Need advice stat on changing rehabs!

Please update us all and let us know what happened!

Call around or ask your doctors about a facility to handle his medical conditions. Also ask the social worker at the current facility - but I would do that after talking with his doctor...and perhaps the hospital that made arrangements for his transfer out of the hospital. You're going to have to do the hard work yourself in finding an adequate facility. Once you find it, you will probably need the doctor to help you handle the transfer.

Did they send him to rehab for physical or occupational therapy for the MS? I haven't heard where they move to rehab for diabetes or dementia.

Go to the facility social worker for assistance with the transfer. They can help with faxing the records to determine appropriate rehab placement. If you can, I would tour other rehab centers to tour. Lastly, I would contact the hospital social worker to express your concerns. It may be helpful to the hospital staff to know that the facility may not be able to handle all the care needs they say they can. Some facilities have liaisons to evaluate patients for admission.

I can sympathize with you. The rehab unit that my late mother was in was ready to discharge her telling her "Ma'am, you're too well to stay here." WRONG ANSWER! DEAD wrong as she suffered an ischemic stroke there and did not live.
Good luck to you Jenny. Were you able to get in touch with the vacationing doctor yet?

It is my understanding, from what I have read here, that Medicare and medicade will only pay for actual medical issues that can have an medical end result, such as a broken leg. Other issues, like dementia are not considered treatable to a cure, thus not covered. They will not put him anywhere else, as that I not a paid coverage... I am shocked too, but that's what it comes down to... They will tell you to take him home and care for him yourself.....

Why would someone with dementia be allowed to have an insulin pump. Rehabs can handle sliding scale insulin injections but there is liability if the facility allows a patient with dementia to manage their own insulin pump. I would have never allowed such an admission if I were the rehab manager. IF the nurse has to manage the pump -- the patient should not be allowed to have an insulin pump. That's for self management and a person has to be totally with it to do that.

Hi Jenny ...

there are different kinds of insulin pumps out there, the staff are not familiar with all of them because there are too many to keep up with. Your best bet I think may be to get the product information (the make, model #, etc.,), and go online, to see if there is a printout with instructions. Perhaps you could ask the Social Worker to help printing up manufacturer's instruction

This educational information can be given to the staff to utilize. Also, the pump likely has a booklet, sometimes an instructional CD, that came with it and can be inserted into the computer to give in-service potentially using this as a tool to teach staff.

Unfortunately the competition of marketing various medical devices take precedence over the importance of continuity of care; it's unfortunate & stressful to have so many different types for everyone involved.

Most LTC/Rehab have a staff person (RN/LPN) designated as the "Staff Development Nurse" and they would be the 'go to' person responsible for ensuring this teaching (i.e., how to use the insulin pump) would be required for all licensed caretakers assigned to your Dad (they have all the staff 'sign off' that they've completed the inservice prior to caring for your father.

As long as they have the proper tools to learn from, the manufacturers try to make these devices user-friendly. Initially it's just seems so overwhelming when a staff nurse knows nothing (they just need to take a few deep breaths and know the information is out there; it just has to be found & accessible to everyone.

e.g., *print out / booklet with instructions, else a CD to watch in computer,
*perhaps there exists a youtube video to watch ?
*most all cell phones can access youtube

Staff Development RN/LPN makes it mandatory for all licensed staff to complete the inservice on this particular insulin pump before caring for him.

Many of the manufacturer's of medical devices have instructional videos, &/or a 1-800-# around the clock staff 24/hr day hotline to answer any questions. And to help customers troubleshoot if they get confused, or anxious.
The people ansering the 1-800 # are typically well trained and know exactly how to walk someone through it, one-step at a time.

Jenny, were you able to reach the vacationing doctor's answering service, or him?

AlvaDeer makes a good point about the unsafe discharge.    I'm wondering if that would be something that Medicare would grade negatively at the next review?   Maybe you could drop some hints when you complain about the social worker?  

Or just innocently ask if that complies with Medicare standards for discharging a diabetic on an insulin pump?

I would tell the rehab that, if they cannot handle the insulin pump they need to send him to ER for placement where they CAN handle it. This is an unsafe discharge on the hospital's part.

So - his doc of 10 years WILL NOT override the discharging physician even though the discharge instructions were made in error. So he's stuck in a place that cannot handle him - and they can't manage his insulin pump. I don't get it.
:(

Jenny, Plymouth has good advice.   I would think that overriding an order could be valid if it's from a doctor with comparable specialty (i.e., not a podiatrist, for example!).

Another valid option is to contact the office of the vacationing doctor.   In my experience, doctors make arrangements of advice to their staff how to handle emergencies, including referrals to doctors with whom arrangement are made for emergency back up.

They also have answering services which can be more useful than many might think.

I've had to call in emergency situations to ask the service to locate the doctor, and it wasn't long before the doctor called me back directly to address the emergency issue.

Doctors probably have iPhones and can text an order, change, or quick response enabling the existing facility to make the change from an insulin pump to shots.  

I'm surprised that a social worker, or one of the Admins didn't suggest this, but not all of them are good at addressing compromises.

So I'd call the doctor's answering service right now and ask them to contact him, and (a) either text a script, or (b) contact the DON at the existing facility ASAP to authorize (and confirm by text) the necessary change.

I hope this works out for you, quickly, and yes, I can guess how exhausted you are.    I've gone through a few situations where I just held everything together long enough to get home and collapse.

Jenny,

I believe the best thing to do is to contact the facility dad is going to and ask them if they will accept the endocrinologist‘s orders. It’s not responsible for any of us to speculate regarding laws in your state or individual facility protocols. I’m so sorry for what your dad has been through. You’re an amazing advocate and I’ll pray for a good outcome.

Jenny, I'm confused.    "....don't mesh with their instructions".   Who does "their" represent, and which is the "new facility"?   Have you found another one besides the one at which he initially was placed, or is this still the same one that doesn't have the capability to meet his needs?

I would think that whichever doctor treats him for his diabetes is the one to call to (a) get correct instructions, and (b) confirm that he needs placement elsewhere.

Okay - so, the issue now is that the new facility won't take him because the discharging doctors instructions regarding his insulin pump don't mesh with their instructions. HOWEVER, his treating doctor of many years can issue an order for his diabetic care to mesh with what the home can do. The concern is this - CAN the orders from the doctor at the endocrinologist's office override the discharging doc's orders?

I called the facility that I wanted to move my dad to and they walked me through the procedure process.

I had to stand over the person tasked with sending the paperwork from the facility we were leaving, they wouldn't get it done. So don't be surprised if you have to push them to get the paperwork sent.

It would have happened within 24 hours but, took 3 days because I was told they had done it and they hadn't done it. I ended up literally standing over the person to ensure that my dad was getting the best care available.

Jenny, someone recently asked a similar question about transferring from one facility to another, but I can't remember the post or the name of the poster.  

So I'll rewrite my suggestions:

1.    Contact the doctor who treats him for any of his conditions, or the doctor who treated him at the hospital if it was one of his regular doctors and not just the attending physician.

2.     Explain the situation to his staff, ask for a facility recommendation, and a letter concurring that the change is necessary.   This is to ensure that Medicare covers the stay at the next facility b/c of the switch.  

This is what I was advised to do when I had to move my father; I had the letter, but Medicare never questioned the justification for moving.

3.     JoAnn is correct about finding a new facility, but you could also contact the rest of your father's medical team to see what recommendations they might have, assuming that they're aware of facilities that treat his particular needs.

Select Specialty Hospitals are long term care hospitals, and treat various conditions while also weaning a patient toward being able to get therapy.   My father was in one for long-term ventilator/trach weaning.   

I don't know generally how much rehab they provide though; at the time my father was there, he physically wasn't up to doing much more rehab as he was still dealing with respiratory issues and the trach.

4.     To file a complaint against the social worker, go straight to the top at the hospital:  contact the administrator, and be sure to file the complaint in writing, asking that it be noted in the personnel records of the offending social worker. 

I would be sure though by verifying (if you haven't already) with the current facility that they didn't receive adequate medical information, and raise that issue with the administrator.

5.     You can also file a complaint with Medicare; it might be added to the list of items to review when it does its next inspection.

6.     If the hospital is a for profit hospital, research to determine the name of the holding company or owner, and write them directly as well.   

Make it clear that you would never return to that hospital.  

Please keep up updated as to your progress; this sounds like a very unsettling and frightening situation for you and your father.

We lost a bed at the "best" place today because the SW at the hospital changed the plan they had agreed to. And is there a way to file a complaint against the SW at the hospital? (Thank you, JoAnn!)

Thank you!!

Ask the SW at the rehab to help you find a facility that can provide for him. As long as another facility has a bed you should have no problem. You may have to pay for the transport though.