew up in out in the Midwest, similar size to yours doesn't even have an urgent care facility.

My son had a serious motorcycle accident last year. After a couple of weeks in the hospital he was to go to rehab. His wife went hither-thither and yon scoping out about a dozen rehabs and they narrowed it down to 3 that met their criteria. They took the first of those that had an open bed. NO WAY should the hospital or doctor be dictating which rehab your friend must use. When my son and DIL asked the surgeon about the places they were considering she said things like, "they do excellent PT and they also do drug rehab, so consider if you'll be comfortable in that environment," "They have a great reputation in the medical community but I haven't had a patient there yet so I can't speak for experience," and "Several of my patients have used that facility. They made good progress and I didn't hear any complaints." Putting undue pressure on which rehab to use seems very fishy to me!

My DIL and I prepared their house as well as we could before the release date, putting furniture in storage, taking up throw rugs, and converting a four-season porch to a convalescent room. When the main physical therapist inspected the house he noted that the bathroom door would not accommodate the electric wheelchair. So they ordered a bedside commode. They ordered a temporary ramp for out the front door. They ordered a hospital bed. I agree with GA that therapists are creative in finding solutions; and they're the ones who should have been doing the home inspection.All of these temporary measures were much cheaper for the insurance company than staying in rehab beyond the point where it was necessary. The insurance company was getting VERY insistent that a discharge take place.

My son is a well-educated professional, with good people skills. He is not easily intimidated. He remains polite and reasonable, but looks out for himself. His wife, a teacher, is an awesome advocate. I feel sorry for older folks who often are treated as invisible anyway and are very vulnerable when ill or injured, trying to get respect and their rights in an adverse situation.

I realize that as a friend you may not know all the details of the situation. But from what you wrote it sure seems suspicious. I think your friend should get an ombudsman involved.

As for your own situation, you now understand you need to stand up for yourself and also have an advocate on your side. But rehab centers can be a very important step between hospitalization and going home. I hope you never need one, but if you do, please be assured that what you are describing is not typical.

Sunshsiney, thanks for the explanations and insight. Given what you've written about the closeness of the community, you might want to consider an attorney with specific elder law attorney in a larger city. Even if the family has to drive a little farther to meet with him/her, it could be done w/o being part of the local community knowledge network.

There's another method and that's to turn the tables on the admin who's being so arbitrary. The husband can ask for (demand?) a care conference (many here have been through those), take some supporters and pose very specific questions, such as what are the goals for this week, the following week, and for discharge? How are these to be implemented? There HAS to be a plan. Grill them.

Someone who's really gutsy might also mention being held against one's will, something to that effect. I suspect given the description of your community that this wouldn't be in their nature, but it might be time to consider getting tough. i still think something's wrong and needs to be addressed,

Also, I don't understand why a group of friends don't just come in and take your friend home. She's not in prison....or is she?? Seriously, there's something odd about this whole situation.

One has to realize just because a patient isn't having physical rehab and no doctor visits that nothing is happening.... something is happening, her ankle is still repairing itself.... as we age it takes longer for the bone to regenerate, thus the more time we give it to fix itself, the better it will be.

Rehab might feel that your friend being released back home to a husband and son, that your friend might dive into doing all the chores once again.... guess what would happen?.... she'd be back into rehab because she re-injured her ankle or re-broke it [easy to do until 100% healed].

As to being placed in a certain rehab facility, it depends on who has an open bed. I know when my Dad had surgery and needed rehab it would have been great to have him in the rehab just down the street, but it was booked, and the closes rehab with an open bed was 40 minutes away.... he had no choice.

Recently I broke a bone, first time in my life, so this has been a new experience and quite a journey for me. That was 2 months ago, and the bone is still healing. My next step will be going to rehab on whatever schedule is needed.

First, it's unfortunate that the hospital, or rather the treating physician, was so adamant about choice of the rehab facility. On the other hand, there may be significant differences in the rehab, PT and OT provided by the three, and that may have been a factor in his/her choice. Still, the family was entitled to an explanation why the choice was made, especially since reading the rest of your post, I think this facility is milking your friend's stay.

Second, there's something amiss in the different positions taken by the rehab staff and physician vs. the admin staff.

We did experience this as well when my mother broke her leg. Her orthopedic doctor, not the SNF doctor, cleared her for release. Admin wanted to keep her longer; I don't recall what the therapy staff's position was. It helped that my sister was a nurse and wouldn't be intimidated. Neither would I, having worked for lawyers for years including some who specialized in medical malpractice.

We decided to bring Mom home; it wasn't AMA because in our opinion the only doctor who mattered was her orthopaedic doctor, and he was in communication with other treating doctors (not the SNF doctor) who were in agreement. So Mom came home.

If your friend isn't getting any nursing, care or therapy, and she has care at home, I think there's something amiss at the Admin level when the position is taken that countermands the physician and rehab staff. This smells like a ripoff, designed to keep her there to maximize Medicare benefits.

My suspicion is strengthened by the fact that the only complaint the Admin rep made was something that would require MAJOR retrofitting - one doesn't enlarge a hallway or bathroom without moving walls. Query how your friend managed before?

I'm also surprised that someone from Admin did this so-called inspection. In my experience, it's been either reps from PT or OT or both. That was the situation when Dad broke his hip. However, and this is important, they made alternate, workable suttions.

In your case, I'm wondering if your friend uses a walker or rollator, which likely could get through smaller hallways. Grab bars are mandatory. Therapists are creative in finding solutions; they're the ones who should have been doing the home inspection.

If your friend's family isn't comfortable advising them that they plan to take her home, they could get an ombudsperson involved - they offer advice and guidance on situations with nursing homes. They could call your local Area Agency on Aging, or do a google search for ombudsperson agencies in your area.

There is another possibility and that's that what your friend believes is available in care at home is not what her husband and/or son want to provide. Do you know the family dynamics? Are the husband and son supportive of her desire to return home now?

One thing that might be interesting is to google the nursing home, then google the same name followed by complaints. Also check the Medicare web site with lists of facilities and see how it was graded. That might be ammunition for your friend's family to use to get her out of there.

You could also research elder law attorneys, check their websites and see which ones focus on nursing home malpractice and issues. For a few hundred dollars, a call from an attorney or a letter with a medical records release might shake up a few people and they'll find they'd rather release her than battle the family or an attorney.

Oh BTW, you can also check on the doctor who was insistent on going to that facility. Medicare just completed a large sting in which numerous people at different levels in the health care profession were rounded up for fraud and collusion.

Good luck. I hope the husband and son take a stand and stop this situation, if I'm reading it correctly and am also correct in suspecting some collusion.

Sunshine, when I was your age I was a gym rat, doing cardio, lifting weights, could hike for miles on end... was in excellent health... but please note as you age we do get issues with osteoporosis, it doesn't matter how much calcium you take, it can still become a speed bump in recovery should one break a bone. Some women and men don't even know they have it unless a bone density test is taken.

A few years ago my Dad had a heart attack and it was highly recommended that he go into rehab but my Mom dug in her heels, she said she could take care of him at home.... she didn't even want physical therapists to come to the house. May I mention she was 90 years old when this happened. How quickly she learned that she couldn't help my Dad to the bathroom or even up the stairs. Dad just sat in living room in his recliner 24 hours a day, his muscles getting weaker and weaker. Because of not getting the proper rehab until weeks later and Mom being so stubborn, it caused Dad not to fully recover.

Couple years ago Dad needed surgery and afterwards it was highly recommended that he go into rehab... this time my Mom said "yes". She had learned the hard way.

Rehab is typically a voluntary activity. If goals are met, the individual services such as PT and OT and speech therapy would discontinue, and discharge would be planned, so on the face of it this doe not quite make sense. Just keeping someone for as long as funding is available is generally wrong too. A facility may feel an obligation not to discharge to an environment they know is unsafe. You can typically demand to discharge against medical advice, though then the costs of the stay may not be covered. The big question is whether that would really be best, versus fixing the concerns at the home which may be very valid...or may be a total smokescreen for a profiteering rehab center that is not worthy of the name and is trying to keep paying customers as long as possible. Maybe get an independent OT or PT home evaluation done...then involve the ombudsman or office of long-term care to find out what the discharge requirments and goals for a non-AMA discharge would be, or consider requesting transfer to a different facility on the grounds of not getting services.

Sunshine, oh my gosh, you mean your friend's husband and son needed to be fed by a village of people, for the past 5 weeks if not more? Plus someone comes in twice a week to clean the house and water the plants?

Can't those fellows do things for themselves or do they have physical decline problems where they are unable to fend for themselves... and that is why the rehab facility felt it was better to keep your friend there until her ankle got better?

I am just trying to get a better picture of this situation.

Flyer makes some good points which I hadn't considered. Between the husband and son, I would think they could make their own meals. And watering plants is pretty simple. The support of the community is wonderful, but this 2015 and men have become very self sufficient in meal prep and house management.

I'm wondering if this small community is one of the rural religious communities in which men and women have very defined roles, and the women are the caregivers. If so, that could be a reason why the husband and son haven't stepped up to challenge the nursing home.

Perhaps they're really not prepared mentally or physically to provide the care your friend needs.

That makes just as much sense as the nursing home admins having an ulterior motive.

Fourth sentence should read "this is 2015".... sorry for the omission. Computer gremlins are busy today.