zephyrine3147 Asked November 1, 2024
Can a rehab facility discharge my husband, who had a stroke five weeks ago, when I am unable to care for him?
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My husband had a stroke and is in rehab. Right now he is incontinent, can hardly communicate, his fine motor skills are compromised and he is not too stable on his feet. He is very frustrated and unhappy and wants to return home. He refuses physical/occupational therapy. I have secondary progressive MS and cannot take care of him. But the rehab facility wants to discharge him in 10 days for lack of progress. I have no idea how to deal with this situation and what my options are. I am completely exhausted and need help myself.
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I'm sorry you are going through it
That does NOT mean he needs to come home with you!
He needs to be transitioned to a skilled nursing long term care facility. (Rehab skilled nursing is considered short-term).
Make it very clear that YOU CAN NOT TAKE CARE OF HIM AT HOME!
There should be a social worker who can give you guidance on your options.
If they have not already spoken to you, then ask to consult with a social worker.
When I was facing this 9 years ago, a county social worker let me know that my husband qualified for Home Based Community Services through medicaid.
In our case, he was being kicked out of the long term nursing home due to unmanageable behavior. He was rolling out of bed onto the floor and scooting across the floor, trying to "go home". He couldn't walk or talk and was in diapers, with a feeding tube because he couldn't chew and swallow food.
With the Home Based Services, you could try and find home care for him.
That can be a little daunting, depending on where you live and what your needs and budget are.
For me, it became clear that continuing to work full time while relying on a care provider to come to the house every day was nerve wracking. I was afraid my job would be compromised if a person didn't show up or was late. My job performance and my husband's care would both be compromised if I had to come home after working 8 hours to take care of him the rest of the night.
I learned that I could be paid as his full time caregiver, and that is the choice I made. That is how I became a caregiver for my husband.
It all happens so suddenly and unexpectedly. I don't think any of us ever really plans for this. And if we do, we think it will be easy as we offer loving kindness to our loved one. It is the hardest job you will ever do! And, without the support of the person you rely on to be there for you in hardship.
You are right to understand that you Can Not try and take care of his needs on your own at home. The first step is to get him admitted to a nursing home for now. Then, you can think about any other options which may be more suited to his needs. Permanent long term care may be where he stays.
Apply for SS disablility now. It is a long application process and there is a 9 month waiting period for benefits.
Let your husband know how hard this is on you, and what his future looks like if he refuses therapy now. He WILL end up in a nursing home. Perhaps that will light a fire under him and he will want to give therapy a try.
I would bet that the Medicaid or Medicare has already told the family that Medicare and Medicaid are not paying for further rehab.
They will help with placement, but placement must happen here now or this family is going private pay. They will have already received the papers regarding medicare/medicaid non-payment for longer stay.
I was in a huge panic trying to find an AL for my mom when she was in rehab after a fall and they wanted to discharge her. It's not easy. I'm sorry. And he won't make it easier. Of course he wants to go home, but that's not realistic. Don't let him convince you otherwise, just say that you are sorry that it is not possible.
Your facility will have a discharge planning committee and it is usually run by social services. Go in today and request an appointment.
We as a Forum of strangers cannot help.
THEY CAN.
You will tell them what you told us and you will tell them that your hubby cannot return home and will require placement. They will have questions about finances.
Your second stop will need to be an Elder Law Attorney about your finances. Take all relevant budget outlines with you as to your assets and your expenses. You may need division of finances to protect your own assets for your own care in future.
I am hoping there is family, close friends, faith-based community, SOMEONE to go with you to your attorney appointment; it is difficult to hear and measure choices and you need two heads taking it all in.
So Discharge planning is first step.
Ask the social worker to explain WITH YOU to hubby that he will not be returning home until he can regain his abilities, so he needs to work hard, and meanwhile he will be in rehab, then move to care until he can recover more. Do NOT EXPECT happiness around all this; why WOULD HE BE? This isn't a happy time. It is worth mourning and crying, and even worth rage. But this is what has happened, and it must be handled a day at a time.
So get in there right away today. Over the weekend gather together all your financials and plan to attend an attorney. You are going to ask for an hour of advice about "options for division of finances while hubby is in care after a stroke". Tell them you need to "buy an hour of their time."
Good luck. I hope you will update us.
Remember, this is not now about what ANYONE WANTS.
Remember the magic words "UNSAFE DISCHARGE:" say it over and over to the rehab center; let them know you are ill and cannot care for a stroke victim, and any attempt to transfer him home to you would be considered under the law and unsafe discharge. (This can lose or threaten their license to operate).
You make it perfectly clear that you can not "Safely care for him at home and to discharge him to home would be unsafe for him as well as for you"
The determination if he needs Long Term Care facility, Skilled Nursing can be discussed. And if you need to begin the process of applying for Medicaid.
If your husband is a Veteran it is possible that he may qualify for some benefits through the VA. You can contact the Veterans Assistance Commission or your States Department of Veterans Affairs. Both can help determine if either of you are due benefits.
If you have not seen an Elder Care Attorney now is the time. Make sure all the paperwork is in order so that you can make the decisions you need to and be able to access accounts if and when you need to.
Are you his PoA? If not, is anyone? If someone else is his PoA other than you, this is the person who now must step and help figure this out. If he doesn't have a PoA then it will be you. Other than a facility he could have in-home aids, if this is something you can afford and live with. If you say you need help yourself, maybe you both would benefit from hired aids, or you both transition into a care community (one level of care for you, another for him). I'm so sorry for this situation and your stress and exhaustion. May you receive wisdom and peace in your heart as you make decisions and find solutions.
You can ask if this facility has any long term beds available or one will need to be found at another facility . I’m sorry that no one there is telling you how to deal with this situation .
Once you know the level of care he needs , you will have to start looking for a bed for him . If the social worker at rehab is not helpful , you could call your County Area Agency of Aging to help you . Or on this website under finding senior care , a place for mom , will help you find facilities .