Can a "short-stay rehab" withhold information in order to force the patient into long-term care?

London, once you pull a patient on an AMA, you are pretty much blacklisted. Not only that, some insurance companies then refuse to pay the bills. You are pretty much backed into a corner now. About the only chance for rehab is directly from the hospital with a new person as POA.

In this forum we see too many families who bite off more than they can chew when they take a patient home. Zowie has to deal with PT issues, speech issues and now digestive issues. Personally, I would not take all that on at my age (62) because it is a 24/7 job. All the people who are glad to help you anytime quickly evaporate.

My mother went into the hospital in July because of a UTI infection. Stayed there for 4 days. I put here in a Nursing/Rehab for rehab to get her stronger. She did well for a few days, than she went down hill because they were giving her meds that made her very loopy among other things. So she couldn't do her rehab at all. I saw her just about every day. Found out from my son that they had given her 3x the dose in one day. She was not responsive at all. Took her back to the hospital because she had pnemonia. Sorry about the spelling. Their she was in the hospital for another 4 days. I sent her back to he rehab...yeah I know wrong move. She was there for 24 days and nothing got better. Had to send her back to the hospital because she wasn't feeling well. There she stayed for 5 days. So while all this is going on the nursing home wanted me to file for medicade. Well this time I said she wasn't coming back. So I took her to another rehab and she was there 2 and half days and they wanted me to file for Medicaid. Well I took her out on a AMA which means I will be responsible for her. Well they wouldn't give me a list of her medications and she cant stand on her own but I have a bad back and its been very difficult for me. I know my mother just needs therapy for a while and she will be back up on her feet I know this because shes done it so many times before. Now I cant find a rehab that will take her. Im down to my short ends. Rehab therapist will say what ever they want to...to keep your loved ones in there. I have only know one good place for my mother and they have no room for her. I just fired her doctor because all he wanted to do was put her away. He is wrong. Never again. If anyone can help me it would be appreciated.

Good for you speaking up about not wanting rehab and home care can be great. Our county finally got to be part of Visiting Nurses instead of a hospital and the health department handling home care through medicare-you had to learn to be combative to get good help-I can not remember how many times they wanted to cancell on me with the old system-and when I found out what they were being paid from medicare-it was unbelievable.

Wow, it looks like I narrowly avoided a mess recently. My mother (Alzheimers and a host of other debilitating ailments) was in hospital and the discharge nurse wanted to send her to short term rehab. I said I preferred not and she said how about a visiting nurse and physical therapist. Medicare will pay for it. I said, "that's much better." I also spoke with my mother's CT. Home Care for Elders case manager who told me that for a person with cognitive issues even short term rehab away from their home can be detrimental cognitively.

I am glad you called that 800 number is it an Ombudsmen the nursing home my husband was in most of the time tried to keep it a secret and did not post it very often and now when I go in to see Winnie I never see it posted anywhere.

My mother went in because of a partial hip replacement. The only reason she went in was because the doctor would not release her from the hospital until I agrees to let her go to rehab. I found one that was "The best in the nation". Yeah right with in the second day I was calling the 800 number that they have posted for any concerns. They sent someone and we all had a meeting so I could get out all my concern and then I told them she would be leaving after her 3 months was up. They wanted her to stay another 6 months and I just told them I could care for her better than they could, So I went through training on how to transport her.

Any patient on Heparin should never be allowed to walk or leave the bedside without assistance. If she was on Warfarin/Coumadin, that's OK. All falls must be reported to the physician, not necessarily to the family, but it does show courtesy.

I am primary caregiver for my aunt. She fell in her home on Jan. 2 and had surgery to repair her femur bone on Jan. 3rd. She has been in rehab and doing great for a lady that is 98. This morning she fell at about 3:30 am cutting her forearm. The nurse on duty did not call me as they are suppose to and I guess did not inform the head NR over the rehab center. When they did call me at 7:15 this morning and I got there the head NR was saying that it had been so long the ER would probably not put stitches in now. The cut has some kind of strips covering it (really a lot of these strip things) and they are afraid to remove them now to see how deep the cut really is. (The nurse who was on duty when she fell of course was gone by this time) because she has been on blood thinners since her surgery and they do not want the bleed to start again. My thoughts are, do they not want her to go to the ER because they are afraid the fall will be reported to Medicare and they do not want a report against them. I was very pleased with the rehab when she first arrived been since that time I have seen the lack of communication between each shift and have started losing faith in their service.
Thanks for any help you can give me or any ideas.
Pray for guidance in Illinois:)

My mom just got out of rehab following a partial hip replacement. If we had taken her out, even though her Dr had approved it, medicare would not have paid for it because the facility's Dr had not checked her out!!! They have a need to keep their beds full-- an empty bed equals zero income-- and they were pushing to keep her in. The recommendation was made at that facility to talk to the charge nurse; she was the one who sorted through all the details and finally got the ball rolling. Hope this helps!

No one can make you put your parent in a long-term care facility without your signature and the signature of an attending physician. If you place your parent in a short-term stay, sometimes called, " Respite Care:", then that's all you'll get. Look for a facility which is on your level with the same understanding and care that you want. Stop if they constantly refer to "insurance" or payments. You don't need it.

Zowie-so many good answers to your question-and I noticed the messages are quite similar to each other...SO, at this point it appears that the writing is on the wall---what you need to do next. Since I have been volunteering at a nursing home, I did see first hand of the deficiencies....I also saw some, when I had my Mom, and I was not satisfied with the treatment-These people are great in giving you scripted answers-as to what YOU want to hear, and not what is actually taking place. So -as suggested, have her rehab done at home, or in a facility you can trust... I would think there must be a rating list you can refer to with your council on aginging. Keep in mind the 'glitz' of a for-profit facility may not give your Mom the care that a not-for-profit facility will..I found this to be very true-personally.
Best~
Hap

To have my mother out of that place is such a relief. Her home care will be demanding, but as sylvester18 said nobody can take care of a parent better than loved ones.

I wish there was a way to put this kind of place out of business. I think the thing that bothers me most is the way they can provide the worst of treatment -- even kill people -- and Medicare, Medicaid and other insurance companies pay them the same amount of money a truly top notch facility gets.

Any time you hear the words "I thought you knew..." or its just a matter of semantics..." and my personal favorite -- "you don't understand the medical definition of the words we use..." Get your loved on away from there ASAP.

Usually the best nursing home is the one that is close to you where you can drop in often and has liberal visiting hours and any concerns take to the head of the department if you do not get assistance keep going up until you get to the director they all have to be inspected and any complaints are open to review. It is best to be calm when making complaints-most problems can be addressed easily but if something really bothers you you can have the person transfered often the PT department is responsible for ordering equipment.

bottom line, NOBODY will care for your Mom or Dad like you can. Take her OUTTA there ASAP and rent the equipment and do the rehab at home. These jacka22es will make excuses of recooping your Mom at every cost. Don't wait until after she is not able to walk anymore like I did with my Dad. He went into the "REHAB CENTER" and couls somewhat walk,they IMMEDIATELY placed a bed and chair alarm on his bed and his wheelchair. If I had it to do all over again I would never have placed my Dad in a nursing home. It may be a task to rehab your Mom, but just think, if the tables were turned, and she was able to, she would do it for you. Families need to stick together and make these nursing homes go out of business.

you have to ask this directly to the Staff /R.N./DOCTOR.SOCIAL WORKER/ THERAPISTS/ ETC. of this facility and tell them you wishes. what do you want.

We I had my mom fell and broke her hip I had to put her in rehab. They wanted to keep her for 6 months and after 3 months I took her out. This was suppose to be top of the line NH. Every morning when I got there something was all was wrong. They should have some numbers posted on a board where you can call and tell them your concerns. That is what I did and someone from the office came and meet with me my mother and everbody that had something to do with my mothers care. I told them my concerns and that I was taking her out and they got me everything I was going to need at home to take care of her.

Good Luck

tpfzowie, your story is a heart breaker. It may be representative at long-term care and healthcare at its worst, yet, all it takes is one such experience to leave a sour taste in a consumer's mouth. The entire healthcare system is manipulative to one degree, or another, which is why strong family advocacy is required at every fork in the road to avoid our loved ones being railroaded. ED's descriptive of "manipulating vultures" would be funny if it weren't true. ED's also right about the purity of your love for your Mom. Don't put up with it and do let them know that your Mom is not a prisoner, even if you need to file a complaint.

KarenW', your story serves to highlights the weaknesses in a system that professes to care for society's most vulnerable, yet doesn't care enough to require a physician on duty in all nursing homes. What a mess. "Manipulative vultures" bordering on organized criminal thuggish behaviors toward consumers, families and the general public. States' regulatory agencies already have what it takes to ride herd on such unethical practices, yet the shell games continue.

Isn't it ironic that adult protective services and other agencies that are part of the consumer shell game in long-term care might consider it neglectful if a family member were to delay obtaining medical supervision from, say, Thursday to Monday, as was the case in your Mom's situation, yet a federally-funded rehab facility can get by with not having a physician in charge of its residents and can further defer having one of its residents seen by a physician until the start of the following week? God bless resident care in rehab centers and nursing homes. Your story and tpfzowie's are a tribute to family caregivers who are watchful of elder care needs for their loved ones. You are both caring caregivers facing tough circumstances.

tpfzowie, sure hope you are able to advocate on behalf of your Mom's care by getting her far away from the existing facility to one where her needs may be better taken care of and where your voice is respected.

Thanks to all of you for your responses. I am glad most of you found some employees responsive to yours needs.

My mother had to be transfered to the hospital, due to a GI bleed. She has had an endoscopy and all that was found was a small ulcer in the esophagus. I am relieved that she is out of that place.

We are working with the social worker at the hospital to set up home care for her. After this experience she would have to be impossible to care for at home for us to consider anything other than home care.

My! Not good stories. My Mom was in rehab for a month after her broken hip. The place wasn't the greatest but the surgeon said she is going for rehab not for plush furnishings. You need to find the best rehab you can and we did, the PT were great. I had some issues with her getting food she ordered and could eat and some of the supplements they put her on. I asked questions all the time and was never denied an answer, I think they knew I would watch every move they made while I was there.

The social worker was great and she was the one that coordinated her release and obtaining the equipment she needed at home.
Ask for the Director of the facility and the head nursing supervisor if you have problems and I think they would help.

I don't wish anyone to have to go to a rehab facility but as I tried to tell my Mom it was only temporary. Blessings to all.

ZOWIE:

Have her transferred to a facility where milking that insurance isn't the top priority. So shop around. In the meantime, make a habit of looking at the staff dead in the eyes at all times when they talk with you. It takes years to master the ability to have an answer on tap for everything, and their honey-tongued eloquence is designed to scam people who don't know any better by preying on their fears. I call them the "Ernest Hemingways of Bull ___."

Your love for your mother is pure. If a red flag pops up whenever your speak with those manipulating vultures, challenge them. Ask them to explain it to you in plain English as is you were a 6 y/o who doesn't know anything; and then show to you how it's going to improve the quality of care your mom receives. Chances are they'll give you more verbal pyrotechnics and suggest you make another appointment because "they're very busy" or "pressed for time." What you're feeling tells you something isn't right, so trust your instincts.

-- ED

When my 95 year old mother had surgery for a fractured him, tortunately, I found what seemed a pretty good rehab facility close to our home. She was admitted on Thurday afternoon. However, she was not seen by the MD there until Monday morning. While he was in her room the pt let me know they planned to release her on Friday because she was doing so well (rthe hospital orth had ordered short-term rehab (7 days) to dissuade me from taking her directly home from the hospital. However, the rehab MD told her she would be there for weeks and she was upset. The rehab MD wanted to put her on morphine which I nixed.
Mom came home after 7 days and she had pt./visiting nurses for short term. With the exception of cooking she still takes care of her own needs.
I realize having a stroke is different from recovery from a fall. Here's my point...I do believe if I had not been an advocate for Mom she would have been kept in the rehab center for a longer period of time than necessary as she has good insurance. Putting her on morphine would have been detrimental as she has breathing probs. You must, must, must, keep up the important work of staying on top of things. Do not put up with double-speak. DOCUMENT EVERYTHING. When she is released make certain she comes home with the correct pills (if there are any leftover) and correct prescriptions.
Of course you are concerned that rehab workers might take out on your Mom what they are feeling toward you. I once visited mom at 2:00 a.m. and I was told by the "manager" that I needed Medical Power to learn when the last time she was given pain meds. My understanding is as long as I'm on the list; I could be given that info. Didn't matter as I had a copy of the Health Care Power of Attorney. She still did not want to give me the information. I will say the PT folks were the best! I have no issures with them.
Perhaps there is another resource where you can get the training you need...that way you will be better able to communicate with the rehab workers.
Good luck.

It seems to me that if I were in your shoes--I would have your Mom removed from the facility and tranfered to another, Perhaps the employess who work there have been instructed to answer you in a way you do NOT wish. The fact of the matter is you want what is BEST for your Mom-and the 'double talk' you are hearing needs to be eliminated. Some of the facilities that are out there-are very good at doing just that 'doule talk'...Can you check with your local ombudsman - or area council on aging about this situation and see what they advise? By no means are you obligated to keep your Mom where she is--or are you? The bottom line is to look and look today to have your Mom transferred. From what I have witnessed or have heard about-many facilities are in business strictly for the money-and care is perhaps secondary.
Good Luck with your decision making process!
Hap

Unfortunately, the social worker is one of the best double talker's at the rehab. I must say their people management skills are top of the line. You know you have been "managed" every time you question anything.

Mom's primary care physician is the medical director at the rehab. Her attitude has been that we are expecting mom to do things she doesn't want to do.

Today, the social worker told me the equipment had been ordered for delivery on Friday. All I can do is wait and see.

I have been,and will continue to spend as many hours a day as possible at mom's side. My sister is often there when I am not..

Only the speech therapist has given us any progress reports. She will even call me at home, if she doesn't connect with me at the facility. the rest have a habit of starting their sentences with "I thought you knew..."

I cannot wait until I can take her out the door on Saturday.

the saddest thing about all this is that this is considered the best rehab facility in the area. I don't want to know what the others are like....https://www.agingcare.com/assisted-living-facilities

When my mother was in rehab after a stoke, there was a social worker there who met with us and discussed ordering a walker and also in home physical and occupational therapy. Mom was at the rehab hospital for three weeks and my sister and/or I were with her everyday. If possible I would spend a day or two at the facility with her going to all her therapists and they will show you what and how to assist her. I'd start with her doctor or the social worker on getting the equipment you need, the doctor would have to prescribe it. Good Luck!