He was discharged from hospital on Wednesday and it is 3 am Saturday now.
He acts like a great patient with therapist or nurse who we've just met, but is a terrible patient for me and does very few of things needed for complete knee replacement therapy. My mental health is at risk.
My dad just had 21 at acute rehab and I wanted him to do more acute rehab because the first 2 weeks were worthless and he was asleep the whole time. The facility wanted to discharge him. I called another acute rehab and they said they would assess him and bring him to their facility after he had had 3 midnights at home (or at a nursing home or other place... just not the hospital)
This made little sense to me but as I dug into it, I found out its because of how Medicare reimburses. If they transfer from one acute rehab to the other they must share the reimbursement 50/50 because it's considered one "visit"...even if one facility had him for 90% of the days/time. So I guess they need him discharged and allow 3 days/nights for the paperwork to be processed and off one facilities roles at Medicare before a new one will take him. This I THINK is true for any transfer of similar level facilities. Acute to Acute or Nursing Home to Nursing home.
After the 100 days, however, nothing is covered until there is new hospitalization.
I hope that helps.
After my mom's knee replacement, she did pretty well in rehab and listened to the therapists most of the time. With me, she was a complete whiny uncooperative pain. "I'm tired" "Maybe later" "I'll do ONE exercise" and on and on. Maddening! And PT is SOOO important to get their range of motion back. I made her go after her second one which wasn't a real rehab facility but rehab in a nursing home which is not nearly as good but better than nothing.
Call some rehab facilities and see what they say.
If he doesn't to the therapy, it will be him not walking.
Call his Dr and let it be known it's not working out and husband needs to work with a Therapist or you might see if he can have in home therapy.
"Refusing care
If you refuse your daily skilled care or therapy, you may lose your Medicare SNF coverage. If your condition won't allow you to get skilled care (like if you get the flu), you may be able to continue to get Medicare coverage temporarily.
Stopping care or leaving
If you stop getting skilled care in the SNF, or leave the SNF altogether, your SNF coverage may be affected depending on how long your break in SNF care lasts.
If your break in skilled care lasts more than 30 days, you need a new 3-day hospital stay to qualify for additional SNF care. The new hospital stay doesn’t need to be for the same condition that you were treated for during your previous stay.
If your break in skilled care lasts for at least 60 days in a row, this ends your current benefit period and renews your SNF benefits. This means that the maximum coverage available would be up to 100 days of SNF benefits."
Most of that applies to a break in care, as in went to facility, but chose to leave. It would likely be best to contact Medicare to ask directly if he can still go, since it's only been a few days.
On that note, however, there are several issues to consider:
1) will he even agree to go?
2) if yes to #1, once there will he cooperate and participate?
The PT sessions are instructional, to provide various exercises and demonstrate how they are done. It is up to the patient to then "practice" these throughout the day, for the # of times recommended, between visits.
If he isn't cooperating with you between visits, who is going to stay on his butt in the facility, with a bull whip, to make sure he continues?
If you can determine he can go back to the SNF, then I would be up his behind with the usual threats:
If you DON'T do these exercises EVERY day, there is a chance the replacement can fail or never work correctly, and you WILL end up in a NH. There was no point to getting a knee replacement if you aren't willing to put in the minimal effort to ensure your knee/leg works properly and you can get around. I won't be signing up for pushing your wheelchair around, not when YOU have the ability to take steps to avoid that!!! USE IT OR LOSE IT!
If your husband is under Medicare he has 30 to 60 days from the hospital discharge date to initiate physical therapy in an approved rehab facility up to 100 days benefit with a doctor’s order. However, if he does not want to go that is another problem for both of you to figure out.
Sorry it’s been so difficult.
Many people also think 30 mins with a PT twice a week is all they need to do, when ongoing daily exercises is actually required for recovery. PTs must see this all the time!
Can you speak to the PT about this?
PT may then get a bit more tough 🤔 & explain HIS recovery can be great or not - it will depend on HIM. Hopefully they can help him to find his own motivation.
It may be hard to transfer into rehab facility now but ask the PT about this too.
Anyhow, you will know for next time! (How's his other knee? 🙃)
He had his 2nd stroke in 2015. My mom made him do rehab, said she would visit everyday if he cooperated. He recovered to 70% from bed to wheelchair to walker to cane.
He continued with one of the PTs afterwards 3 days a week. They even renovated to add an exercise room.
Then COVID hit and he stopped the PT. Then both my parents were hospitalized due to complications due COVID. My mom had to have rehab for 3 months.
My dad was released in a couple of days. He was very difficult to care for and he had a knack for when I would finally catch a bit of shuteye. Would call me, say he was hungry, then not eat. Had to spoon feed him, wouldn’t get out of bed, and give his medicines one at a time and search his bed to make sure he swallowed them, etc.
A week later, had to take him back to the hospital. Diagnosed with acute Kidney failure (20% function). Would not pick up the phone. Mom was in ICU. Had get my Aunt (his side) to call repeatedly until he answered. Returned home and we started 24/7 home health.
He was very uncooperative with the agency people. My mom had been released and was at my late Uncle’s old house. I was a gopher. Groceries, breakfast, lunch and snacks in the day, then visit my mom when the night shift arrived.
One night I was with my Mom, the agency person for my dad called the agency person for my mom and said his blood sugar was 480. Drove back to the house, blood sugar 590, called my cousin in law who works for the hospital my Mom was admitted to meet us at the drop off because he would be more comfortable with a family member.
My mom’s friend is a CNA (they used to work at the same hospital and she took care of my grandmother before she passed in 2005) and she took over the day shift for my dad when he was released.
After a month, kidney function returned. We made him use a walker because he is a fall risk from the stroke. Did very little with the home health PT in comparison to the sessions before COVID.
I took him to my doctor where he said he was in good health and did not want the home health and requested the paperwork not be filed.
Frustrated and ‘the saga continues...’
Hope you find clarity and peace!
I was wondering if Adult Protective Services could give you some idea of what can be done since Dad is definitely a risk to himself.
Would he tolerate a candid talk, be able to appreciate that declining home health may be a fast-track to getting placed in a facility? That happened to a friend's uncle. He kept firing home aides and turned out relatives who came to care for him. Then one day he went to VA hospital for a health crisis and when that was resolved - definitely against his wishes - was sent right over to their LTC ward where he stayed until his death the following year.
Here's hoping for clarity and peace for you and yours!