He was discharged from hospital on Wednesday and it is 3 am Saturday now.
He acts like a great patient with therapist or nurse who we've just met, but is a terrible patient for me and does very few of things needed for complete knee replacement therapy. My mental health is at risk.
"Refusing care
If you refuse your daily skilled care or therapy, you may lose your Medicare SNF coverage. If your condition won't allow you to get skilled care (like if you get the flu), you may be able to continue to get Medicare coverage temporarily.
Stopping care or leaving
If you stop getting skilled care in the SNF, or leave the SNF altogether, your SNF coverage may be affected depending on how long your break in SNF care lasts.
If your break in skilled care lasts more than 30 days, you need a new 3-day hospital stay to qualify for additional SNF care. The new hospital stay doesn’t need to be for the same condition that you were treated for during your previous stay.
If your break in skilled care lasts for at least 60 days in a row, this ends your current benefit period and renews your SNF benefits. This means that the maximum coverage available would be up to 100 days of SNF benefits."
Most of that applies to a break in care, as in went to facility, but chose to leave. It would likely be best to contact Medicare to ask directly if he can still go, since it's only been a few days.
On that note, however, there are several issues to consider:
1) will he even agree to go?
2) if yes to #1, once there will he cooperate and participate?
The PT sessions are instructional, to provide various exercises and demonstrate how they are done. It is up to the patient to then "practice" these throughout the day, for the # of times recommended, between visits.
If he isn't cooperating with you between visits, who is going to stay on his butt in the facility, with a bull whip, to make sure he continues?
If you can determine he can go back to the SNF, then I would be up his behind with the usual threats:
If you DON'T do these exercises EVERY day, there is a chance the replacement can fail or never work correctly, and you WILL end up in a NH. There was no point to getting a knee replacement if you aren't willing to put in the minimal effort to ensure your knee/leg works properly and you can get around. I won't be signing up for pushing your wheelchair around, not when YOU have the ability to take steps to avoid that!!! USE IT OR LOSE IT!
If your husband is under Medicare he has 30 to 60 days from the hospital discharge date to initiate physical therapy in an approved rehab facility up to 100 days benefit with a doctor’s order. However, if he does not want to go that is another problem for both of you to figure out.
After my mom's knee replacement, she did pretty well in rehab and listened to the therapists most of the time. With me, she was a complete whiny uncooperative pain. "I'm tired" "Maybe later" "I'll do ONE exercise" and on and on. Maddening! And PT is SOOO important to get their range of motion back. I made her go after her second one which wasn't a real rehab facility but rehab in a nursing home which is not nearly as good but better than nothing.
Call some rehab facilities and see what they say.
My dad just had 21 at acute rehab and I wanted him to do more acute rehab because the first 2 weeks were worthless and he was asleep the whole time. The facility wanted to discharge him. I called another acute rehab and they said they would assess him and bring him to their facility after he had had 3 midnights at home (or at a nursing home or other place... just not the hospital)
This made little sense to me but as I dug into it, I found out its because of how Medicare reimburses. If they transfer from one acute rehab to the other they must share the reimbursement 50/50 because it's considered one "visit"...even if one facility had him for 90% of the days/time. So I guess they need him discharged and allow 3 days/nights for the paperwork to be processed and off one facilities roles at Medicare before a new one will take him. This I THINK is true for any transfer of similar level facilities. Acute to Acute or Nursing Home to Nursing home.
After the 100 days, however, nothing is covered until there is new hospitalization.
I hope that helps.
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