Long story short, my Dad had open heart surgery about two weeks ago. He was set up to go to an inpatient rehabilitation facility but the days leading up to him being discharged and then transferred he had a lot of depression and anxiety and he refused to go and participate and be compliant with the PT, OT, and refused to take any meds or eat because he wanted to come home and had no other choice but go take him home even though my Mom and I insisted that he was unsafe to come home and physically incapable of taking care of him. After a day and half of coming home, he was pretty sick (vomiting and incontinent) and my mom was completely worn out after not being able to sleep because she needed to care for my Dad and he has eventually gone back to the ER. The plan now is to hopefully get him back into another inpatient rehabilitation facility assuming the last one won’t accept in again OR a SNF because my Mom is completely incapable of providing the care he needs. I also spoke with my Dad and he has agreed that he will be cooperative in taking meds and eat and do what he needed to do to get stronger, if and when he goes. It’s been a very stressful last few weeks and we need help. I plan on speaking with another case manager to hopefully see how quickly he can get into a facility, whichever will accept him. But I’m so worried that because he’s already got so many red flags noted by the hospital, we won’t be able to get him into one. If anyone has any insight or advice, I’d be so grateful.
From what I read, Dad needs more than Rehab can do for him. Maybe Skilled Nursing. But that will be private pay or Medicaid if he fitscthe criteria.
Typically, a referral from a doctor is required.
If you don’t have HCPOA and Fin’l POA, Advanced Directives, etc in place, this is a good time to get both your parents’ wishes documented. You can always revisit the docs annually to ensure the written plans continue to reflect your parents’ wishes.
You can either hire the consultant for rehab/LTC placement first and get a referral to an elder care attorney or vice versa.
The hospital should not discharge to home unless he is capable of largely independent care with minor assistance from your mother. YES, talk to case manager at hospital.
Three days in hospital for Medicare to pay for rehab. He will have a combined limited number of days (100ish, consultant will know specifics) — AND your father will need to show consistent application and progress toward PT and OT goals — in rehab before you need to go to private pay in rehab if he needs more time.
Hope this is helpful.
I spent a lot of time with her and noticed that the facility, along with the aides, did not meet the standards one would expect from a rehab center. It was very sad to see other patients being dropped off with no family checking in on them.
I agree with the person who said don’t say he was “kicked out” or that he has “mental health” issues. What he is experiencing is perfectly normal the fear and depression are a sign that he is realizing that he is not immortal.
LTACH Long Term Acute Care Hospital. It would not provide for rehab services but could get him more time to get stabilized on medications, get his post surgery check ups and time to get used to the whole rhythm of how care facilities work while monitoring his post surgery status. LTACH tend to be either their own closed unit within an hospital or in a separate free standing building attached to the hospital by a bridge. You cannot enter an LTACH directly, it’s all by referral. Even if it was 2 weeks in an LTACH it might could be a good way to deal with his health and his fears. LTACH is by referral only so the hospitalist would be the one to convo with the other docs on his care team to see if this approach would be helpful and do the request to Medicare for approval. It’s a continuation of his post hospitalization so covered by health insurance. It’s time limited but gets renewed somewhat routinely.
Should he go instead into a SNF, if he goes in for rehab it’s a post hospitalization benefit paid by Medicare but only if he is progressing in his care plan. If he goes all out-of-compliance in attitude as he did the last time, the SNF will have to move him from rehab patient paid by Medicare & health insurance to instead consider him a custodial care resident. Custodial is private pay, maybe LTC insurance if your folks already have a policy or he files for LTC Medicaid. If it’s LTC Medicaid, imho mom needs to find a CELA level of elder law attorney to deal with this as she as the community spouse does NOT have to impoverish herself - only Dad does - but it’s complicated path for couples to deal with as their assets have to get segregated properly so he becomes impoverished and she is able to retain all that she can and get a resource allowance as well (if they are average assets & income). Realistically it is NOT a DIY if it’s couples with 1 in a NH and 1 exhausted overwhelmed living at the home spouse.
also personally I’d dial back any mention of mental health issues. ((Unless he has in depth mental health and behavioral stuff existing big time in his old health records, otherwise I’d just gloss over on this.)) If he has behavioral health concerns plus with medication management issues in his chart, most SNF will not take this type of resident. Finding a long term care psych hospital that can deal with post heart surgery patient will be hard to find in most areas of the US. To me, you don’t want to go there unless that’s really really really what he needs to be in.