My bil (AF vet) got covid after many years of avoiding it. He is highly immune compromised due to treatment for cancer. He even made it through his daughter's wedding this past November -- he and my sister sat at a table in the corner far away from people. His oncologist told them both to wear a mask anywhere and everywhere, and that is what they have done.
Dec. 23, he went to a local restaurant to pick up their meals for the next several days. Staff refused to bring the food to the car as they usually did so he had to go inside where it was shoulder-to-shoulder people. Yes, he had his N95 mask on (but as we all know, the effectiveness of masks is questionable). Five days later, he had symptoms, tested positive two days later and hospitalized Jan. 19.
For a while it was touch and go. Seven weeks ago he was put on a ventilator and PEG for feeding. Ten days later he was transferred to a hospital within a hospital that aims to get people off the vent. They were successful and the ventilator was wheeled out of the room ten days ago. Tracheostomy was removed this past Friday.
In the last week we have seen his recovery leap forward. He is of sound mind (for a while he was delusional), talking, eating, drinking, able to sit himself up in bed and move to the side of the bed and "dangle" (apparently "dangling" is a big thing). With assistance he can stand for short periods and transfer to a chair. He is not yet toileting on his own.
The place where he currently is says it is time to take the next step and be moved to another facility within the next week or two. My sister assumed they were talking a rehab facility but the VA only approves a SNF for him. In her thinking, a SNF is a way of giving up on him and she wants him in rehab.
Please share your experiences to help me understand better why VA is pushing a SNF instead of rehab.
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My sister said their other insurance (not VA) has approved her husband for a number of facilities of her choosing. All that she needs now is an open bed at one of these facilities.
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I would check and ask about this SNF in terms of their rehab, PT, OT regimine, as they vary a whole lot. Some have quite a lot of rehab and some almost none at all.
With this level of improvement I think it is very unlikely that they are "giving up on him". He appears to be getting so much better in leaps and bounds.
I am assuming you have asked this question of the "powers that be" here? And what have they said to you?
He truly is moving forward from a near death to recovery, and like you I hope he gets wonderful support. I couldn't wish him more luck. I am so glad there is motivated family looking in here, because in this case it may make all the difference.
I hope you'll keep updating us here.
I'm only doing bits and pieces of research for my sister. She has a DNP (but has been bedside for about twenty years), so doesn't really need a lot from me.
No specific place has been mentioned but on her own, she found four rehabs within reasonable distance of their home that she was going to ask for a referral to. Johns Hopkins where he has been inpatient several times, University of MD since that's where she graduated from, an Adventist place, and one more I can't remember.
I don't think she looked at SNFs with rehabs because when our mom was in one, it was a very depressing environment and you had to wonder what, if anything, was being accomplished, other than folks marking off the checklist of what they did for that person that day. (But I will also say my mom was stubborn and rebellious and uncooperative and angry, so you get what you give, right? They probably had meetings where they drew straws to see who had to deal with her that day.)
Yesterday there was no discussion with the case manager about placement.
Or are they recommending long term custodial care.
That is the differentiation she needs to ask about. It's the SERVICE she needs to ask about, not what facility it happens in.
I have a friend who recently had a horrific fall and brain bleed. The hospital recommended subacute rehab. She and her husband fought like tigers to get her to acute rehab at Rusk-NYU where she made a complete recovery. Support from her neurosurgeon helped.
Clarify what's being recommended.
Also, if they are recommending ltc WITHOUT rehab, ask for (i.e., demand) a care meeting with the rehab team and go over their assessment of BIL's current condition and progress. Is it an accurate assessment? Or is it based on a previous assessment?
Don't be shy about ringing up the office of his local elected officials and getting support from the person who advocates for Vets and elders.
My sister has tried very hard to work with the case manager and not be perceived as going against the case manager and causing resistance from her, but the cm is stuck on a SNF and won't consider other options. And because that is what the cm has determined, that is what VA has determined. My bil called the VA himself on Friday. (His tracheostomy has been out for over a week and he is eating solid foods. I think the PEG will be removed this week.) Their secondary insurance (to what VA offers) will cover one of the facilities my sister has found, including the one his oncologist prefers. And his medicare kicks in on May 1.
Your sister may want to ask more questions about the plans for his care and therapy before concluding that the type of facility is the determining factor in how his recovery will go. It wouldn't surprise me if the combination type facilities were a little less expensive than the rehab-only ones since there is an opportunity for gaining a permanent resident. Spoiler alert: that is what happened with my mom when, after a second fall, she liked the facility she did her rehab in so much that now she's planning to move into an independent living apartment there.
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