My dad went through routine surgery late September 24' and died three times on the table and an hour of CPR three day stay at in ICU and a couple weeks of bed rest. An acute rehab was mentioned by doctors at the hospital that was in house. He didn't qualify per the programs decision. Then we were handed paperwork containing nursing homes and rehabs only. Not told to try other acute rehabs or acute care hospitals(we had no idea of acute care hospitals until his last stay at the most recent nursing home per insurance case management, and thought that to get into acute rehabs you had to be more mobile). Now that we are after three nursing homes/ rehabs and finding out that most of these places are one size fits all and the insurance is denying going to a acute care hospital(we are in appeal process now) as of yesterday. What do I do if he wasn't give the proper guidance right out he gate from social work?
On in-pt rehab facility, a facility like this is super specialized; all abt rehab without custodial care only residents of a Nursing Home. Type of patient will likely be one that at the moment b4 the trauma was healthy & fit, competent & cognitive, probably still working. Someone with no major health issues so no serious comorbidities like advanced HD, diabetes, RA, no cancers unless in remission or past 3-5 yr mark. Trauma from something like a massive car accident (eg through windshield then a roll off) or a stroke or a workmans comp incident that or a sport injury (hit by the boom while sailing). Trauma event that has hospitalization with several procedures done (eg brain bleed management, cornflake surgery 4 facial bone damage) plus have TBI (traumatic brain injury). Once stable at the hospital only then off for rehab for weeks if not months in specialized rehab. A place that does TBI work will have them there for weeks if not months. Long slow intensive process involving PT, OT, ST. If this does not sound like your Dad, that’s why it wasn’t where he was discharged into. I’ve know 2 to go into these: 1 was early 70’s Sr ptnr @ white shoe law firm, 2nd marriage w/2 in elementary (went to school with ours); horrific auto accident, ER to stabilized then move to bigger teaching hospital then to TBI rehab place. He was there abt 3 mos and stopped progressing so health insurance stopped. Transferred to a NH as a custodial care resident; died maybe 2 years later. Other was a sailing accident, hospitalized + surgeries, 2 mos specialty rehab, back to work and back sailing although wears a helmet & no air travel. Both big healthy guys, working and active with better employer health insurance. They are imho the ideal candidate for specialty rehab place.
On the LTACH, those tend to be a free-standing facility connected to a hospital by a sky bridge or a separate floor or wing within the hospital but run by the LTACH. Neither you nor I can enter an LTACH directly, admission by MD referral only. It is procedures driven for patients who are very very ill &/or have involved medication management. My MIL early 80’s went into one; she was in a Nh & got pneumonia, off via EMS to ER then admitted; pneumonia persisted then sepsis; NH would not take her back; admitted to the LTACH as super septic and cascading organ failure. She was there not quite a month, then died. What was interesting to me was how many younger folks were in the LTACH. What I was told is they were mainly end stage cancer patients on involved medications (lots of black box drugs). There was no rehab sector in the LTACH as all intensive clinical care. As technically a hospital, it’s a health insurance benefit, so Medicare Part A coverage or your employer coverage. Runs on a 30 day cycle then discharged. Although a fresh ICD-10 might be added to have them stay beyond the 30. Kindred (I think they got sold so has a new name) is the big player in free standing LTACH nationwide.
Does Dad “fit” either? The way described, especially if discharged from ICU & home w/2 weeks bed rest with no inhome PT/OT, is that he did not have probability to do the progress that rehab requires. That 2 weeks post discharge would have been the window to get rehab going. That yo-yo of 3 NH/rehab stays is a bandaid on a bigger issue that he is not going to ever go back to what he was & it’s the point of: can he live safely & securely @ home? or needs 24/7 oversight in a NH? possibly a candidate for hospice?
Not to be harsh, but upset with SW, MDs suggestions only goes so far as ultimately it was his or his POA decisions made; & doing a medi-mal lawsuit if over age 74, usually goes nowhere.
The key here is to get them placed in the right level of care. You are right that this will be so very expensive. I am so sorry.
When you talk about an acute care hospital, do you mean a rehab facility? If he’s made significant progress and now would tolerate intensive therapy, he might be considered. His current therapists could have influence in this situation.
I don’t think that your belief that you received improper guidance will have any impact on his situation now. I’m sorry for the situation you are all in, it’s never easy.
"Acute rehab refers to an intensive, specialized rehabilitation program that starts immediately following a severe injury, illness, or surgery, like a stroke, brain injury, or major trauma, where patients receive high-intensity therapy to regain functionality and independence in daily living activities, usually taking place in a dedicated inpatient hospital setting; it involves a comprehensive approach with physical, occupational, and speech therapy, often with 24/7 medical supervision."
How old is Dad? Does he have Medicare? What are his Medical conditions? This info is important for us to give you better information. Because Medicare and insurances determine how Dad's care is handled after a hospital stay. You can't blame the hospital.
You said that Dad did not fit the acute rehabs criteria at
the hospital. That maybe why you were not given other Acute rehabs names, he did not fit the criteria for any. The SW may have called around and found jo acute rehabs would except him. Maybe none were within a certain mile radius. The SW gave you a list of names of rehabs and NHs that they felt your Dad would get into. I am surprised that you were not asked to chose one and the SW set it up.
What are you being told at these rehabs about Dads ability to rehab? If on Medicare, he is probably coming to the end or done with his 100days. If he didn't qualify for acute Rehab back in Sept why do you feel he will now? He has to be able to do the therapy.
He was evaluated for the Hospital program, and he didn't qualify for their rehab. Generally, disqualification for acute rehab coverage will follow him when application is made to other facilities.
You currently are in appeal, which is the proper direction if you are told he cannot qualify, and you wish to appeal that decision.
A decision will be made on this appeal.
I know nothing about your dad's decline these last 3 months, nor his case, of course, but it is quite certain that acute rehab does best work when done on acute basic ASAP. It sounds as though the experts did not believe your dad would benefit from acute rehab; there would be no other reason to decline him, as this is a covered service, one that MAKES money for the hospital.
In general, if you have a complaint about hospital services I would speak with said hospital about the way in which to follow up with filing a complaint. Consider also making an appointment with the Hospital Ethics Committee.
You can also consider contacting (information will be found online) the JCAHO or the Joint Commission on Accreditation of Hospitals for information on how to file a complaint regarding your hospital. They are responsible for the licensing of hospitals and are the people to investigate claims of substandard care.
I wish you good luck and hope others have some other ideas with you.
Basically, your appeal may be the last chance for acute care rehab. We can't really know anything about your dad, his condition, nor are we rehab experts, so we cannot guess about the rightness or wrongness of this hospital's decision.
I hope you'll update us on how your appeal was decided.
"Proper guidance" is a perception or an opinion. You "...thought that to get into acute rehabs you had to be more mobile" was an assumption made by you. You can try a complain to that social worker's superior but it will be he said-she said situation. Keep appealing to the insurance company and tell them that if the staff would have presented it as an option from the start that you definitely would have taken it at the time, and not in hindsight.
I just got through dealing with an emergency hospital stay resulting in an in-hospital hospice situation for another elderly Aunt this past week. I get how it's like drinking from a firehose with info and people and forms and decisions. I wish you success in getting appropriate care for your Dad.