Can rehab send a patient home too soon?

The rehab people are the experts. It may be your opinion that they are discharging too soon and you should discuss with them in discharge planning conference their reasons for discharge. Usually it is a matter of the person being unable or unwilling to participate, or able to but cannot make further practice. Healing injuries take time, and there is little rehab can do about them.

I am assuming your Mom will be returning to your home? Or is she being discharged to a facility. Her frailness is unlikely to be helped in rehab, and she may never regain strength. Strength is a factor measure in over all health, age, debility, balance, and a dozen other factors.

I am sorry you feel your mom is being discharged too early, but once rehab decides on the advice of their OT and PT people that further progress is unlikely they cannot get coverage for further time in facility.

I would request conference if you are POA so that you can fully understand their reasoning regarding discharge. I surely wish you AND your mom healing and the very best going forward.

If you take her home, as you may be considering, you will be (choose one word: stuck, providing everything, need paid help, miserable). Okay, maybe choose two words.

This is one of those tragic situations that doesn't have a happy ending. Please avail yourself of all the advice you can get from rehab about finding a living situation where she will have all the help she needs 24/7. That seems like long-term care to me.

I hope you don't have wishes to bring her to her home or yours and provide all the care she needs. It is unlikely to be possible for mere humans to do that.

According to Laurie's profile, her in-laws live in Florida, and she lives in NJ.

What does your H think, since this is his mother?

The problem is that family thinks that Rehab will get their LO back to where they were before hospitalization and with the elderly that most of the time doesn't happen. The physical therapist reports to Medicare. Medicare determines whether therapy continues. If the person has hit a plateau or is not making progress, Medicare will have them discharged.

If you feel that you cannot care for the LO, this is the time to place them into an AL or LTC.

In my opinion, yes - they can discharge too soon in certain cases. BUT, that's typically because their hands are tied. AND - that is generally because the patient is not cooperating. Medicare only covers so many days of rehab in a year. And compliance - and baseline when they enter rehab are both huge factors for any progress during their rehab.

If a patient comes in and they are anxious to get home and ready to do the work - and prepared to be compliant with the requests of the PT and OT - if they have any capacity to improve - they will make a lot of improvement.

If a patient comes in and they tell the PT and OT every single day how much they hurt and that they can't possibly do what they are asking - then PT and OT won't ask. They can't risk hurting the patient. My FIL used to say "I'm doing everything they ask me to do." Well yeah...but they stopped asking you to do more than point your toes and wiggle your fingers because every time they walked in the door you immediately began telling them how much pain you were in and how you didn't think you could do much that day - so they began taking you at your word and scaled back their plan until it was down to nothing - so sure - you did everything they asked - because they didn't ask you to do much of anything! Often the patient doesn't even really get that they sabotaged themselves. With my FIL, I don't think they ever directly told him that he was being relegated to "skilled nursing care" until discharge. He just enjoyed not having to work so hard and getting to sit around and watch tv without anyone bothering him.

It wasn't until we got him home and read his discharge papers that we would understand that he had basically "failed out" of rehab for lack of trying.

And then there are the patients that come in at a baseline that can't be improved upon. Those that really are already at the best that they can be - and extra PT and OT may not really make any progress. That's where we were this last time with my FIL. Rehab could not get him anywhere further than where he was.

So it really depends on where your MIL was before she fell, and how much damage the fall really did - physically and mentally. She could be scared to try. She could be scared to be home alone. She could have been needing more care at home for a while now and this is just the catalyst.

But rehab typically knows if a person is going to make progress or not pretty quickly.

HI Laurie - from the experience I had when my father was in rehab after fracturing his ribs, it's common for the rehab to try to discharge the patient too early - it's usually based on the amount of time that Medicare will provide.

In my father's situation, I think he was in rehab for about 4 weeks - I can't recall the exact amount of time, but when the case worker called to let me know that he was being released, I pushed back hard - and also spoke directly with the Administrator. You have to really be forceful to state your case of why she is not ready to return home - and the liability to the rehab in releasing her too soon. In his case, they kept him there for an additional week, or so, but it still wasn't long enough - but at least it was something.

You can contact the facility administrator and case manager and be as assertive as possible - also check with Medicare the length of time that is allotted for rehab. Wishing you all the best in this ~

If the patient wants to go home and they are capable of communicating this to their care workers, they will be allowed to go home and accept the risks of their decisions.

My mother has done this many times, I disagree and lose every time. She detests hospitals and all facilities and does everything she can to get out. She also expects the rest of us to take care of her, which is not possible, we cannot pick her up or carry her, and we are working and cannot be here all the time. Now I should not say all is bad, our health systems do their best to give her good support at home, but she has a lot more risks in living at home than she would in a facility which is my concern, but not hers. As well aging at home is less costly for everyone.

She does tell me why, when she is in there she cannot sleep, they are constantly testing her, interrupting her, she cannot smoke...and various other reasons for wanting to leave. I do not think you can fight this, you have to accept it. You can ask for services for aging at home from the health system, they are available just hard to find. And you can have a conversation with your mother and tell her that the services she needs to be safe at home are her decision, she cannot expect her husband to care for her, although I do not think she will listen, my mother does not.

Good luck.. sensitive topic for me. My mother has checked herself out many times.

My husband was released too early and with barely enough notice to line up proper care for him. Was extremely disappointed. Rehab wouldn’t give him even a day or two for me to do what I needed. Lesson for me…always have the next step completely lined up and ready to go.

Length if rehab stays are typically determined by insurance. There are all kinds of markers that need to be met for a patient to continue to qualify for rehab and the PT’s need to fill out reviews every so many days to meet them. It doesn’t just include a malady it also requires that progress is being made. I imagine if one wanted to self pay you could stay past that date but you would loose coverage for that issue at that point I believe. However just like the hospital they have to make a safe discharge and should be giving you options for that unless they have assessed that she is safe to go home on her own without any help. For us when my mom was in rehab after her stroke everyone agreed it was too early to stop her intensive speech therapy but insurance didn’t count that need on its own as a reason to stay. We were also told she could not be on her own and needed someone there with her so she needs 24 hr care, skilled speech therapy but she can’t stay here… She would have coverage for a step down rehab (nursing home) or home speech therapy 2 times a week which her ST said would not be skilled or substantial enough and visiting nurse 2 times a week. We elected the third option which released her into our care and enabled her to get out patient ST 3 or 4 times a week, those sessions are limited to x many a year rather than amount per week so she could go less often as she was ready. I’m off point, the point is insurance was dictating all of the care, the rehab had even kind of found a reason for her to continue PT in order to keep her a little longer since what she really needed was the speech therapy to continue on a daily basis before the window for rapid recovery of her speech and processing.

I would talk to them, ask for a family meeting or talk to your MIL’s therapists about why she is being discharged and what she needs set up or what her options are. They are giving you time to get things set up and make decisions by telling you 10 days ahead. Typically they aren’t the bad guys in this scenario it’s burocracy and rules that aren’t made for individual cases that are the culprit, the rehab staff are the ones that have to ride that line between actual people/patient's and the rules.

I would appeal the insurance decision to send her home. Sometimes this works. They seem to send people home too soon all the time. Insurance companies*&%$#!

Rehab will discharge her as soon as actual rehab services are not contributing to her recovery. They will not keep a patient just b/c the patient needs continued care and assistance. Rebuilding strength will involve Physical Therapy over a longer time. In-home PT may be prescribed for a few weeks following a hospital/rehab stay and then is to be continued at an out patient facility. The family or hired care givers are responsible for continued personal care, ttansportation, and other needs. It sounds like her husband my not be able to do all she will need and outside help will have to be hired.

As a retired PT that worked at several different rehab. units, long term care facilities, and home care agencies this is due to insurance rather than the opinion of the therapists. When I first started working in the 80's the average length of stay in rehab. was 6+ weeks!
In-pt rehab. is extremely limited and once they transition to home care that is extremely limited too. The therapists are under constant pressure to discharge. Often I was asked to set their discharge date after seeing them one time.
Overwhelmed, clueless families aren't told to start discharge plans from rehab. before they even arrive. Insurance rules, I can't tell you how many times I heard "but we have good insurance".

Simple answer: YES.

I have seen this happen with Medicare Advantage plans in particular (as opposed to traditional Medicare). I'm sure it happens with private plans too.

These decisions are profit driven, like much in health "care." A close friend of mine was discharged from a Seattle hospital without proper care in place. That very night she fell and fractured her pelvis. She died about 4.5 weeks later.

Based on a friend who had a similar situation with a family member: it’s my understanding that a rehab center cannot release a person to an “unsafe environment.” If you believe she will fall, trip or not manage basics like dressing, showering and meals, you can push back with “unsafe environment” and see what the rehab center says. But if you think she needs to stay when the issue is fragility and not injury, the unsafe environment argument might not work. Good luck.

Appeal the discharge (I think with Medicare or Medicaid?) BEFORE she is discharged. It’s routine.

Yes, they can send someone home too soon. It has a lot to do with Medicare coverage and requirements for them to move patients out as soon as possible. We had to move my mother into assisted living when she left rehab, and she stayed there for 6 weeks before she was able to live independently again.

Yes. From my own experience, Medicare wanted my mom to come home before she completed rehab because she "wasn't making enough progress".

I appealed her discharge through Livanta and won. I suggest you call them and appeal - the worst they can do is say no.

https://www.livantaqio.com/en

Yes. My dad could not walk from the wheelchair to the car when he was discharged. It was a s**t show getting him home. They told me he had made progress but I don’t know what that progress was.

I've been there. I had to file two separate appeals which were both upheld. Until my home was ready to receive my LO, i was not ready to bring her home. Once the home was equipped with everything she needed, I said ok, send her home. I learned how to do peg tube feeding, bed pan use, changing bed linens like they did it at the rehab and hospital, cleaning her better than they did at rehab and sooner, so that she didn't get bed sores. She went from not walking to wheelchair to walker, and sometimes I catch her getting up without the walker. You will be amazed at what you can do when you have to. The system sometimes is not on your side. I would have loved to see more progress at the rehab facility, but she responded better at home with me waiting on her, than she would have at the rehab. I learned a lot about being a caregiver by doing it. I got all the in home services that the insurance had to offer. The rest was up to me and God. The rehab had the fancy rooms full of equipment, but it didn't have the love .

Laurie24: Imho, the rehabilitation facility may seemingly discharge too soon. However, the patient must be able to show progress.

I'm probably too late but you can appeal their decision!

If your Mother-in-Law is being discharged due to a Medicare or a Medicare Supplemental insurance decision, you can appeal. Her social worker at the center should be able to provide the number to call. In my case, the number was on the notice of pending discharge. I appealed my discharge date and was denied. I requested a second review (again by phone) and about 5 days later I received notice my stay was extended by 30 days. Unfortunately, I was already home.

Make sure your social worker at the Rehab Center sets up home health care. My care included in-home doctor visits, occupational and physical therapy, and personal care by a CNA three times a week. Good luck!

Rehab is constrained by the number of days allotted by the insurance company. Ask for an evaluation by PT, OT, Speech Therapy (if eating is a problem), and her doctor. Make sure they all make recommendations for the amount of follow-on care she needs after her rehab days are completed. She may qualify/need assisted living or skilled nursing care.

tell the hospital you are unable to get 24 hr care and they will send her to a nursing home until things get better or possibly not get better. at least its better to let hospital place her instead of you as it will be impossible for a nursing home to take her from her home as opposed to be placed from a hospital. its a different world in nursing homes since covid as far as staffing is concerned, they dont tell you that in the hospital.

If she is not complying with the PT regimen, or not making progress, they will end the PT and discharge her accordingly.

Also, for what reason was she in the hospital for 2 weeks for a dislocated shoulder?? This doesn't sound correct (my husband has dislocated his several times and it is a trip to the ER where they pop it back into place and then you go home). Worst case is that they have trouble getting it back in easily so she'd need to be sedated or put under first. But still, she should have gone home the same day. I would question the doctor and hospital about this admission.

Tell the discharge admins that she is an "unsafe" discharge and don't go get her. Talk to a hospital social worker about transitioning her directly to a facility (LTC?).

Laurie, any update?

Diagnosis of Progressive Supranuclear Palsy could be deciding factor.It is similar to Parkinson’s but progressing much faster and if she is frail there could be little motivation to participate in PT.