Do rehabilitation centers sabotage insurance paperwork to force people into long term care?

No. Showing improvement is not the same as “progressing” in rehabilitation. Sitting up in a bed & eating is a basic ADL (activities of daily life). Progressing will be precise measurements and repetition of specific exercises based on the ICD-10 codes she left the hospital with. And the latter is what Medicare will require in order for her to stay on post hospitalization rehab in a SNF. That her rehab therapist filed for an early appeal for her, to me, shows they really quickly realized that she was not be “progressing” per the usual schedule and were very much proactive in trying to get her care plan extended. Appeal denied.

I’m with the others that whatever TBI she had is way more intensive and involved than what you as her family realize. This may be hard for you and your family to accept. NH has to know what her long term care placement will be as they cannot continue to have her now as a custodial care resident without a decision made by family as to how payment will be forthcoming as Medicare rehab patient care has stopped and Medicare does not pay for custodial care. Right now while it’s in appeal, NH cannot force a payment but once the 2nd appeal determination is turned down, they can and will seek to place financial & legally binding responsibility onto someone or they will find a way to get her out of their NH. If she has no resources, then y’all need to speak with the NH asap on her filing for LTC Medicaid & becoming Medicaid Pending if this Nh participates. Or find a NH that does & will.

Right now for most States LTC Medicaid, its income max of $2829 and nonexempt asset max of 2K. If over assets, then by & large end up doing a legit “spend down” by private pay for her care till eligible for LTC Medicaid. Liquidating assets by private paying for care is what folks flat use do to eventually become eligible for LTC Medicaid. The NH & the PT are not in collusion on this.

Otherwise if family does not pay or take her into one of their homes, what tends to happen is a NH will find a reason to call EMS to take her to the ER and then refuse to take her back. Then the hospital discharge planner will then contact you to come and get your mom. Beyond stressful for all, please try not to let things get to this type of situation.

Your mom’s situation is a bit different as a surgery is planned. & what I’ll guess this Nh will likely do is try to get her next scheduled surgery to move up so she exits asap.

Please realize the bill she is accruing for her now custodial room&board still will exist. Nh will seek to get someone to pay. That she had an unpaid bill at this NH will appear should a future NH run a credit check.

fwiw I’m in PT right now as a follow up to getting Euflexxa shots on one of my knees. PT is one I’ve seen before for post surgery rehab in the b4 Covid times. It’s a free standing rehab center with PT & OTs. Anyways they do not take Medicare post hospitalization rehab as Medicare requires reporting on a schedule into the Medicare online portal for progress in order for coverage to be in force with progress determinations within 24 -48 hrs. This place does a weekly update approach, more sports medicine rehab guys. I’m mentioning all this as what probably happened for your mom was that every day for those initial 2 weeks ended up with the PT / OT filing their required timely Medicare notes as “insufficient progress” or “non-compliant for care” and rehab had to stop. There unfortunately is nothing to appeal as her chart shows no measurable “progress”. It is what it is.

Is she participating in rehab?
Is she making progress if she is?
If she is not participating and if she is not making progress Medicare will not continue to pay for rehab.

"Do facilities weaponize insurance denials to liquidate patient's assets?"

How are we supposed to answer this question? You are insinuating that a rehab facility is in collusion with a LTC facility? The LTC facility gets "customers" but many require Medicaid, which doesn't reimurse them much. Unless it is privately owned, then only the "corporation" benefits. And they'd need to do their own bookkeeping/accounting to cover it up. FYI LTC facilities have no shortage of "customers"...

How would the rehab facility benefit? Through kickbacks? Again, unless it is privately owned, then only the "corporation" (and not individuals) benefit. An audit would flush this out.

100 days is not a guarentee. Medicare pays 100% for first 20 days and 50% 80 to 100 days. MIL is responsible for the other 50% unless her supplimental picks up, which my Moms didn't. She owed 150 per day back in 2016 which would have amounted to 12k if she had been in till 100 days.

Medicare Advantages are contracted out by Medicare and must follow parts A & B guidelines. But they are a b***h to work with.

Someone is saying Mom is as far as they can take her and Medicare agrees. There is no getting better because the infection did damage. Does she see a neurologist? Maybe she needs tests run to see where she is brain function wise. In the meantime, if there is no one to care for her at home, maybe place her for now in a SNF or AL. See if she can continue to have therapy. My Mom had it at her AL as an "in home" thing.

My guess is she is not on traditional Medicare, but in an Advantage Plan (read "dis-Advantage Plan). I have observed this multiple times - where patients in rehab who are on Advantage plans have to fight for the coverage and an appropriate length of care. I suggest continuing with the appeal regardless of whether your make a move.

If moving her to long-term-care (perhaps under Medicaid?) is an option, is there a reason to reject it? You can always take her out of LTC.

You can "hope" as much as you want, and I encourage that, but the opinion of the experts in rehabilitation are not seeing progress and do not believe that it will/can be made. After this amount of time trying and assessing the probability is that they are correct. You are now also dealing with a decubitus ulcer which is in and of itself life threatening.
You have appealed.
It has been denied.
There is no one anywhere who wants to think that progress cannot be made by their senior with exemplary care, but the fact is that is often the truth, and that Medicare will not cover this care "just in case" progress can be made.

You need a long discussion with MD and possible brain scans should be done to assess the current known damage to your MIL's brain so that decision for long term care can be made. You need also to know that wound care can be done in-facility.
You need to know where this decubitus happened and be certain that it was reported to the state as is necessary in almost every state.

I am so sorry. You may be looking at palliative and comfort care, possibly even hospice care soon. It does appear that the damage to your MIL's brain was severe. I know that's hard to accept. I wish you all the best.

What kind of insurance does she have?

My mom’s Medicare paid for her entire 100 days in rehab. Even though my mom was in her 90’s she was still able to do her exercises. Mom had Parkinson’s disease.

Also, was she able to fully participate in the exercises? Rehab is a pretty rigorous program. If she wasn’t able to keep up, they won’t continue working with her.

Has your mom ever done a home health program? If so, was she able to progress with that?

Home health care is good. My mom’s doctor ordered it for her and she did well with it. If she wouldn’t have shown any improvement, Medicare would not have paid for it.

What are they doing to help heal her bedsore? That has to be treated. Is she experiencing any pain that is preventing her from doing her exercises?

What exactly did they say to you? Did you have a meeting with the staff? Please schedule one if you didn’t.

Best wishes to you and your family.

It’s not the rehab center , it is Medicare denial that is the problem. Does she have one of those Advantage plans? If so, it is not surprising she is being denied. Your fight is with the insurance company, not the facility. If you don’t win that fight, you have to decide whether to self pay the facility for continued care, and eventually apply for Medicaid, or take her home and care for her at home. Good luck to you.