My father's in a SNF for short term rehab and I am so confused, anxious, scared, lost... please help?

No need to worry. Yet.
What you described sounds like a normal care meeting to me. It’s simply a status meeting with the whole team and they always include the resident (unless they refuse).

if you’re not comfortable speaking candidly in front of your father, contact the Social Worker privately to make sure s/he understands the situation at home. Be clear that you and your mother cannot provide hands-on care for your father at home unless he is able to transfer independently. This is no time to let any feelings of guilt or obligation get in the way of an honest assessment of your and your mother’s abilities.

The SNF will not release your dad if he can’t be physically independent and there’s no one to transfer him. However, if the two of you just nod your heads as they discuss care plans that include your physical assistance, they will plan to discharge home. You have to speak up.
Also, if you haven’t already, start planning financially for long term care. Talk to the SNF’s business office. If Medicaid will be in the picture, you need to get your ducks in a row. It’s a good idea to meet with an elder law attorney.

feelinglost-

I really feel for the situation you and your parents are in. It sounds like you are not panicked about financial issues involved in your father's care but about how you and your mother will manage to care for him if they release him before he's fully mobile.

Unfortunately, I think you're right to be worried. I believe these meetings are called to make sure the patient will have the support they need when they go home. Generally they want to release the person as soon as possible. I honestly don't know if the fact that your father has supplemental insurance will play into how long they will keep him. The one time my mother was in rehab, they required her to pay the patient's share for days 21-42 up front (estimating her rehab would be 6 weeks) and released her when that time was up.

I believe when you're in for rehab, they have to release you when you're not continuing to improve (AlvaDeer, please correct me if I'm wrong). So that will figure into when they decide to release him. He may still need a lot of help. He may always need a lot of help from this point on. If he doesn't want to exercise or move around at home, it's likely he won't want to do it at the rehab, either, and that may put a cap on how much progress he's actually able to make.

No, they don't think this is a good way for anyone to live. Unfortunately, they don't concern themselves with that. They want to make sure the patient has support at home, even if that means someone helping him walk, get up from a chair, bathe, eat, and everything else. If you don't think your mother and you can provide the assistance he needs, now is the time to apply for a permanent nursing home spot.

A private meeting without your father there might be a good idea. In your place, I'd want to know how much independence they think he will ultimately attain. Unfortunately, they probably won't be able to tell you that, because a lot depends on him and his motivation. There's only so long that a rehab can and will keep him, though. And given his lack of self-motivation and the fact that he landed there to begin with, he probably will never be better than he was when he went in. If I were you, I would assume that and start making plans accordingly.

Feelinglost, please do not let this be handled by any attorney that is not certified in elder law.

I can't begin to tell you how awful this could turn out if the person is only jumping on the elder law meal ticket. It happens, they don't have to have any special training or schooling to say "elder law" please get a certified elder law attorney. It will be cheaper than paying for the education of an attorney that wants to handle elder law. (I know that lots of people believe that you will be paying more for a certified specialist, not so, they do this everyday and they don't need to do research to represent you, which you pay any attorney for their time scouring law books to find precedence and laws. It is cheaper to use someone that does this everyday.)

I learned the hard way to not trust professional to professional referrals. Please do your own due diligence.

I know it seems like a lot, but a bad elder law attorney can create irrevocable damage.

If you don't feel like you and your mom will be able to care for dad when he's ready to be released from rehab, then TELL them that! Normally, a SNF will tell you that an elder is not suited to go back home due to his limited mobility, etc, and that he'd be better off STAYING in their facility as a long term resident, if that's what they feel to be the case. If they feel that he'll have adequate care at home, then they will release him.

I definitely do not think you are a terrible person for asking the questions you're asking......you are smart and sensible. Because caring for a person at home who suffers from mobility issues will only land him back in this situation again and again, and may even land YOU and mom in the hospital, realistically! Your dad may ultimately need long term care in a nursing home, but you won't know that until his stint in rehab is finished. Also, check out his insurance to see what the benefits are for days 21 -100 in rehab, and how much they will pay and what his co pay will be, etc.

I have to tell you, the scariest time in my LIFE is when my dad was put into rehab back in 2014 after he'd broken a hip. He and my mother were living in an independent living apartment and his mobility was worsening on a daily basis. Yet he refused (of course) to use a walker. He fell and broke his hip, had surgery, and went into rehab but was NOT making progress, according the Medicare guidelines. So, every day, they'd threaten to 'release' him from rehab and admit him into the Long Term Care section of their facility as a resident. Well, what about MY MOTHER? She couldn't very well go live with him there! I felt like I was having a nervous breakdown (as the only child) at that point. To make a long story short, I found an Assisted Living Facility *ALF* that would take both of them and that's what I did: I moved them from IL into the ALF together. My dad passed in 2015 but mother is still alive and now in Memory Care. Sigh.

It's a long, hard road with these folks, I know. And I feel for you and the panic you are feeling right now.

All the best

Feelinglost, please go to www.nelf.org and find a certified elder law attorney in your area. If dad has to go on Medicaid you really want an attorney that knows how to ensure that your mom isn't left penniless. There are rules and regulations that require someone knowledgeable to protect the community spouse and ensure the best care for the Medicaid recipient.

I would do this like tonight and starting tomorrow make appointments to get this sorted out. It takes a bit of time.

I am sorry that your dad is so ill, I hope that he improves and is able to come home, but if not it is good to be prepared.

You were part of a very careful and about as thorough as they get care plan meeting. They like family and patient there. And yes, you got all the facts and you got them right. As far as how long he can stay, medicare will cover him for these first days, yes, unless he reaches a point where he cannot or willnot cooperate, or he has reached a level beyond which they do not feel he can progress. At that point he is not a "rehab" patient and the choice is to return home to you or to be placed.
I think that what you are saying here is that you fear he will return not well enough for your Mom and you to care for him.
I think you are right in this fear. That will likely be the case.
You need NOW to go to social services and saying that he will not be coming home if your Mom cannot care for him at home. He must be independent in many things for him to return home. That it is your feeling he may NOT be. And it is not a question of lifts and hoyers and this and that, you will NOT be caring for him at home with equipment if his needs are too great for your Mom. So that you will need placement if he does not make excellent progress.
So that will then be on them. Make no mistake, they don't want to do the work. They want you to take him home along with their platitudes of "we can get you help" (they can't) and "We can make this work" (they can't and won't).
So start now. A visit with you and your Mom (AFTER you and your Mom talk this out together) WITH A LIST of the things Dad must be able to do to return home to your care. If he cannot do them he will need placement. PERIOD and no argument.
This puts them on notice. They will coordinate more carefully with PT. And you yourself will know how much progress he is making.
Make contact with the doctor. Give him a letter to his hands or on the chart. Dear Dr. Manderly. I need to tell you that I feel that my father may not be able to return home to the care of my mother. In order for him to return to our home he must be able to do the following: (make the list). If he cannot do these things my Dad will need to be placed. Call me with any questions. your name.
If, 10 days in, Dad is not making progress you will know this. That is the time to recontact the social worker. She or he is your touchstone; you are VERY unlikely to see another care conference. They don't have them often. When my bro was in I assumed weekly. We had one in the 28 days he was in. They do it by law. You won't see it again. So you have to be there and on them every second. You must be strong. No argument. Stick with "It seems very unlikely he can return home."
My brother's 28 days was paid by his medicare and his supplemental completely. They "bought him more time" when PT was done by claiming need for wound care. Doctor didn't want him leaving before a one month repeat MRI.
Keep on them.
But more than that, you and your Mom must level now with one another about what you can do for him at home and whether he needs placement. Then must let him know. Whatever way is best. The therapeutic lie of "you need more therapy and time before we can take you home" OR the truth "We can't do the care at home any more and couldn't be more sorry. Expect rage, tears, depression. Who would NOT have those things in these circumstances.
Good luck. A day at a time. Do not let them bully you into care you KNOW you two cannot accomplish.
Hope you will update us.

Hi Feeling Lost
i have been reading through your thread seeing if there was anything I might add that would be of any help.

When you see the therapist ask what they have as dad’s goals and where he is on those.
Depending on the condition of the patient, sometimes just sitting up in his chair can be considered therapy. I think your idea of having a list to discuss with the therapist is a good one.

You mentioned a financial advisor and Medicaid. It’s important that your mother, as the community spouse, is protected. Each state has slightly different rules for Medicaid but it is important that the person who helps you with Medicaid is well versed in your states laws. It’s often recommended that you see a certified elder attorney with experience in Medicaid.
Be very careful of how you sign any paperwork. It’s best if you don’t.
Are you the DPOA for your parents? That’s another thing to check on with the attorney.

Let us know how your dad is doing.
Your parents are fortunate to have you.

Dear Lost, no you aren’t over-reacting, it’s a difficult situation and you can’t see your way through it. The ‘point of the meeting’ is probably that it was a requirement for them to hold it, even if from your point of view it didn’t achieve anything except to confuse you more.

But you need to give us more information. How old are you, your mother and your father? Are there any other relatives closely involved in this? How is your father’s mental health – if they ‘talked around him’, were they assuming that he wasn’t mentally competent? Same questions about your mother – are you dealing with dementia in either parent, or simply with father’s difficulty in walking?

There is lots of experience here, and you can also just vent if that’s what you want to do, but more information will give you more help. Best wishes, and keep calm while you learn more.

Thanks, I'm sorry, I realise worrying about that too probably just muddies the waters even more (hugs).

The point being, though, that in the absence of any confirmation that your father cannot make decisions, the person who decides whether he is discharged home or to a short term or longer term facility is him. So the person you and your mother need to be honest with when it comes to discussing the care plan, and how it's to be delivered without risk or harm to anyone, is... him again.

The ?NPH and the short-term memory issues and the repeat testing etc - with everything that's been going on (his back injury, possible pain relief in there somewhere too?) I think it's probably best to take deep breaths and wait. Don't forget that the fracture will have caused a heck of a mess in relevant areas, and that common types of pain relief can also affect mood and brain function, so that trying to assess him at the moment must be a bit like trying to find out if there's a nail in a burst water main.

Going from Day 1 to now, would you say he's made continuous progress in rehab, more or less, allowing for off days?

Does he want to return home is your key question. If so, your next questions will be:

When?
With what support?
With what equipment?
With what plan going forward?

You and your mother, with your father on board too once you've explained it to him, must insist that the home is assessed and your father's needs are assessed before anyone will sign any discharge paper.

You and your mother and your father are all at risk if your father depends on manual handling and the family has neither the training nor the equipment nor the support to do it. It sounds as though you have all been "managing" somehow, and you're right - that's how the fall happened.

Maybe you are panicking, a bit. Who wouldn't?! That's okay. But things do not have to be how they were before, and the best way to make sure of that is to be honest to the point of blunt about the practicalities. All kinds of difficulties can be overcome; people with all kinds of disabilities not only live at home, but cope *alone* at home. If your father wants to go home that's fine, but it won't happen and it won't go well unless everyone faces up to the realities of his needs.

One other point to be made here: while rehab in a nursing home may be paid for by Medicare and supplemental insurance, long term care is not paid by Medicare and may not be paid for by insurance either (depending on whether he has supplemental Medicare insurance or long-term care insurance, or both). So having him admitted to a nursing home as a long-term care patient requires money, unless he qualifies for Medicaid and the NH has a Medicaid bed. Medicaid requires not only financial need but a very high level of disability to qualify. Mobility issues alone probably won't qualify, as long as he's able to feed, wash, and toilet himself, and does not have severe cognitive decline. So the nursing home's decision whether to admit him as a long-term care patient may well hinge on financial considerations, not just medical ones. Unfortunately.