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My dad has sent to VA rehab for a wound that is still several centimeters deep and they want to send him to a skilled nursing facility now saying he doesn't need the level of care they offer in their rehab facility and they have a waiting list. Has anyone experienced this and had any luck with appeals? in my mind if he needs to go to a skilled nursing facility he still needs the nursing care and just because he doesn't need the level of care they CAN provide he shouldn't have to leave until he can go home. Any advice would be appreciated.

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My daughter, RN, has worked rehab/LTC forv20 years. Rehab is limited to what they can do. So, they now feel that Dad is beyond what they are capable of.

Wonldcare can be a outpatient thing. My daughter now runs a Woundcare unit separate from the hospital. Maybe u can take Dad to one similar.

I think the medical field lays too much care on family. This is a Medicare thing. When I worked as a secretary for our local Visiting Nurse Assoc., some of our patients were people expected to care for their own wounds. Some were elderly and not able to do this and no family. My nurses went in and did it. We had a client who came in everyday to have a dressing changed in the middle of his back. He had no wife. Medicare felt he could care for this wound.

My VNA was nonprofit, subsidized by the Township. We did the homecare Medicare would not cover.
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If his wound is still several centimeters deep, it may take weeks if not months to heal depending on where the wound is. He will get better care at the appropriate level of care.
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Deandrews, the VA like any medical facility has to "stage" care of its patients and move them along to higher or lower levels of care as their situation changes.   

I would take this as a recognition that the facility he's in now is not able or isn't needed to address his wounds, and that he can move along the healing path through a different placement.
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My BIL was recently in a SNF for five IVs a day. Somehow they also worked in PT so his was probably covered by rehab.
Home Health did my aunts wound care at home. They came two or three times a week.
My husband had a procedure on his rear and the surgeon very carefully explained to me how his wound would need debriding, repacking etc three times a day. I said who will do this. The dr says, you will. 😳
and I did. For several weeks.
For those of us who aren’t in the hospital setting often, it sometimes comes as a surprise as to what is appropriate for the hospital vs home vs rehab.
My cousin gave her husband IVs at home.
If your dad has to pay out of pocket for SNF and it’s only for wound care, perhaps you could make arrangements for him to receive that care at home? Talk to his doctor.
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Homecare and wound care nurses will probably teach his family how to perform wound care to do at home.

AlvaDeer is correct - his wound does not sound like it needs complex wound care & he will be discharged.

I was a homecare RN & it was expected I teach the CG’s how to do the WC & have them demonstrate it to me until they were comfortable doing it. Most wounds of that size don’t require a complicated dressing change.

Remember that nutrition is very important with wound healing and the person needs to eat plenty of protein to build new tissue & prevent muscle wasting. I would offer him a nutritional supplement like Ensure or Glucerna for diabetics. And frequent repositioning to prevent further bedsores.
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They are correct. He doesn't need hospital level of care for wound healing. Wound healing is a specialty at this point. And the instructions for his wound care will be overseen by a wound team in all likelihood, in rehab. Wound care is something that can easily be learned by techs; it is a special science. Most good rehab placesnow have wound teams specialized in this care. Often patients are actually discharged home with visits by wound care team members. Staying in the hospital today for any length of time is indeed very rare. Most things are sent down to skilled nursing care within 5 days if such things as intravenous IV administation of medications are not needed, and often even IV antibiotics are given by visiting nurses.
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