Skilled nursing for rehab supposed to be a few days, they want to keep him over a month. Any advice?

So Dad has had 3 hospitalizations and rehab stays since last fall? Are they all for the same thing, like a C-Diff or TIA recovery? Falls? What is the source of the recurrent rehab stays probably warrants looking closely at to see just what the problem is and what could be the best way to resolve it.

Could it be that dad is beyond the AL stage? That he now needs to be LTC in a skilled nursing facility rather than AL?

How are the orders or action being done that he leaves AL and then does rehab? IF it's the AL that's doing the referral or sending him to the hospital, my guess is that they want dad moved to a higher level of care facility. If his needing a higher level of care has been mentioned to you or to dad, you probably need to find a NH for him. I'd try to have a frank conversation with the social worker @ his old AL and at the rehab facility as to their perspective dads situation.

Medicare's rules on rehab are pretty precise. They have to be progressing. Once they plateau, rehab stops. I haven't found NH rehab to be bilking the system in my experience with my mom & MIL. Rather it more that the elder goes back to the same pattern that caused the problem; so it yo-yo's. I'm sure that some rehab's keep them longer that other places would; but usually that is a benefit for the elder even with a 20% copay.

Had the same thing w/ my mom. Thought only a week in rehab - but she needed to be there for 6 weeks to regain her strength.
It is my understanding that most patients average a month in rehab.
Rehab in our case was what my mom needed.

You are not jaded but being realistic in my opinion. My Mom's insurance went to the 20% after 2 weeks. (UPMC supplemental)
I would first try sending them an over night registered letter (C/O law dept.) and advise them to move him back. His PC should be able to back this up I would think. I would tell them that you need an immediate response or the issue will be turned over to his elder law firm. Look on the Dept of health state website and see if their are any complaints against them or if you are in Cal. look at this site. If not I bet they could give you good direction. A little dirt goes along way to show them you mean business.

I agree with panapal write them a letter and if that doesn't work get an attorney for the elderly. I wish you the best and God Bless

Why did dad go to the hospital in the first place? Was this just an excuse on the part of AL because it was clear to them he needed a higher level of care? Maybe not showing up for meals not taking care of personal hygiene? Refusing to leave his room. The hospital Drs must have decided he needed a rehab level of care to try and get him back to independence. it is highly possible his level of dementia was put down to being old and at the time sick and once he got to rehab it was clear he needed longer than a few days. have you been talking to the AL, Hosp and rehab to find out what is really going on? And last of all when were you able to visit dad and see for yourself how far he has deteriorated. Elders often slip through the cracks when there PO lives a long way away. Before you start flinging dirt make sure you personally know the facts. i am not trying to be unfeeling towards you or critical but simply making suggestions of how to best help Dad.

They seem to think that after the county issues the Letter of Determination with the box "Facility illegible" so they can receive extended benefits that they can turn our parents into "cash cows" and do what they want. They seem to actually believe their own socialist ideas that our children and elderly parents belong to the state. Lord take me quickly when its time for me to go home.

Anyone at anytime can go AMA (against medical advice) as long as they are not in a psychiatric facility. Tell the rehab place you want your father(?) to go back or you will sue them for signing him in without your written permission. (I am assuming this is your father since you do not exactly say who this is).

My dad had a hospital stay due to painful cranial neuralgia. After the many rounds of medication to alleviate the pain( I still don't know how he survived it) he was discharged to a rehab for the allotted time Medicare allowed. When I met with them and told them what my goals for my dad was, I made it clear to them that he would be checking out on the final day of Medicare allotment. My dad does not have AL or Dementia but the stay in the rehab was good and bad. It took him down a notch mentally along with the new medication which he had to get used to. Two months later with visiting pt and ot help he is now walking with his cane again. Still very wobbly but nonetheless walking. Prior to that visit to rehab he could bath himself, prepare something to eat, walk with a cane, exercise everyday , etc. my dad is 95 but I believe the whole experience at rehab reminded him too much of a nursing home which he thought I intended to leave him there. The mind of an elderly person is so much more fragile that it is up to us as their children to make the system do the right thing when we can. Make sure you have all the info especially from his PC . Being POA is so difficult long distance that I moved to where my parents lived than when my mom died I moved my dad back with me . Trust me either situation is still so hard but you must listen to your heart in most instances and just do the best u can. Blessings to you.

I agree witj all that's said but, there's this thing called a telephone which could have easilu neem used to call POA, no matter how far or how close you live the telephone still works. When in doubt call

These are all good answers. My question is why don't you have your dad in your city where you live? It's alot esier to handle things if you could just drop by.

Hello, I would keep rehab stay as short as possible. My father was in a rehab center. Along with his regular doctor's medicines, they were giving him something else that, at times, would make him sullen and withdrawn. When he was non-responsive, it upset my mother because she thought he was going into dementia. When he came home, and he was just taking his regular doctor's medicines, he became like himself within a few weeks. To this day, we don't really know all they were giving him. After a year later, my father, who is a pastor, is back at his regular duties at his church. He also just went out-of-town for four days ALONE to conduct a training workshop at a friend's church!
So my advice is to keep that rehab visit SHORT! I believe rehab, after the hospital, has become a scam that is part of our medical system. We had a fifty-four-year-old friend who had stomach cancer. They put her in rehab before hospice. When she went to rehab, all knew her cancer was terminal. If you have good insurance, rehab is just a way to rip the system!

We just experienced this with a friend who had open heart surgery. He was sent to rehab for a couple of weeks. That was what the doctor ordered. Rehab messed up his medications and he was sent back to the ER. Went back to rehab. Each Monday, they told him he was going to have to stay another week. Each Monday he became more discouraged. This went on for nearly a month. We suggested he make an appointment to see his own doctor. The doctor agreed, he did not need to stay and released him. The Rehab NH gave them the run around on excuses as to why he was not ready.

My husband (a pastor) visits people in nursing homes weekly sometimes, daily. In his 27 years of ministry, he has seen it all. There are good and bad. He has seen many nursing homes who won't let go, like this one. Let's face it, Nursing homes are not in for the warm fuzzy feelings of helping people. They are in it for the money. It is a business.

Make an appointment with your dad's personal doctor asap, Don't tell the NH until the day of. Let the doctor know your concerns. He will probably agree with you that your dad needs to get back to his routine of daily life.

Our friend is home and doing very well. He is resting much better and gaining strength. No more discouraging reports for him which was certainly not helping his health.

It is difficult to be far away from the ones you love and have to help long distance. I am my dads POA and live 2 hours away. I am on the phone a LOT to take care of him. I pray you find answers. God Bless.

Ferris - if they sign out AMA is there the possibility that insurance will not pay?

Re-reading on this, I keep going back to he has had 4 rehab/ skilled nursing stays since last fall. What is going on that is making him go from AL to rehab?

Spirit - being his POA does not mean that a facility has to have you personally sign a document for this admission; he could have been cognitive enough to do that. If he has had 3 prior rehab admits last year, a pattern is set for how to deal with decisions on him. For you to be required to be in the loop on decision making, you would need to have a state of Florida guardianship done. AL implies that he is competent & cognitive enough to do his ADL's. If that's not the case, then he probably needs to somewhere that does a higher level of care and you file for guardianship to always be involved in any decisions.

I assumed this was your dad, but perhaps it's not?

I find that hospitals do what they want. O hate that they don't talk with the PC when starting a new med. I was told that medicaid may pick up any balance if Mom could not afford it. Also, I had a call from the nurse anytime they were making changes. The hospital and rehab should have copies of your POA. I requested that they not discuss anything with my Mom at the hospital. To have the doctor/nurse call me. My daughter worked at the rehab and is second on the POA so she was kept in the loop.

I had a similar experience last October with mom in NY. She was hospitalized for a fainting spell and fall, and then they sent her to rehab (I approved). Rehab was supposed to be 1-2 weeks. They tried to keep her for 2 months. I spoke to many people in the industry about this, and this seems to be a common practice. Medicare pays 100 days, so they try to keep patients for the full 100, then kick them out on day 101. You don't have to comply with "dr's orders" if you feel your mom is safe to get discharged. If she's in Assisted Living, I'm sure that the nursing staff will be sent out to mom's rehab place to evaluate her before they clear her to return (my mom is in Assisted Living, and this is their protocol). Once I felt that mom was safe to get discharged, I called a family mtg and yanked her out of rehab. They cannot go against your wishes if you are her POA. If you are too far to do this in person, maybe you can have someone go on your behalf to confirm whether mom is ok enough to get discharged. Or take a long weekend trip there yourself and do it.
Just remember.. they cannot override your wishes. You just need to determine whether she is well enough to get discharged.

Sorry, I didn't see this was for your father. In any case, they didn't have the right to sign him in without someone who had the ability to know what they were signing, on his behalf.

Hello SpiritGate! I worked as an Occupational Therapy Assistant in Skilled Nursing and Rehab Centers for many years, so I will try to answer your question. First of all, I know that doctors are notorious for telling patients that they will only have to stay in rehab for a few days when actually it is the PT, OT, and Speech Therapists who write the goals and determine how long it is going to take to reach those goals. You are right in saying that Medicare pays 100% up to the first 21 days and then it goes to 80/20. However, I know that most rehab stays generally last at least a month depending on how the patient is progressing and whether he/she is reaching their goals. Also, due to Medicare reimbursement issues there are certain "windows of time" that the therapist must capture a certain amount of treatment time in order for the nursing home to be reimbursed, which is often the reason why most rehab stays last approx. 1 month. However, as the Financial POA, you certainly have a right to know when your dad is being admitted to a Skilled Nursing and Rehab Center and even to refuse it! Also, ferris1 is right in that Dad can leave AMA (against medical advice) at any time, and especially if you sign him out. However, if you think he would benefit from staying there through the first 21 days then you might just make it very clear to the Case Manager that he will not be staying beyond that 21 days and will be returning to the ALF. Generally it takes a good 2-3 weeks to get someone's strength and transfer skills back to where they need to be anyways. So you can think what you want about them "bilking the system", but realistically it sounds as if he would benefit from therapy or the doctor would not have deemed it medically necessary before he returns to the ALF. Perhaps there is a safety factor involved there? I don't know, because you really don't say why he went to the hospital in the first place. Obviously the Alzheimer's or dementia is a concern.

IMHO it rarely works out well, for the senior, to have their POA lives out of state, or even an hour away. Go get your dad and move him into a facility near you. NONE of this would be happening, or being questioned, if he were 10 mins away from you. Best wishes for your dad, and hope you can get permanent control of situation before too long.

To echo what was said above. I am an OT and was a rehab manager for a short time. I stopped bc I could not take the lack of ethics in the system. First I will assume the company in your Dad's facility is one of the few ethical ones in the SNF world. In that case it may be that he is progressing slowly and really does need more time.
If the company is one of the many who only cares about money, they will want to keep him for 100 days whether he needs it or not.
You probably need to go there yourself and see how he is doing to assess if he is really ready to be discharged.

Well the OP never came to back to their thread from 3 days ago.

As others have said the father needs to be in an AL in the area that the OP lives not in FL alone. Father most likely retired to FL and had a nice retirement, but when serious health issues arise you need to get the parent by you, not leave them down in FL(can't think of worst state between healthcare and those who prey on the elderly for a senior to be alone in). Get your father by you.

As POA they cannot do anything without your consent or they face federal fines. I would do out rehab at home here in south jersey we have a great company holy redeemer that done more for my mom at home that genesis rehab in Voorhees, NJ did for my mom. You must also beware in the nursing facility they might give him a drug to try and make him look like he needs help. These facilities are there to make money not help people. I have learned that first hand. bring your dad to live with you. It takes me some time to work with someone with dementia or Alzheimer's but it can be done.

In my state, if an elder requires too much help with activities of daily living, they are not allowed to stay in assisted living. You would want to know if your dad is able to return to the AL. If he leaves rehab against medical advice (AMA) there might be consequences. His doctor may drop him. He may not be able to take his medicines with him or get prescriptions for meds. He may not be eligible for temporary extra care in the AL, paid for by Medicare, if he leaves AMA. I would contact the local Long-Term Care Ombudsman for that county. The ombudsman is an advocate for residents in long-term care homes. To find the Ombudsman go to http://theconsumervoice.org/get_help

Contact your local long term care ombudsman, she/he will be able to assist you. They are an advocate for those in facilities. If he is on skilled care and medicare is paying for it, days 1-20 have no co-pays, days 21 on have a co-pay your dad will need to pay unless he applies for long term care Medicaid. Good luck

Thank you all for your answers. I have had a busy week. Background info: My Father has a seizure disorder and originally fell during a seizure while in Independent living. (He walked two miles a day and enjoyed the activities and all the friends at the Independent living.) That was a hip fracture and the first rehab past the 21 days in another city. 2nd hospitalization was for MRSA he received at an AL where he was receiving short term respite care while waiting to go into the AL when Independent living forced him to move ( all of this was at one facility with different levels of care). He went to a different rehab following the MRSA and went over the 21 days. The third hospitalization was after he fell and broke his hip and then went to rehab. His neurologist finally made the call: no more PT rehab to have him walking because the seizures were not under control and he was being rehabbed to walk and kept falling. He is now using a wheelchair.

This hospitalization was due to pneumonia. Rehab was supposed to be a few days to gain strength to transfer and pivot into the wheelchair and onto the toilet.
He lives in a specialized AL for people with dementia. We have finally gotten the seizures under control and he is not falling. Although the Al is not perfect, they take good care of my Dad. I wish he could live with me but he cannot.We do not have the money for him to live in as nice as a facility in the Wash DC/ MD/ VA corridor and most important, my Dad made the choice to stay in Florida when he could make the choice and I honor that. My sister and her family live in the town we moved him to and visit him daily. I am the POA and conduct his business. My sister takes him to medical appts and we collaborate on his care. We have a nice check and balance system and it is working for our family. My niece, a 30 year old CNA, has been with him every day at the current skilled NH aka rehab. She is expecting a baby and is not working.

The day after I wrote to ask for help, we had a care meeting; my niece was in attendance and I was on the phone. That morning I was told he signed himself in and he signed to pay for the extra days even though I am the POA and medical surrogate. At the care meeting they told us he did not have dementia and unless I could prove it, he could stay.Their records did not indicate dementia. The social worker told us he was walking 50 ft and he needed to continue rehab for his hip fracture. They also told me that he needed to be there for 6 weeks. They were surprised when I told them he was there for pneumonia. They were mad when I said he needed to leave this week.

Before the meeting, I had contact with the local ombudsmen, or ombudswomen in this case. She told me both facilities would need to work out his discharge but to call her back with any problems on his release.
My sister took him to his doctor yesterday and he wrote an order for Dad to be released. The rehab wanted him to stay and they told me today another doctor ordered him there for 6 weeks based on an email they received. I called that other Dr office and actually spoke to an advocate who told me the Dr did not tell them to keep him, but the Dr said to release him. ( another one of my Dad's Doctors.) Well I was really angry and told her I had contacted the local ombudswomen and that I was going to file a complaint with the state of Florida against this facility. Less than one hour later, the social worker and the Ex Director of the rehab called me to tell me they were discharging him and that it had all been a terrible misunderstanding and poor communication. Suddenly, their attitude went from total disrespect of our family to one of being overly nice and attentive.
Before they left, my niece was told by the staff that their professional director (not the ED) told all of the professional staff, OT, PT and Speech that we were lying and my Dad did not live in the AL but at home independently and he did not have dementia. One of them said we are glad you are taking him back to the AL and reminded my niece and sister how lucky Dad is to have his family so involved. The staff were great, the management was not.

The good news is that we got him out of there this afternoon and he will be getting his eval tomorrow for outpatient OT,PT and Speech at his AL. He was so happy to return to where he calls home now.

This was the worst Rehab/SNH we have experienced. They twisted information so that they could take his money. No other facility disrespected us and they all worked with me as the POA. Every administrative person I spoke to told me the same thing: he was competent to make his own decisions, until today. Now their administrative staff recognize the dementia.

Our journey is not over with my Dad. We still have numerous health issues to deal with.
Here is my lesson:
Please don't give up when you KNOW that there is something wrong with the care your loved one is receiving or what they are saying to you is just wrong.
Blessings to this community and to all of you for writing.

Thank YOU for your thorough explanation of the situation and your resolution of it. What a nightmare!

Great to hear it! If the management does not listen to the family, then you are right to get him out of there. Anyway, I am glad to hear that he is home now at the ALF and that he can continue to get therapy as an outpatient. Thanks for the update!

I am currently going through this with my mom in rehab and I cannot get them to release her! Thanks for all the above posts, I may pursue other avenues.

Spriritgate, I hope everything works out for you. But you should have mentioned that your sister and her family lives in same area as your dad. Your first post made it sound like he was in FL on his own, which isn't the case.

The same thing happened to my father. I could see that he had improved after 2 days and I wanted to bring him home where I had 24 hour care arranged for both of my parents. The care facility still would not release him. They said he had not met goals. He had to be able to walk 500 feet, feed himself , dress himself and go the bathroom by himself. He could do all these things and more.
I got my father's PCP involved. He called the facility and insisted that their evaluation was incorrect. After 2 more days, several meetings and many phone calls we found out that the care facility had two patients with the same name. They were being confused between the two.
I know this was an unusual mistake but my father's PCP was a great help to us in this situation.

They should always ask for birthdates.

Glad u were able to get it all straightened out. There iss no law that says u have to stay with a particular facility. I know people who r not satisfied witha care of a patient and move them. I live in SouthNJ across from Del. so understand about the "corrider". I'm assuming ur sister has the medical POA? If not, being the closer she my need it. My daughter, RN, is secondary on my Moms. Was great when Mom was in daughters facility. Nurses/doctor talked to her.