So my father has been in a SNF at a nursing home for what we hope will be short term rehab since September 22. So he's still under the Day 1-20 of the Medicare pays for it thing. I went to a 'care meeting' with my mother today and... I am more confused and upset and anxious and scared than I was two days ago when he seemed out of it. Has anybody been through this sort of thing?
I don't really know the point of the meeting. A Social Services coordinator was there, someone from Dietary, a Nursing Coordinator, an Activities Director, and (briefly) his primary physical therapist. The therapist said he's walking 60-80 feet and more or less getting used to a walker (he has issues with contracture on his left hand and needs help gripping it, I guess). The therapist says some days are better than others and that there are still problems with stability and turning and shuffling and walking... all of which led the the fall that landed him there (on top of a host of other problems). Anyway, this seems sort of like progress.
Anyway, the Nursing Coordinator said when the 20 days ends and that his supplemental insurance will cover the rest for days 21-100 but... it'll be up to physical therapy when he's strong and stable enough to come home.
But... they talked around him, saying "if he can" when the sign-in sheet was passed around, talked about "do you hold his hand when he's walking around?" and when my mother said she wanted him to be able to be independent enough to get up and around the house on his own (neither she nor I is big enough to trained enough to do physical lifting and care safely... as we were doing before he got hurt) and somebody said "you can get a lift chair" as if that was the only chair he'd ever have to sit in.
Shouldn't that be when they start saying "maybe consider long term care"?
So... I walked away kind of terrified they're about to say "he's fine, you have 48 hours to take him home."
Is that bad of me?
How long do people usual spend in short term rehab at SNFs?
Do other ones have the 48 hour notice rule?
My mother and I (I live with my parents) have a lot of fears about how life was before and how it could be again (he won't do exercise or move around much at home)... which of these people who were at the meeting (and seemed very scripted) do we tell about these fears?
Should we have a meeting without my father there so we can feel more free to say them?
How do I talk to my father, even to my mother about them?
How can anyone at a nursing home having a meeting about this sort of thing, asking if someone will be there 'most of the time' to help him and if we've walked him around my the hand, even suggest that's a good way for anyone... him or us... to live?
Am I overreacting? Panicking for no reason?
Am I awful for asking these questions?
I adore you for having read this far in my panicked post and appreciate all words of advice, experience... that you might have.
What you described sounds like a normal care meeting to me. It’s simply a status meeting with the whole team and they always include the resident (unless they refuse).
if you’re not comfortable speaking candidly in front of your father, contact the Social Worker privately to make sure s/he understands the situation at home. Be clear that you and your mother cannot provide hands-on care for your father at home unless he is able to transfer independently. This is no time to let any feelings of guilt or obligation get in the way of an honest assessment of your and your mother’s abilities.
The SNF will not release your dad if he can’t be physically independent and there’s no one to transfer him. However, if the two of you just nod your heads as they discuss care plans that include your physical assistance, they will plan to discharge home. You have to speak up.
Also, if you haven’t already, start planning financially for long term care. Talk to the SNF’s business office. If Medicaid will be in the picture, you need to get your ducks in a row. It’s a good idea to meet with an elder law attorney.
I really feel for the situation you and your parents are in. It sounds like you are not panicked about financial issues involved in your father's care but about how you and your mother will manage to care for him if they release him before he's fully mobile.
Unfortunately, I think you're right to be worried. I believe these meetings are called to make sure the patient will have the support they need when they go home. Generally they want to release the person as soon as possible. I honestly don't know if the fact that your father has supplemental insurance will play into how long they will keep him. The one time my mother was in rehab, they required her to pay the patient's share for days 21-42 up front (estimating her rehab would be 6 weeks) and released her when that time was up.
I believe when you're in for rehab, they have to release you when you're not continuing to improve (AlvaDeer, please correct me if I'm wrong). So that will figure into when they decide to release him. He may still need a lot of help. He may always need a lot of help from this point on. If he doesn't want to exercise or move around at home, it's likely he won't want to do it at the rehab, either, and that may put a cap on how much progress he's actually able to make.
No, they don't think this is a good way for anyone to live. Unfortunately, they don't concern themselves with that. They want to make sure the patient has support at home, even if that means someone helping him walk, get up from a chair, bathe, eat, and everything else. If you don't think your mother and you can provide the assistance he needs, now is the time to apply for a permanent nursing home spot.
A private meeting without your father there might be a good idea. In your place, I'd want to know how much independence they think he will ultimately attain. Unfortunately, they probably won't be able to tell you that, because a lot depends on him and his motivation. There's only so long that a rehab can and will keep him, though. And given his lack of self-motivation and the fact that he landed there to begin with, he probably will never be better than he was when he went in. If I were you, I would assume that and start making plans accordingly.
My mother and I do have things we want to be more of less sure of... like him being able to get up from a chair on his own... when/if he comes home. We didn't get a chance to ask today, not even just because he was there but because it was so rushed.
We probably do need to start making plans. Just don't know how to start... or even if it is time to start... I just hate the idea of waiting for another injury at home.
I can't begin to tell you how awful this could turn out if the person is only jumping on the elder law meal ticket. It happens, they don't have to have any special training or schooling to say "elder law" please get a certified elder law attorney. It will be cheaper than paying for the education of an attorney that wants to handle elder law. (I know that lots of people believe that you will be paying more for a certified specialist, not so, they do this everyday and they don't need to do research to represent you, which you pay any attorney for their time scouring law books to find precedence and laws. It is cheaper to use someone that does this everyday.)
I learned the hard way to not trust professional to professional referrals. Please do your own due diligence.
I know it seems like a lot, but a bad elder law attorney can create irrevocable damage.
I definitely do not think you are a terrible person for asking the questions you're asking......you are smart and sensible. Because caring for a person at home who suffers from mobility issues will only land him back in this situation again and again, and may even land YOU and mom in the hospital, realistically! Your dad may ultimately need long term care in a nursing home, but you won't know that until his stint in rehab is finished. Also, check out his insurance to see what the benefits are for days 21 -100 in rehab, and how much they will pay and what his co pay will be, etc.
I have to tell you, the scariest time in my LIFE is when my dad was put into rehab back in 2014 after he'd broken a hip. He and my mother were living in an independent living apartment and his mobility was worsening on a daily basis. Yet he refused (of course) to use a walker. He fell and broke his hip, had surgery, and went into rehab but was NOT making progress, according the Medicare guidelines. So, every day, they'd threaten to 'release' him from rehab and admit him into the Long Term Care section of their facility as a resident. Well, what about MY MOTHER? She couldn't very well go live with him there! I felt like I was having a nervous breakdown (as the only child) at that point. To make a long story short, I found an Assisted Living Facility *ALF* that would take both of them and that's what I did: I moved them from IL into the ALF together. My dad passed in 2015 but mother is still alive and now in Memory Care. Sigh.
It's a long, hard road with these folks, I know. And I feel for you and the panic you are feeling right now.
All the best
He does have other medical issues (some that are even still maybes until they can be tested for after this fracture heals) that could mean it's going to get worse.
His supplemental insurance does cover 100% of what Medicare doesn't for days 21-100, so there's that. And he may not exercise at home, but he works in rehab for some reason so maybe he'll get more time.
They just threatened to 'release' your dad to long-term care? Like told him "work or else?" but never carried through on it?
Thanks so much.
I would do this like tonight and starting tomorrow make appointments to get this sorted out. It takes a bit of time.
I am sorry that your dad is so ill, I hope that he improves and is able to come home, but if not it is good to be prepared.
I think that what you are saying here is that you fear he will return not well enough for your Mom and you to care for him.
I think you are right in this fear. That will likely be the case.
You need NOW to go to social services and saying that he will not be coming home if your Mom cannot care for him at home. He must be independent in many things for him to return home. That it is your feeling he may NOT be. And it is not a question of lifts and hoyers and this and that, you will NOT be caring for him at home with equipment if his needs are too great for your Mom. So that you will need placement if he does not make excellent progress.
So that will then be on them. Make no mistake, they don't want to do the work. They want you to take him home along with their platitudes of "we can get you help" (they can't) and "We can make this work" (they can't and won't).
So start now. A visit with you and your Mom (AFTER you and your Mom talk this out together) WITH A LIST of the things Dad must be able to do to return home to your care. If he cannot do them he will need placement. PERIOD and no argument.
This puts them on notice. They will coordinate more carefully with PT. And you yourself will know how much progress he is making.
Make contact with the doctor. Give him a letter to his hands or on the chart. Dear Dr. Manderly. I need to tell you that I feel that my father may not be able to return home to the care of my mother. In order for him to return to our home he must be able to do the following: (make the list). If he cannot do these things my Dad will need to be placed. Call me with any questions. your name.
If, 10 days in, Dad is not making progress you will know this. That is the time to recontact the social worker. She or he is your touchstone; you are VERY unlikely to see another care conference. They don't have them often. When my bro was in I assumed weekly. We had one in the 28 days he was in. They do it by law. You won't see it again. So you have to be there and on them every second. You must be strong. No argument. Stick with "It seems very unlikely he can return home."
My brother's 28 days was paid by his medicare and his supplemental completely. They "bought him more time" when PT was done by claiming need for wound care. Doctor didn't want him leaving before a one month repeat MRI.
Keep on them.
But more than that, you and your Mom must level now with one another about what you can do for him at home and whether he needs placement. Then must let him know. Whatever way is best. The therapeutic lie of "you need more therapy and time before we can take you home" OR the truth "We can't do the care at home any more and couldn't be more sorry. Expect rage, tears, depression. Who would NOT have those things in these circumstances.
Good luck. A day at a time. Do not let them bully you into care you KNOW you two cannot accomplish.
Hope you will update us.
i have been reading through your thread seeing if there was anything I might add that would be of any help.
When you see the therapist ask what they have as dad’s goals and where he is on those.
Depending on the condition of the patient, sometimes just sitting up in his chair can be considered therapy. I think your idea of having a list to discuss with the therapist is a good one.
You mentioned a financial advisor and Medicaid. It’s important that your mother, as the community spouse, is protected. Each state has slightly different rules for Medicaid but it is important that the person who helps you with Medicaid is well versed in your states laws. It’s often recommended that you see a certified elder attorney with experience in Medicaid.
Be very careful of how you sign any paperwork. It’s best if you don’t.
Are you the DPOA for your parents? That’s another thing to check on with the attorney.
Let us know how your dad is doing.
Your parents are fortunate to have you.
The financial advisor is helping my mother get in touch with an attorney that he's coordinated with for years.
I know what POA is but I don't know what DPOA is, or at least I can't think of it right now. Anyway, no, I'm not. And my mother isn't POA for my father, because he's been unwilling to take that step, despite telling everyone in medical situations "my wife can sign for me." The financial advisor they have has also talked to my mother about how to talk to my father about signing one.
But you need to give us more information. How old are you, your mother and your father? Are there any other relatives closely involved in this? How is your father’s mental health – if they ‘talked around him’, were they assuming that he wasn’t mentally competent? Same questions about your mother – are you dealing with dementia in either parent, or simply with father’s difficulty in walking?
There is lots of experience here, and you can also just vent if that’s what you want to do, but more information will give you more help. Best wishes, and keep calm while you learn more.
So... maybe we're being naive in thinking he can come home? A different hospitalist said he could but...
The point being, though, that in the absence of any confirmation that your father cannot make decisions, the person who decides whether he is discharged home or to a short term or longer term facility is him. So the person you and your mother need to be honest with when it comes to discussing the care plan, and how it's to be delivered without risk or harm to anyone, is... him again.
The ?NPH and the short-term memory issues and the repeat testing etc - with everything that's been going on (his back injury, possible pain relief in there somewhere too?) I think it's probably best to take deep breaths and wait. Don't forget that the fracture will have caused a heck of a mess in relevant areas, and that common types of pain relief can also affect mood and brain function, so that trying to assess him at the moment must be a bit like trying to find out if there's a nail in a burst water main.
Going from Day 1 to now, would you say he's made continuous progress in rehab, more or less, allowing for off days?
Does he want to return home is your key question. If so, your next questions will be:
When?
With what support?
With what equipment?
With what plan going forward?
You and your mother, with your father on board too once you've explained it to him, must insist that the home is assessed and your father's needs are assessed before anyone will sign any discharge paper.
You and your mother and your father are all at risk if your father depends on manual handling and the family has neither the training nor the equipment nor the support to do it. It sounds as though you have all been "managing" somehow, and you're right - that's how the fall happened.
Maybe you are panicking, a bit. Who wouldn't?! That's okay. But things do not have to be how they were before, and the best way to make sure of that is to be honest to the point of blunt about the practicalities. All kinds of difficulties can be overcome; people with all kinds of disabilities not only live at home, but cope *alone* at home. If your father wants to go home that's fine, but it won't happen and it won't go well unless everyone faces up to the realities of his needs.
Every time he's had a medical issue (heart attack, bladder tumors, stamina and mobility issues, his hand) we've said "why didn't you say?" and he's said "I didn't want to admit to getting old" so he's not really one for facing reality.
Even the day he fell, he'd been unstable that day and we asked him to let us know when he was getting up. He "wanted to prove that he was still capable" and got up on his own, while we weren't in the room, and fell.
A speech therapist asked him a couple days after he was admitted to the SNF if he thought he could get up and go to the bathroom on his own. He said yes. She said no, and that they'd be watching for 'impulsivity' but... he behaves there. I'm worried he wouldn't do that here, because he hasn't always when we've worried and asked. He's resented us for it.