Transitional Care Unit. That is perhaps more commonly used here than "rehab". Another term, when it is in a hospital, is "swing bed," meaning the room can be billed at either a hospital rate or a transitional care rate, depending on how it is used and the level of care given. Often rural areas do not have a separate facility for rehab and patients are just moved to a lower/different level of care when they no longer need hospital-level care.
willows, I hear ya! I am grateful that my husband was able to take his full ten-year dementia journey from the comfort of our house. We were truly fortunate. But I know that almost all of the members of my caregiver support group placed their LO in a care center at the end. I heard their anguished decision process at meetings. And then I heard how they advocated for the best possible care for their LO after the placement. We all do what we must, what we can, and what we have support for. You and I are the lucky ones.
My mother was in rehab twice and my husband once. (Both with dementia.) My conclusion was that no loved one of mine would go to two of the nursing homes associated with the TCU, and one of them would be a very suitable choice. TCUs are particularly problematic for those with dementia, as they are typically not set up for such patients. I spent every day with my husband when he was in TCU.
My mother is now in a nursing home. She is thriving. She gets her newspaper every day. We have "trained" the staff to be sure she has magazines in front of her at all times. They dress her nicely and compliment her on her looks. She has family visits 4 or 5 times a week. If we notice anything not just right we politely report it. Mom hated to have her daughters deal with her bathroom needs. She is much more comfortable with the paid staff doing it. I truly think she is in the best place for her.
We each have to deal with our own situations. When some kind of a care center is the best choice for a loved one, VISIT OFTEN. Willows, I think you are right that no place but home can provide the depth of positive love and attention our loved ones deserve. That's why we visit often, to provide a good dose of those ingredients.
(And a good care center DOES provide a lot of love and attention -- just not exactly as a family does.)
The "best" of nursing homes leave much to be desired. Many of them are understaffed and a patient can remain in a dirty diaper for a long time before he/she is given any attention. My husband was sent to a rehab facility (also a nursing home) after he was released from the hospital last fall, and I couldn't wait to get him home where I would take decent care of him. In fact, the facility where he was taken was the so-called "assisted living facility" adjacent to one of the most luxurious retirement homes in DuPage County. Oh, my stars! It was pretty awful. As his advocate, I found myself there every day just to make sure he got the attention he should have gotten. Half the time, nobody came when I rang and I ended up taking him to the bathroom. He might as well have been home. Also, many dementia patients who end up in nursing homes don't live as long; they become very depressed, receive little stimulation and eventually expire. I make sure my husband gets the Chicago Tribune in front of him after breakfast every morning, as well as history books (he was such a history buff), and he sometimes reads aloud to me and I know he comprehends at least some of it. He was diagnosed with dementia seven years ago. There is nobody in any nursing home that can give him this kind of positive love and attention.
I have copied and pasted a reply I made to another caregiver regarding NH care and Medicaid - I went through this process in Texas and each state can be a little different - Sava Senior Care has facilities in Tennessee and 800 number for them is 866-300-3257 - the whole process is pretty much a pain in the butt - but I was able to make it happen - and I think actually going to NH and sitting down and talking with them made the whole process easier - I don't think I would have ever made anything happen on the phone -- good luck...
I copied and pasted this answer from another discussion, and it was to a working caregiver, which may not apply to you but it outlines my concentrated effort for a care facility with Medicaid. the process for medicaid and placement in a skilled nursing facility is daunting but here is how I got through it, sounds like it may be time for you to make this very difficult decision for the best of both of you. I worked with a Sava Senior care facility in Houston, TX to place LO in a medicaid pending nursing home, I see that they do have some facilities all over US- I was not able to pay the 4,000 to 6,000 for private pay so I was limited to a facility that would take Medicaid Pending. It is my understanding that the states requires some of the facilities to have both Medicaid Pending and Medicaid beds available but it is a limited number. My LO was falling two to five times a week at home, not able to walk or get himself up and down and was totally incontinent, plus weighs 300 lb and I'm am only a third of that, I was his only caregiver and had to leave him alone while I worked which was just not good. I wanted him in a facility for his safety. My situation was such that my health was declining taking care of him by myself while trying to work and take care of all of my chores as well, it was just too much for me and could not afford full time help to care for him. I took him to the ER a number of times after his falls, they always just checked him out and sent him home, so waiting until he fell and broke something was not an option for me. I never tried to refuse to take him back so I really don't know how that would have worked. I was desperate to get him into a facility and was trying to check places out in the evening or at lunch, was not getting a lot accomplished. So I just went to my boss explained what I needed to do and took two days off of work. I had been missing a lot of work with him and hated to take more and I was lucky my boss was very understanding and even gave me a few tips. I did some internet research and the Department of Aging here in Tx has a listing of all nursing homes that accepts Medicaid, I called as many as I could to find out if they took Medicaid pending and made a list of the ones I felt were okay. Note, I did not do this on my days off but rather in the evening and lunch otherwise I would have probably had to have taken another day. I made a map and my first day off, I went and visited as many Medicaid accepting facilities that I could including a few that I knew did not have Medicaid Pending available, as they can put you on a waiting list. I visited 8 nursing homes that day and talked to the administrative staff at each one - explaining my story to them, they were most helpful and answered a lot of questions for me, one of the facilities that did not have a Medicaid pending bed actually made some calls for me and recommended a sister facility (this was a Sava Senior) that I eventually placed him in - one that was not on my list so it was a huge help. But ask a lot of questions - one of the places that was close and I really liked would have crammed him into a room with 3 other people - that was something I noticed in the walk thru that they had some 4 people rooms and I had to ask to clarify that - and indeed the 4 people rooms were Medicaid pending, I did not feel that the transition from home to NH for a dementia patient would be very smooth even sharing a room but 4 in a room (a small room) was just too chaotic. So ask a lot of questions. By the end of that very long day, I was exhausted but had chosen two that had Medicaid pending beds available, a first choice and then a second for backup and knew what they needed to start the process. My second day, I collected the paperwork that the nursing homes needed as well as bank statements - SS info etc. (In retrospect - I should have done this the first day, as I could have just given the nursing homes the paperwork when I visited as this could have made things quicker. but as I was going back with LO to have him look at facility as well, I just took them the paperwork that day. I needed full medical record from Primary Care Dr - along with medical record from his Neurologist (this is very helpful in getting him accepted at the NH especially if he has dementia) and record from his last ER visit. I called the Drs offices and hospital in the morning and explained to them what I needed and that I would come that afternoon to pick them up - did not take no for an answer as one of the dr's offices tried to put me off. I had printed out his bank statements for the last six months, downloaded a Medicaid application and filled it out, made copy of his DL and SS card as well as his insurance information and made a copy of his small life insurance policy, I then carried all of this to Kinko's and had 4 copies made, one for each nursing home, one to use with the Medicaid application and a spare just in case. When I took LO to NH to visit - we only went to the first one because he was okay with that one, I was able to hand them all the paperwork needed to start the process, and a week later I was able to get him into the facility. Now this was not an easy decision and I am still wrestling with guilt - he is being pretty good but asks to come home - but he is getting physical therapy, regular bathing, his medications and has only fallen once in over two months. I know that a lot of caregivers that comment here do not like NH - and truth be told, neither do I, but I do think every situation is different, in my case - since his children would offer no help or support and with his financial situation the NH really was the best choice for his much needed full time care and safety. I do feel better about placing him because I did the multiple visits - you would expect the more expensive homes to be the nicest, but that was not always the case and a couple of the places I got no further than the front door and I knew that it was not going to work, however, I did the tour and talked with them, well just because I was there and wanted as much information as possible in making the decision. Now just so you know, once he is Medicaid approved - you can easily move him to another facility as Medicaid approved beds are more available than Medicaid pending. I may move LO as the facility he is at is not as close as I would like but will leave that up to him, he is about a 25 minute drive, there is a facility about 10 minutes away so I could visit more, but he is adapting and doing pretty well so will think long and hard before moving him. For your information, the nursing home submitted the Medicaid application on the day of his arrival - approx 8/15/14 and I just last week got the approval back, I do think that filling the form out correctly and providing them with all paperwork required at the time of submission makes it go faster. Good luck with your LO, I hope that this helps. I really think that waiting for a LO to fall and seriously hurt themselves before getting the proper help is a very serious flaw in the medical and insurance care of elders.
If a person is already Medicaid, there is no problem. I put my aunt in a wonderful nursing home four years ago. She already was Medicaid. But I took her to the emergency room in the hospital first, for she had fallen, and I wanted to make sure no bones were broken or cracked. She was sent directly to the nursing home. (there were no broken or cracked bones, but she couldn't walk due to the fall) marymember
I think it is a state-by-state and maybe even county-by-county situation. I haven't heard of anyone having a problem here in Minnesota. Of course, some facilities don't accept Medicaid at all, but those that do don't seem to turn away applicants with dementia.
Medicaid is a highly stressed assistance program right now. There is a shortage of beds here, in Calif., as well. Unfortunately, dementia patients require more care than others. The result is obvious; the Medicaid patients that require the least? amount of care are the ones that are taken. It's even hard to find Respite beds under Medicare coverage in Calif.
I don't know how it works in TN, but here in NY the county social services has a list of what beds are open. I believe the list is generated by the state health department. Tennessee beds are consistently 99% filled, so you would go on a waiting list unless you are very lucky.
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My mother was in rehab twice and my husband once. (Both with dementia.) My conclusion was that no loved one of mine would go to two of the nursing homes associated with the TCU, and one of them would be a very suitable choice. TCUs are particularly problematic for those with dementia, as they are typically not set up for such patients. I spent every day with my husband when he was in TCU.
My mother is now in a nursing home. She is thriving. She gets her newspaper every day. We have "trained" the staff to be sure she has magazines in front of her at all times. They dress her nicely and compliment her on her looks. She has family visits 4 or 5 times a week. If we notice anything not just right we politely report it. Mom hated to have her daughters deal with her bathroom needs. She is much more comfortable with the paid staff doing it. I truly think she is in the best place for her.
We each have to deal with our own situations. When some kind of a care center is the best choice for a loved one, VISIT OFTEN. Willows, I think you are right that no place but home can provide the depth of positive love and attention our loved ones deserve. That's why we visit often, to provide a good dose of those ingredients.
(And a good care center DOES provide a lot of love and attention -- just not exactly as a family does.)
I copied and pasted this answer from another discussion, and it was to a working caregiver, which may not apply to you but it outlines my concentrated effort for a care facility with Medicaid.
the process for medicaid and placement in a skilled nursing facility is daunting but here is how I got through it, sounds like it may be time for you to make this very difficult decision for the best of both of you.
I worked with a Sava Senior care facility in Houston, TX to place LO in a medicaid pending nursing home, I see that they do have some facilities all over US- I was not able to pay the 4,000 to 6,000 for private pay so I was limited to a facility that would take Medicaid Pending. It is my understanding that the states requires some of the facilities to have both Medicaid Pending and Medicaid beds available but it is a limited number.
My LO was falling two to five times a week at home, not able to walk or get himself up and down and was totally incontinent, plus weighs 300 lb and I'm am only a third of that, I was his only caregiver and had to leave him alone while I worked which was just not good. I wanted him in a facility for his safety. My situation was such that my health was declining taking care of him by myself while trying to work and take care of all of my chores as well, it was just too much for me and could not afford full time help to care for him. I took him to the ER a number of times after his falls, they always just checked him out and sent him home, so waiting until he fell and broke something was not an option for me. I never tried to refuse to take him back so I really don't know how that would have worked.
I was desperate to get him into a facility and was trying to check places out in the evening or at lunch, was not getting a lot accomplished. So I just went to my boss explained what I needed to do and took two days off of work. I had been missing a lot of work with him and hated to take more and I was lucky my boss was very understanding and even gave me a few tips. I did some internet research and the Department of Aging here in Tx has a listing of all nursing homes that accepts Medicaid, I called as many as I could to find out if they took Medicaid pending and made a list of the ones I felt were okay. Note, I did not do this on my days off but rather in the evening and lunch otherwise I would have probably had to have taken another day. I made a map and my first day off, I went and visited as many Medicaid accepting facilities that I could including a few that I knew did not have Medicaid Pending available, as they can put you on a waiting list. I visited 8 nursing homes that day and talked to the administrative staff at each one - explaining my story to them, they were most helpful and answered a lot of questions for me, one of the facilities that did not have a Medicaid pending bed actually made some calls for me and recommended a sister facility (this was a Sava Senior) that I eventually placed him in - one that was not on my list so it was a huge help.
But ask a lot of questions - one of the places that was close and I really liked would have crammed him into a room with 3 other people - that was something I noticed in the walk thru that they had some 4 people rooms and I had to ask to clarify that - and indeed the 4 people rooms were Medicaid pending, I did not feel that the transition from home to NH for a dementia patient would be very smooth even sharing a room but 4 in a room (a small room) was just too chaotic. So ask a lot of questions.
By the end of that very long day, I was exhausted but had chosen two that had Medicaid pending beds available, a first choice and then a second for backup and knew what they needed to start the process.
My second day, I collected the paperwork that the nursing homes needed as well as bank statements - SS info etc. (In retrospect - I should have done this the first day, as I could have just given the nursing homes the paperwork when I visited as this could have made things quicker. but as I was going back with LO to have him look at facility as well, I just took them the paperwork that day.
I needed full medical record from Primary Care Dr - along with medical record from his Neurologist (this is very helpful in getting him accepted at the NH especially if he has dementia) and record from his last ER visit. I called the Drs offices and hospital in the morning and explained to them what I needed and that I would come that afternoon to pick them up - did not take no for an answer as one of the dr's offices tried to put me off. I had printed out his bank statements for the last six months, downloaded a Medicaid application and filled it out, made copy of his DL and SS card as well as his insurance information and made a copy of his small life insurance policy, I then carried all of this to Kinko's and had 4 copies made, one for each nursing home, one to use with the Medicaid application and a spare just in case.
When I took LO to NH to visit - we only went to the first one because he was okay with that one, I was able to hand them all the paperwork needed to start the process, and a week later I was able to get him into the facility. Now this was not an easy decision and I am still wrestling with guilt - he is being pretty good but asks to come home - but he is getting physical therapy, regular bathing, his medications and has only fallen once in over two months. I know that a lot of caregivers that comment here do not like NH - and truth be told, neither do I, but I do think every situation is different, in my case - since his children would offer no help or support and with his financial situation the NH really was the best choice for his much needed full time care and safety. I do feel better about placing him because I did the multiple visits - you would expect the more expensive homes to be the nicest, but that was not always the case and a couple of the places I got no further than the front door and I knew that it was not going to work, however, I did the tour and talked with them, well just because I was there and wanted as much information as possible in making the decision.
Now just so you know, once he is Medicaid approved - you can easily move him to another facility as Medicaid approved beds are more available than Medicaid pending.
I may move LO as the facility he is at is not as close as I would like but will leave that up to him, he is about a 25 minute drive, there is a facility about 10 minutes away so I could visit more, but he is adapting and doing pretty well so will think long and hard before moving him.
For your information, the nursing home submitted the Medicaid application on the day of his arrival - approx 8/15/14 and I just last week got the approval back, I do think that filling the form out correctly and providing them with all paperwork required at the time of submission makes it go faster.
Good luck with your LO, I hope that this helps. I really think that waiting for a LO to fall and seriously hurt themselves before getting the proper help is a very serious flaw in the medical and insurance care of elders.