Follow
Share

My grandma (age 80) fell about 2 months ago & broke her hip. She had surgery to replace the ball joint (not the whole hip). She was in the hospital for a couple of days & was then moved to a rehab center for the past several weeks. Her doctor, both her normal doctor & the doctor who performed the surgery saw her mid week last week & both said she was doing really well - better than they thought she would at this point. So they told her she could go home sometime this week. Well now the Occupational Therapist is saying she won't let my grandma leave until she has a home visit completed & the OT wants to watch her dress the next few mornings. The OT said she wouldn't let her leave until end of next week at the earliest & if she had her way she'd be there for 3 more weeks yet. She lives in a well known senior apartment here in town. They have all the amenities that the OT is saying she needs to have - railings in the hallways, walk in shower, elevators, etc. The watching her get dressed in the mornings bothers me - seems a little creepy. She's been dressing herself for a good week, week & a half without help. Why does it matter how she got there? My grandma has no other health issues & wants to go home. Can they legally keep her there if the doctor gave the OK for her to go home?

This question has been closed for answers. Ask a New Question.

22 Answers

Most
Helpful Newest
First Oldest
First
Have you spoken with the OT? They very seldom work all alone. They have regular, if not daily meetings with each other to discuss patient progress.. There is a system of checks and balances and the therapists have to answer to someone for their decisions. When my husband was in rehab last year, everyone knew what his plan of therapy was so they could help him, from the aides to the dietician to the charge nurse.

At some point, Grandma’s Medicare will run out and she will HAVE to be discharged or she will be self-pay. When my husband came home, he did not have a visit by the Visiting Nurse until he’d been home for about a week. A few days after that, the therapists came and approved the house as safe for him.

Rather than guess and wonder why the OT says Grandma needs more time in Rehab, call an emergency Care Conference with the therapists, social worker and the nurse if she has time. They are the only ones who can honestly answer your questions.
Helpful Answer (9)
Report
Thank you! Yes, her medicare runs out after today it's out of pocket pay. So she's stressed about that.
Helpful Answer (2)
Report
OT is for upper body is it not?
I do believe that Drs have final say, get the administration involved asap, tell them there is no money for self pay, you'll have to run to keep up with discharge.
Helpful Answer (4)
Report
They Can't force her to stay. Tell them there is no money. Call the doctor and tell him what is going on. They are trying to milk her.
Helpful Answer (8)
Report
PT is physical therapy OT is occupational therapy. This comes into effect if the person needs to relearn or learn a different way of caring for themselves.
Helpful Answer (1)
Report
Wow, this OT person is really brazen! Several issues:

1. She/he doesn't have complete authority to override others, especially the doctors. Sometimes there's a physiatrist doctor at rehab; this person usually has the last say in terms of therapy decisions.

2. I can't guess why the OT is flexing his or her muscles, apparently trying to override the doctors. Something is going on there, but I don't know what.

3. Find out who oversees the therapists and discuss the issue with him/her.

4. Your GM can dress at the rehab, using the adaptive tools she needs, although I do understand that a therapist could legitimately be concerned about someone dressing w/o any help, especially if there are fall issues.

5. Has anyone addressed the issue of follow-up home care, very typical after discharge from rehab? The social worker should have raised this issue at least a week or so ago.

You have the right, and if a doctor scripts for it (which in my experience is usually done w/o issue), GM can get about a month's worth of home therapy, which does include adapting to her specific environment. She isn't going to go home "cold turkey" w/o any further support.

SW should have some brochures to hand out for home health care agencies, but do your own vetting. Some are good; some are horrible. One thing you absolutely want is one therapist per discipline rather than whoever's available, which I've discovered is the way some large home health care agencies operate.

Whoever's available the night before and will take the assignment gets it, then either calls that night or something the next day advising when she or he will be coming over. This is the worst situation we've ever had; I fired that agency after day days, 2 different nurses (although they were both top notch), two therapists (one stunk) and a totally irresponsible, arrogant, unprofessional therapist who way overstepped her boundaries.

6. One sure way to bring this issue to a crashing halt though is to present the administrator of the rehab facility with a letter (of which you'll obviously keep a copy), which states something like this.

a. Restate the situation, that the doctors have approved discharge but the OT has created additional demands

b. OT has not stated the reason for her specific demands.

c. Medicare will not reimburse for care after today. The family has no way of paying directly. Reimbursement by Medicare is therefore unavailable, as is payment by the family.

d. Therefore, any plans to keep your GM will have to come from another source, or be provided gratis (free) by the facility. (Perhaps the OT would be willing to reimburse the facility for the charges Medicare would have paid??)

Item d should shake up the admins enough to get the OT on board.

Good luck. Let us know how this works out. We had a similar issue when a facility wanted to keep Mom longer but her orthopedic doctor said she was ready to go home. My father, sister and I stood up to them and told them we were taking Mom home, and that was it. I probably inferred some legal action, but this was 19 years ago and other than standing our ground I don't recall what else we did.
Helpful Answer (4)
Report
Who has spoken to the OT?

The things the OT is recommending are a good idea. Checking that your grandmother's (ideal-sounding) apartment still works for her now that her ways of going about her activities of daily living may have altered can't possibly hurt, and might highlight some issues that could be easily solved. Things may even end up *better* all round than they were before, it's all good.

But if she and the family really feel that everything already meets all conceivable standards, an OT's visit on top is de trop, your grandmother is competent and wants to go home, and her surgeon and primary care doctor have signed her off - then she can go home.

If it were me I'd give the OT a quick courtesy call and just check that she isn't talking about something we hadn't thought of. And while I was at it I'd check that there hasn't been some misunderstanding of the NH's discharge process.
Helpful Answer (5)
Report
The NH is charged with making a "safe dishcarge:. the OT may be the person who needs to certify this. At least in my mom's case, it was the OT who was going to go to mom's home to see that it was set up correctly so that rehab could safely dishcarge her.

Don't personalize. Be grandma's advocate, but understand that this may be part of protocol.

Do post back and let us know what happens.
Helpful Answer (6)
Report
An OT visited my mother's house prior to discharge from the nursing home and I was glad. He noticed a number of small things to adjust that improved safety. The OT also noticed a difficulty my mother had with dressing and suggested a slight adjustment that made it easier for her. The changes suggested for my mother's home cost zero to a few dollars. The NH needs to assure that the discharge is appropriate and that is a good thing. Dr, surgeon, PT, OT....each of these people has an important role to play in a patient's health care.
Helpful Answer (3)
Report
Well we called the nursing home and they wouldn't give us any answers (my mom, my grandma's daughter). My mom then went the route of saying that her insurance is running out & there's no out of pocket pay. So that kicked someone into gear in calling the insurance company - waited 24 hours to hear back from the rehab center on what insurance's answers were. Long story short... apparently my grandma's made a miraculous recovery in OTs eyes & she can now go home Saturday - when her insurance runs out.

Thank you all so much for your help! Great suggestions all around.
Helpful Answer (10)
Report
You can ALWAYS sign yourself out of a facility unless you are under arrest or a court order. Sometimes people get intimidated by the medical establishment.
Helpful Answer (3)
Report
I don't think anyone can keep you against you will if you are competent and able to manage getting out of the facility. After my mom broke her hip several years ago she was in a place I didn't really like and she and I told them that her end date would be when we decided. As soon as I was able to secure my vacation I insisted she be discharged. She was only there a week. I spend vacation and set up care at home. She was up and about and able to do most things. We also set up PT an OT in the home for a few weeks and later at a PT center to continue. However if the nursing home does not agree you may have to sign out AMA (against medical advice) which in your case isn't really AMA because he Dr. has agreed home is an option. Two years later when my mom again needed rehab the person I dealt with most to dictate her care was the social worker in the rehab center. She was the coordinator of her goals to go back home again and I made it clear that home or with me at my home was the only option when she arrived. I think you need to sit with the social worker ASAP and let her know that self pay is not an option and that you are planning on taking her out as soon as her medicare tells her she's got no more funding. But be proactive don't let them talk you into medicaid or any options. Home visits are not something they are required to do if the person has family to act on their behalf. I am in Massachusetts so other rules my apply in different states. But if she's competent and able she can say I'm going and they have to honor that.
Helpful Answer (1)
Report
It's all about insurance reimbursement! Every rehab facility knows how many days they can get out of anyone's insurance - be it Medicare, Medicaid or some other plan. When my father was in rehab after a stroke, the "plan" was to keep him there exactly 20 days - which is how much Medicare would pay, coincidentally.

However, on another matter, legally, OT cannot discharge somebody until the home environment is deemed "safe" - which is probably why they mentioned the home visit requirement. They could be held liable for discharging a patient to a known unsafe environment - and insurance might refuse to pay the bill.
Helpful Answer (0)
Report
Well - yes, but. The insurance providers base their cover on the likeliest recovery period and the law of diminishing returns, calculated by teams of highly qualified actuaries using epidemiological data. So no of course it is no coincidence that this is also what rehab facilities generally allocate, but there are clinical *as well as* financial grounds for it. That shouldn't stop any patient or family questioning whether there is any significant benefit to be gained by remaining in rehab if there doesn't seem to be.

I'm sure you're correct about the discharge issue.
Helpful Answer (1)
Report
they want to make sure she does not have problems with the apartment & the way she does things .so she dont have a fall .there is no guarantee but it will help her & the apartment has to fix the wrong or she should be moved if need be but it should be they should pass the safety issues anyway ..oh i see she is home ..bye good luck
Helpful Answer (0)
Report
There is a tendency to discharge too quickly and the OT could be trying to fight for a safe discharge. The way medicare and rehab works is that you (the patient) are required to be notified about discharge 3 days prior. If you feel that discharge is too soon, you can file an appeal. If the appeal is not in your favor, you can file another appeal. A safe discharge is so important. It can make the difference. I have experienced one parent who was not safely discharged. He managed to make it 25 days at home, suffering a fall the very first day (injury: gash on his thumb), and being treated for an infection. The 25th day at home a hospital acquired resistant infection forced him back into the hospital where he deconditioned, and a subsequent discharge resulted in a fall (injury: broken pelvis). It was a nightmare. In another instance, after only 18 days of rehab, Medicare discharged my mother from rehab. On the home visit, she could not get into her bed. That is a situation where a fall or displaced hip would be likely. She stayed in the rehab/nursing home longer where an underlying fainting conditions became evident. That early discharge would most definitely resulted more falls. Maybe your OT has seen these scenarios and is trying to protect your grandma. My advice is to fight for as much rehab as possible before your grandma is discharged. If she dislikes being in rehab, a few more days would likely assure her of not going back!
Helpful Answer (4)
Report
Good grief. Go and visit your Mother, get her dressed and walk out of that place. It doesn't matter what OT says as long as the doctors said it was okay, you don't need their permission. Patients in hospitals can walk out of there without the doctor's permission and they can't be stopped.
Helpful Answer (1)
Report
Count your blessings if health insurance is covering her stay and constant care. You and Grandma are fortunate that the OT cares enough and in her professional opinion knows that she wont get the care and attention she needs if she is to go home alone. You may need to hire (out of pocket) therapists and caregivers when she leaves the rehab. Many patients need more care but insurance won't cover because the docs who spend 2 minutes a couple of times weekly say the patient is ok to go home. Best of luck to your family.
Helpful Answer (1)
Report
See it's money. They will milk Medicare as long as they can. When Mom was in rehab the last time I told them going in they better do what they needed to because she was only going to be there the 20 days Medicare pays 100%. There was no extra money. It was going for her to be in an AL. She was out in 18 days. Now, she was only in aft a 4 day stay in the hospital. It was just for her to get her strength back. She had therapy maybe 2x a day the rest of the time they had her in a wheelchair. I swore the next time this type of situation happened I was doing homecare. Rehab is so confusing to Dementia/ALZ patients. In a care meeting the Therapist said Mom wouldn't follow directions, I said "She has Dementia". She said a couple of other things and I responded the same way. Really, how can u expect a Dementia patient to follow directions.
Helpful Answer (1)
Report
Just want to say that my post was based on Cshireman88 post saying once no money was brought up, they are discharging Mom. Medicare only fully pays for 20days. The 21-100 days are 50%. So ur supplimental has to pick up the other 50%. In my Moms case her policy had a share clause and she paid half of the 50%. So she would be responsible for $152 a day. After 100days you are on your own. And, I don't think you can walk out of a rehab facility or hospital without a doctors discharge because insurance won't cover the stay. Since our Health System is pretty much big business they are always looking at the money. Either how much they can milk or if it's costing them money, how fast they can get you out. And don't think because they r releasing you to rehab ur ready for it. Your stay is based on what is wrong with u. My Mom was a UTI. She went in on a Tues they wanted to release her on a Friday. When I went in she was breathing funny and looked like death. The nurses had discharge papers from Thur morning. The doctor hadn't seen her on Fri morning. She had done a 180. My daughter,RN, came in and checked her antibiotic and it said Not to be given to people with a sensitivity to pennicilan or allergy. Hospital records showed an allergy. My daughter brought it to the nurses attn and they changed the antibiotic and Mom was sitting up in bed all cheerful the next morning and was released. But to get that xtra day, the doctor had to tell Medicare that a lump in her neck was being looked at. Oh, and I had gone out to the desk at least 3x to say there was something wrong. And was told each time the doctor had released her to rehab...24hrs before. Finally, a nurse called the doctor about Moms change. My daughter says this is done all the time, releasing patients to rehab before they r ready. Rehabs are not equiped to take someone who is not stable. They don't have an onsite pharmacy or equipment needed in some instances. They have sent people back to the hospital and then Medicare fines the hospital for sending them out and the rehab for sending them back. A catch 22. You really need to be an advicate for a LO and know as much as possible how the system works. The health of the patient is not always a priority.
Helpful Answer (1)
Report
I've heard that you can just walk out if you want to (and can do it physically without their help) but then if it's against medical advice AMA Medicare or insurance could refuse to pay. Anyone know how that works?
Helpful Answer (0)
Report
Schedule a meeting with the Ombudsman.
Helpful Answer (0)
Report
This question has been closed for answers. Ask a New Question.

Recent Questions


Popular Questions


Related Questions

Ask a Question
Subscribe to
Our Newsletter