Important things to look for in a post-hospital rehab facility?

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Important things to look for in a post-hospital rehab facility?

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My mom has been in hospital for over a week and the hospital is recommending acute rehab due to mobility issues rather than in home care. Mom doesn't want anything to do with going to rehab, and is refusing. She lives with my sister's family who are saying they need her to work on her mobility before she comes back home.
We're looking for a safe rehab for her to go to with hopes we can convince her to agree and are running into a lot of questionable ones with low reviews on medicare.com and from former clients. What are the most important questions to ask to try to avoid getting mom into a questionable facility?

Care Decisions Hospital Discharge Mobility Rehabilitation Center

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The best thing that can be done now is an honest and difficult leveling with Mom that she cannot be cared for in the home any more if she is unable to get around better. Tell her that there is no question of her returning home in her current condition and that unless she cooperates with rehab and does HARD WORK she will be having to be placed in care. That you will mourn that with her, but that there will be no choice in it for her or for the rest of the family.

As to what is the best rehab? You will be assigned one by hospital and MD and the best thing to be done is to BE THERE and to participate with meetings regarding care, to make it clear that mom will need discharge planning help if she cannot/or will not get back on her feet. That you are BEGGING For intensive PT and OT rehab. That she simply cannot be allowed to languish and if she cannot cooperate in getting better she will require placement.

The POA is going to have to do the best daily followup on this.
You may be looking at palliative care and hospice if mom is content to take to her bed and die.

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Reply to AlvaDeer

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You are so right in your advice. That is exactly what happened with my mother. I had the added complication of this happening during COVID so I wasn’t allowed to be there to see what they were doing and to push her to try harder. So I wrote her encouraging notes that in the end didn’t make any difference. Conversely my Dad, who broke his hip in early 2020 and was also in a rehab during COVID, practically chased the staff around in his wheelchair looking for PT people to work with him. I had to demand that they show up and watched some of his sessions through his window. He regained his ability to walk - she did not. In her defense, she also had a recurrent UTI at the time that made her impossible to reason with. The NH staff nurse was totally unresponsive to my requests to evaluate and aggressively treat the UTI problem. I did my best writing notes and encouraging her through visits at her window, but she just didn’t make progress. I remember how dirty the windows were. The director of the facility didn’t care - so I brought my own Windex. My mother has been with me since her release in September 2020. She is bed ridden and I have to change her pants and use a Hoyer lift to move her to a chair. She did have an LTC policy and I have used it to hire some weekly help. Hope the OP’s mother has a better outcome. Losing mobility is a game changer.

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What state are you in? In NYS the SW will give you a brochure on all the facilities that are accepting patients into their rehab with level of care and the Medicare "grade" that they have. It isn't the most up to date but the Social Workers is a wealth of information that will steer you away from major problem rehabs. Also, ask family and friends for input. NYS allows the patient or patient representative to choose up to five. If you do not they can be placed anywhere and up to a 50 mile radius to their residence.

I was lucky that my uncle had a great Social Worker that really hustled to get him into the proper facility.

Some questions to ask:
What is the PT ratio?
What type of therapy will she need and how do you access the need and progress?
What is the staff ratio for all shifts? (this is always changing due to the extreme understaffing of facilities but they have to post in NYS)
What are the visiting hours? Stay away from facilities that have limited hours you can visit.

Wishing you well in your journey. It is very eye opening when in the thick of it.

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Reply to AMZebbC

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First have a good laugh LOL This will be needed, not so much in selecting a facility, but doing the hard work with therapy. Mom should be made aware of this.

Then, seriously, get an idea of the various facilities around the hospital and/or where you live, make a list of those that are of interest.

As AMZebbC mentioned, she'll probably get a choice of 5. Let the hospital SW know, so that she/he can reach out to them. SW will let you know which one(s) have availability and which ones don't, then go from there. Hopefully there would be availability in one mom may feel very comfortable in.

See if you can tour the facility and hang around the therapy area if possible. If that is all that is needed, you may get a good idea how the department is run with this observation. You may also be able to talk with a therapist or 2. I can't believe I'm saying this, lol, but don't necessarily go by all the reviews on a facility. One person's experience can be different then another.

It's not really that bad, and therapy can be a lot of fun. From a personal standpoint, I really enjoyed both Physical and Occupational Therapy and was sad to see it end.

Be forewarned though, it can be a real downer on the weekend when no therapy is scheduled, so prepare for that.

Good Luck!!

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Reply to cover9339

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Alwayshelp, I remembered back when both my parents needed to go to rehab after a hospital stay. Even though they lived in a large metro area with a lot of live-in rehab centers, my parents had to go to whatever one had an empty bed, there wasn't any pick or choose which one they would prefer. So, keep that in mind.

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Reply to freqflyer

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Right - and that is the problem that most of us face in this situation. It’s more a matter of what’s available at the time. If you are lucky, you get a decent one. But almost all NH/LTC facilities hold out some beds for rehab patients because the Medicare pay makes it profitable to do so. Places that score low on Medicare inspections are still eligible to receive rehab patients. They shouldn’t be.

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When my mom went to acute rehab we chose one that wasn’t also skilled nursing/nursing home rehab so there weren’t long term care patients there and it felt more like a smaller hospital to her, everyone was there for acute rehab. That said when she no longer qualified for acute rehab (her issue was speech/aphasia and that was not enough on its own at that time) but still needed therapy we had the choice of in patient in another facility where she would get ST once or twice a week or taking her home and to outpatient therapy which is what we chose. The hospital coordinator told us where they had beds, I made a couple calls and found another and we chose two to visit based on location. We selected one from there and were fortunate to have picked the perfect place for her and for us.

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Reply to Lymie61

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The actual rehab services are usually excellent and are provided by outside rehab companies. There is no gurantee that even in rehab facilities with good tratings that the hands-on care staff will be attentive or kind. I speak from having been a patient myself in a well-regarded rehab facility. Excellent rehab, good food but terrible non-service from daily staff and terrible attitude from nurses and very poor medication distribution and pain control. No matter what questions you ask, I'm not sure you can guarantee what service the patient will actually get.

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Reply to RedVanAnnie

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I found that when my mama was given a choice between home-care rehab and recommended to go to rehab she would not to the rehab at home she would do it at the rehab place - I was able to use that as a way to get her to do the rehab exercises. "Mama when the physical therapist releases you then you can come home" yes it was a trick but it always worked.

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Reply to Ohwow323

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When I was looking for a rehab facility for my aunt, I found these questions really helpful in making the best decision for her care. I thought they might also be useful for you as you search for a rehab facility for your mother.

What types of rehab services are offered? Determine if the facility provides the specific type of rehab needed, such as physical therapy, occupational therapy or speech therapy.

What is the facility’s experience with patients who have my mother’s condition? Ask about their experience and success rates with patients who have similar medical conditions.

What is the staff to patient ratio? A lower ratio often means more personalized care.

Are the staff members licensed and certified? Ensure that the therapists, nurses and other staff members are properly trained and accredited.

What is the facility’s approach to developing a care plan? Ask how they tailor rehabilitation plans to individual needs and how often they update the plan based on progress.

What are the facility’s safety measures? Inquire about protocols for preventing infections, handling emergencies and ensuring patient safety.

How often are therapy sessions provided? Find out the frequency and duration of therapy sessions and whether they align with her recovery goals.

What is the policy on family involvement in the rehabilitation process? Some facilities encourage family participation, which can be vital for recovery.

What are the accommodations like? Ask about room arrangements, meal options, and other amenities that might affect comfort during the stay.

What is the average length of stay for patients? This can give you an idea of the typical recovery timeline.

How does the facility handle pain management? Ensure there is a comprehensive plan for managing pain effectively.

Which insurance plans are accepted? Confirm that the facility is within her insurance network and understand what costs she might be responsible for.

May I visit the facility before making a decision? Touring the facility can provide valuable insight into its environment and care quality.

What are the discharge planning and follow-up care options? Understand how the facility supports patients transitioning back home or to another care setting.

Asking these questions can help you make a well informed decision and ensure a smooth recovery process.

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Reply to HaveYourBack

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Here's one that you may not think about, but is pretty important, IMO
How good is the social worker?

If you get a chance to see how she/he is in action, that may sway the decision of the facility to choose

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Reply to cover9339

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She is probably already in a rehab by now so I hope you found a good one. If not, don’t just rely on the hospital social worker - do your own research. My experience with both parents was that I learned that if you go to a NH or LTC facility, they contract with outside physical therapy companies to come in do the therapy. So you have two entities to review and consider. How good is the therapy company and how good is the general care at the facility? I found both to be lacking whether it was the five star place my Dad was at or the three star house of neglect my mother was in. The therapists sometimes did not show up or conducted very short sessions. If the patient shows any resistance they simply go on to the next patient. The facility was short staffed and the food was poor quality institutional one-size-fits-all crap. No one monitored nutrition or personal hygiene.
The best choice if you can find it, is a place that is set up exclusively for physical therapy patients with no NH or LTC component. Also, home therapy by visiting therapists can be effective if the home is safe and there is family to work with the patient in between sessions. That’s what we did with my Dad. He went from a wheelchair to walking again.

Important things to look for in a post-hospital rehab facility?

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