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My husband's many health issues have kept him in a cycle of home, hospital, rehab, hospital and back to rehab for over five months. In that time, he has lost more than 100 lbs and that includes muscle mass. It is very difficult for him to do anything major, including getting in and out of bed to a wheelchair or into the car or anything else, really.


He does as much rehab as he is capable of, but when he asks to stop, they tell him he hasn't done enough and they're going to put him down as refusing to work out, even though he hasn't.


In your experience, does it do any good to complain to management? I'm at my wit's end, because he is in NO shape to come home and I don't know what to do for him. Advice greatly appreciated.

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Can you talk to the director of rehab and explain the situation and ask for options? In fact, ask this director why is there documentation that your husband has refused to do PT when he's more than willing to comply but he's very weak. This is inaccurate documentation. Ask the director to witness a PT session from a distance to where he/she isn't visible to both your husband and the therapist to see what's really going on. You should also stand with the director. You need someone from the facility to give you a frank talk of what's going on and what's the next step if your husband isn't capable of doing PT, no matter the reason why. Insurance companies will only continue to pay for PT care as long as the patient is showing progress. The rehab facility is charging the insurance company a lot money and if PT is the only reason he's there, then it's possible they'll end up terminating coverage. I'm not trying to scare you but you need to find out from either talking to the insurance company or talking to the facility's case manager what criteria is used to determine length of time for coverage for PT or for whatever reason why he's in the rehab facility. I think it's either hospice or palliative care or both but I know that one of them for sure offers coverage of in-home physical therapy. This may be your only option for the next six months to a year if the rehab facility has to discharge him because the insurance company is on their case and will no longer pay and he's ineligible for a transfer to a different rehab facility. When insurance companies decide to no longer pay, the discharge process can be very quick, like less than 48 hours. You must talk to your husband's case manager about what's going on, what and if there are options, and get a game plan in place now. In my experience, it makes no sense to complain to management because it all comes down to why your husband is in the rehab facility and again, if it's only for PT, then he needs show progress for justification of continued insurance coverage.
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That's tough. What's his physical ailment? Are you present when he works as hard as he can and then they tell him he hasn't worked hard enough? Have you actually witnessed it or are you relying on what your husband tells you or what the therapist tell you?  Do the therapist say that he has reached maximum improvement from therapy?
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My 93 year-old dad had the same problem with rehab therapy. It's a fact that some people take longer to recuperate than others, and my dad continued with in-home therapy at my insistance. When that was over, as in Medicare didn't cover it anymore, I continued with it. It took three months but eventually he was able to stand and be moved again. Listen to your own heart in all the fuss. You know your husband better than the rehab people do.
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Well this is based on my experience. To get collective experience I suppose you'll have to get several opinions. It's my understanding that unless the patient shows steady improvement Medicare guidelines dictate the patient be discharged. I always ask what is the plan for my loved one. Sometimes they are very vague. Return them to their pre hospitalization activity level is what they might say. Then they seem to independently establish what that level was based on the patients age or diagnosis. In your husbands case with so many back to back episodes that might be hard to determine. I think it's important to share what your realistic expectations are. It might be that your husband be able to transfer, get in and out of the car and in and out of the bed. They usually have so many feet they want the patient to walk, so many leg lifts etc. They measure that from one session to the next and report it weekly in a meeting. He is either progressing or he is not. They may have a length of time required for each session. I've never heard that one but it makes sense. My mother was usually brought into the therapy area along with others. The therapist would work with each individually and as a group. Perhaps a talk with the manager is appropriate. A meeting where you can express your concern and ask how you can support the therapist efforts to help your husband regain his strength. 100 lbs in five months is a significant weight loss whether he needed to lose the weight or not. Is he considered underweight at this point? It might be he needs more time to advance his activity level. It doesn't take long to lose muscle mass but it also doesn't take long to regain it but he has to do the work. He may not be able to regain it in the time frame allowed. All therapist aren't the same. All rehabs aren't the same but the Medicare guidelines should be. If the management tells you they can't meet your expectations, ask for their advice. Make sure that he has home pt after he leaves the rehab. He must keep up the activity level at home. They will usually come for several weeks. You need to do the therapy with them so you can help your husband when the pt stops. My nephew had the surgery to lose weight. He lost 100 lbs in a short period of time. Not sure if it was as little as 5 months. He became a gym rat for a few years and got really buff. It was an amazing transformation. He had to lose the weight or die. He did the work out on his own. He's 50 so there might be an age and health difference but the steps are pretty much the same for all of us. We have to move. A little more today than yesterday to make progress. I wish your husband good health and I hope you get rest for yourself.
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Judging by the answers, I didn't phrase the question correctly ... they're not saying he isn't working hard enough, they're saying he isn't working long enough.

He lost weight because he has had several ileuses (compacted bowels), bad enough in many cases that everything backed up to the point that he was vomiting it out. He was on liquids and even NPO for long stretches of time. Finally, the last group of doctors did more than treat symptoms and they seem to have found the right combination of medicines. He's still afraid to eat too much, even though he knows he needs proteins and needs quantity to gain weight and muscle mass back. He doesn't want to get backed up again, and I kind of understand that.

But even though he can't stand right now and his shoulders are in pain constantly (they put lidocaine patches on them to alleviate the pain), the therapists expect him to do things he can't, and then he just gives up. Also, sometimes the medicines for the compaction work too well, and he spends the morning essentially having the runs and I'd guess we all know how enervating that can be.

I decided after I posted this to email the medical administrator and ask him/her to look at things to see if it can be resolved. So we're working on it. The social worker talked to my husband and he is going to try harder. Thanks for chipping in. I appreciate it.
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Thanks for giving us more info. Yes, I understood that he was being asked to work longer than he felt able to. No problem with the way you posed the question. I have just never had that complaint from the therapist. Usually they are very understanding. Even sitting in a chair or standing can be considered therapy if it takes an effort for the patient to do so. The patches were a great benefit for my mother when she was in rehab. I think you have hit on the right tactic. Communication is the key and a better understanding of what his challenges are. He's lucky to have you helping him recover.
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Talk to the physical therapist and ask what goals they (you dad and the PT) are working on. Find out if everyone is on the same page. Talk about what happens if he does not progress, talk about what happens if they discharge him. If he goes home, he can and should get home health to continue with exercise and to make sure he can safely maneuver in the home. Make sure the PT knows what the home environment is and who will be there to assist him. If you show that you are concerned and interested, this will help in discharge planning and will ensure you and your dad are included fully in those plans. It is true that PT cannot keep your Dad in rehab if he is not showing progress as this is a Medicare guideline that therapists have to follow. Good Luck.
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My husband has been in rehabs since the beginning of February, 2017. He has heart issues and his doctor felt Rehab would be safer than performing surgery on the stenosis in his spine. Last week, the therapist and I met and she told me that unfortunately, after all this time, my husband remains "max assist" which means he can do almost nothing for himself, which is right where he was at two months ago. He does work at therapy, but his blood pressure plummets when he stands and he has already passed out once.
I know we are coming to the end of his therapy with Medicare. It is not his fault or the therapists' fault. The therapy department at rehab centers have a strict guideline they must follow. Patients are tested and evaluated constantly and a therapist cannot decide on their own to throw someone out. If a patient does not meet the criteria, I.e. making visible progress, there is little the therapists can continue to do. Call a meeting with the facility to make sure you understand what their plans are for your hubby.
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Does he have a private doctor? Call him/her pronto. Tell the doctor the situation. That they are wayyyy too pushy with hubby. Hubby is not slacking. He is exhausted and miserable. They are lowering instead of improving his quality of life. Doc should have given the therapy order and he can see that it is implemented properly. The same thing happened to my mom. She's 88 and they were treating her like a person of 35. That should work. If they continue, attend a therapy session and watch. If they don't back off, tell the Administrator your husband needs different therapists. If that doesn't work, find another place. He pays THEM. He comes first.
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smithsilver is right - to a point.

there is NEVER a good reason to threaten any patient! NEVER!!

it is true, Medicare will refuse to pay if no improvement is logged. but this was very carefully explained to us - and they still didn't push my husband beyond his limits. my dh was encouraged to reach further than he had thought possible and praised all the way.

they went so far as to offer to help him after the Medicare ran out - for a nominal fee ($5), I can bring him in twice a week and they will work with him. Yes, the $5 adds up - but it's still cheaper than another hospital stay and way cheaper than a funeral.

don't ever take abuse lying down.
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