Surgeon and physical therapist okay'd release from rehab. Rehab says no. Can they truly keep her?

March into the administrator's office and tell him/her that if the patient is not delivered home properly within 24 hours that you will make sure they do not get paid by Medicare, that you will file a complaint with Medicare, and sue the facility if they try to bill the patient.
Patient must be home by now, right?

GardenArtist, unless this town is back in the 1940's and still using party-line telephone service where noisy neighbors can listen in :)

I remember as a small child visiting my grandparents in the mid-west, the wall phone would ring but neither Grandma or Grand-Dad would answer it.... being a kid I had to ask.... well, it wasn't their *ring*.... eventually I learned which of all the rings was theirs :) Even the local grocery store had a special ring to all the houses so that the people could hear what were the current items on sale.

FF, good point. This town almost sounds like the legendary Camelot - a community taking care of 2 men, cohesive, tight knit.

But I've been confused about something. Apparently the only permanent residents are the 400. The temporary residents are the students. But then I'm wondering about those figures - Sunshiney wrote that " It's a college town and when you remove the "kids," there's only about 4,000 people/adults left". Isn't that the reverse? With the "kids" wouldn't there be more than only the 400 permanent residents? But in the original post Sunshiney wrote:

"First, there are three rehab choices in this small rural town of 25K."

400, 4,000 or 25,000 residents? I must be having a "math moment". Am I missing something? Maybe I need more chocolate for brain food?

It certainly doesn't sound idyllic, though.

"There's a couple of attorneys in town that we could call. You have to remember that when you live in these small towns, everyone knows everyone and everyone's business, too. One phone call to an attorney will be known by the nursing home within an hour and I could guarantee that."

That's despicable, disgusting, and a violation of attorney client privilege. Any attorney who reveals privileged information needs to be reported to the state bar association.

Sunshiney, whatever you do, do not move away from that town.... it is truly amazing that a town of 400 has a hospital plus 3 rehab facilities.

The small town my Dad grew up in out in the Midwest, similar size to yours doesn't even have an urgent care facility.

Fourth sentence should read "this is 2015".... sorry for the omission. Computer gremlins are busy today.

Flyer makes some good points which I hadn't considered. Between the husband and son, I would think they could make their own meals. And watering plants is pretty simple. The support of the community is wonderful, but this 2015 and men have become very self sufficient in meal prep and house management.

I'm wondering if this small community is one of the rural religious communities in which men and women have very defined roles, and the women are the caregivers. If so, that could be a reason why the husband and son haven't stepped up to challenge the nursing home.

Perhaps they're really not prepared mentally or physically to provide the care your friend needs.

That makes just as much sense as the nursing home admins having an ulterior motive.

Sunshine, oh my gosh, you mean your friend's husband and son needed to be fed by a village of people, for the past 5 weeks if not more? Plus someone comes in twice a week to clean the house and water the plants?

Can't those fellows do things for themselves or do they have physical decline problems where they are unable to fend for themselves... and that is why the rehab facility felt it was better to keep your friend there until her ankle got better?

I am just trying to get a better picture of this situation.

Call the patient's rights advocate, should be available to any patient in a facility. Unless the gov't did away with this job.

Rehab is typically a voluntary activity. If goals are met, the individual services such as PT and OT and speech therapy would discontinue, and discharge would be planned, so on the face of it this doe not quite make sense. Just keeping someone for as long as funding is available is generally wrong too. A facility may feel an obligation not to discharge to an environment they know is unsafe. You can typically demand to discharge against medical advice, though then the costs of the stay may not be covered. The big question is whether that would really be best, versus fixing the concerns at the home which may be very valid...or may be a total smokescreen for a profiteering rehab center that is not worthy of the name and is trying to keep paying customers as long as possible. Maybe get an independent OT or PT home evaluation done...then involve the ombudsman or office of long-term care to find out what the discharge requirments and goals for a non-AMA discharge would be, or consider requesting transfer to a different facility on the grounds of not getting services.

Here is my 2 cents. When I needed PT, I chose which place I wanted to go to. It's kind of like which pharmacy you will use. If my doctor would have told me which one I was to use, I would have told her to take a flying leap, I was going to use the one I wanted. It sounds like your friend is being held against her will. Even if it is a very small town, go see a lawyer about getting her out of there. The lawyer is bound by confidentiality however small the town is.

Something else to consider is that if your friend isn't certified as needing this care, Medicare will not pay for it. And from your description, she's getting meals but no care.

Your friend's husband could be left holding a big nursing home bill in his bill paying file.

Sunshsiney, thanks for the explanations and insight. Given what you've written about the closeness of the community, you might want to consider an attorney with specific elder law attorney in a larger city. Even if the family has to drive a little farther to meet with him/her, it could be done w/o being part of the local community knowledge network.

There's another method and that's to turn the tables on the admin who's being so arbitrary. The husband can ask for (demand?) a care conference (many here have been through those), take some supporters and pose very specific questions, such as what are the goals for this week, the following week, and for discharge? How are these to be implemented? There HAS to be a plan. Grill them.

Someone who's really gutsy might also mention being held against one's will, something to that effect. I suspect given the description of your community that this wouldn't be in their nature, but it might be time to consider getting tough. i still think something's wrong and needs to be addressed,

Also, I don't understand why a group of friends don't just come in and take your friend home. She's not in prison....or is she?? Seriously, there's something odd about this whole situation.

@freqflyer thanks for writing. Boy, I was tallying up the age of your dad who you wrote was 90 a few years ago and then had surgery a few years later. He must be nearinig 100 now? You have great longevity genes!

I can relate to what your mom went through. My husband died here at home -- 2 years of me caring for him as he died from head/neck cancer. I recall trying to get hm to the bathroom. What a job! But I would do it over again in a heartbeat.

Fortunately, not everyone gets osteoporosis as they age. My dad's family is not around to ask but on my side there is zero osteoporosis but there are strokes...and thyroid. And, I have the thyroid issue but so far I'm the only one to never have even a tiny stroke. Knock on wood.

Where I live, people live very long and healthy lives. As I've watched, I've noticed they never sit. I know few people here who even watch TV, interestingly enough. As they don't seem to give a hoot about what they actually eat -- red meat from local cattle galore....eggs from our yards... gardens are shared... our wheat is locally grown and milled... milk is from the local farmer's dairy... I truly am becoming convinced that the secret to health is moving and doing a good day's physical work every day. There are no gyms here so it's gotta be the physicality of life here... and no freeways..no smog... Maybe...

@jeannegibbs Thanks for your words, Jeanne. Sorry to hear about that motorcycle accident and your son. I love those bikes but one hiccup...and kaboom...

This friend was the manager of a rural phone companies branch office in town. She's gentle but firm. She's perfectly healthy other than this ankle break. The admin there has been rather overbearing and equally firm in her "this is what you must do" approach. "I realize that as a friend you may not know all the details of the situation" -- ha...I wish I did not know all the details but yes, I do. We live together in an old-fashioned rural town of only 400 people -- wealthy farmers. There are no strangers here. Nearly everyone here is related to others in some way and about 80 percent were born here. I moved here five years ago and was overjoyed at the old-fashioned values and safety found here and the connectedness. It's not unusual. All of the tiny towns around here are similar in that way. So, no, she's not alone...not by a long stretch...or unknown. Privacy is not part of small town life, unless you're just simply wierd. lol...

Thanks for the comment re "typical." I found someone who is friends with one of the hospital board members -- it's a public hospital district paid for by community tax dollars -- who is going to privately ask them questions. Thanks for the nudge re this.

@GardenArtist -- You wrote: "There is another possibility and that's that what your friend believes is available in care at home is not what her husband and/or son want to provide. Do you know the family dynamics? Are the husband and son supportive of her desire to return home now?"

Yes, I know the family dynamics as does everyone is our small town. We live in a town of only 400 people, very well-off farm families, predominately, and we're all very, very -- did I say very -- connected. For the past 5 weeks, the father and son have had their meals taken care of daily by somone in town. We rotate the meal- making, coordinating it through one woman in town. Twice a week, someone different from town cleans the home and waters. Every day, she has more than enough visitors and card games and dinners from those of us here in town. Last night, six of us did Bible study in her room at the nursing center, where we say, again, how great she looks. Not on any pain meds even.

Yes, we all know the family. And no issues there. She not only has family, she has a town of 400 to care for her.

Re the PT or OT comment. I wonder if it's because there is no PT or OT within the nursing home itself. Both are provided by a separate company in that little town. And that's wise, given the size of that town. It's a college town and when you remove the "kids," there's only about 4,000 people/adults left. But, yep, the admin does the inspections.

I smell something fishy too. But maybe it's just being too careful. I spent time reading Medicare rules about discharge. Wow.

There's a couple of attorneys in town that we could call. You have to remember that when you live in these small towns, everyone knows everyone and everyone's business, too. One phone call to an attorney will be known by the nursing home within an hour and I could guarantee that. So we tend to be careful when we're exploring options. Actually that's why I came here. More privacy.

P.S. I forgot to mention that the lead physical therapist came out to my parents house to inspect it for safety. They made some suggestions to help make life a bit easier for Dad once he was finally able to walk under his own speed. You'd think that would have been a wake-up call for my parents to downsize from that 3 story house.... nope :(

Sunshine, when I was your age I was a gym rat, doing cardio, lifting weights, could hike for miles on end... was in excellent health... but please note as you age we do get issues with osteoporosis, it doesn't matter how much calcium you take, it can still become a speed bump in recovery should one break a bone. Some women and men don't even know they have it unless a bone density test is taken.

A few years ago my Dad had a heart attack and it was highly recommended that he go into rehab but my Mom dug in her heels, she said she could take care of him at home.... she didn't even want physical therapists to come to the house. May I mention she was 90 years old when this happened. How quickly she learned that she couldn't help my Dad to the bathroom or even up the stairs. Dad just sat in living room in his recliner 24 hours a day, his muscles getting weaker and weaker. Because of not getting the proper rehab until weeks later and Mom being so stubborn, it caused Dad not to fully recover.

Couple years ago Dad needed surgery and afterwards it was highly recommended that he go into rehab... this time my Mom said "yes". She had learned the hard way.

My son had a serious motorcycle accident last year. After a couple of weeks in the hospital he was to go to rehab. His wife went hither-thither and yon scoping out about a dozen rehabs and they narrowed it down to 3 that met their criteria. They took the first of those that had an open bed. NO WAY should the hospital or doctor be dictating which rehab your friend must use. When my son and DIL asked the surgeon about the places they were considering she said things like, "they do excellent PT and they also do drug rehab, so consider if you'll be comfortable in that environment," "They have a great reputation in the medical community but I haven't had a patient there yet so I can't speak for experience," and "Several of my patients have used that facility. They made good progress and I didn't hear any complaints." Putting undue pressure on which rehab to use seems very fishy to me!

My DIL and I prepared their house as well as we could before the release date, putting furniture in storage, taking up throw rugs, and converting a four-season porch to a convalescent room. When the main physical therapist inspected the house he noted that the bathroom door would not accommodate the electric wheelchair. So they ordered a bedside commode. They ordered a temporary ramp for out the front door. They ordered a hospital bed. I agree with GA that therapists are creative in finding solutions; and they're the ones who should have been doing the home inspection.All of these temporary measures were much cheaper for the insurance company than staying in rehab beyond the point where it was necessary. The insurance company was getting VERY insistent that a discharge take place.

My son is a well-educated professional, with good people skills. He is not easily intimidated. He remains polite and reasonable, but looks out for himself. His wife, a teacher, is an awesome advocate. I feel sorry for older folks who often are treated as invisible anyway and are very vulnerable when ill or injured, trying to get respect and their rights in an adverse situation.

I realize that as a friend you may not know all the details of the situation. But from what you wrote it sure seems suspicious. I think your friend should get an ombudsman involved.

As for your own situation, you now understand you need to stand up for yourself and also have an advocate on your side. But rehab centers can be a very important step between hospitalization and going home. I hope you never need one, but if you do, please be assured that what you are describing is not typical.

First, it's unfortunate that the hospital, or rather the treating physician, was so adamant about choice of the rehab facility. On the other hand, there may be significant differences in the rehab, PT and OT provided by the three, and that may have been a factor in his/her choice. Still, the family was entitled to an explanation why the choice was made, especially since reading the rest of your post, I think this facility is milking your friend's stay.

Second, there's something amiss in the different positions taken by the rehab staff and physician vs. the admin staff.

We did experience this as well when my mother broke her leg. Her orthopedic doctor, not the SNF doctor, cleared her for release. Admin wanted to keep her longer; I don't recall what the therapy staff's position was. It helped that my sister was a nurse and wouldn't be intimidated. Neither would I, having worked for lawyers for years including some who specialized in medical malpractice.

We decided to bring Mom home; it wasn't AMA because in our opinion the only doctor who mattered was her orthopaedic doctor, and he was in communication with other treating doctors (not the SNF doctor) who were in agreement. So Mom came home.

If your friend isn't getting any nursing, care or therapy, and she has care at home, I think there's something amiss at the Admin level when the position is taken that countermands the physician and rehab staff. This smells like a ripoff, designed to keep her there to maximize Medicare benefits.

My suspicion is strengthened by the fact that the only complaint the Admin rep made was something that would require MAJOR retrofitting - one doesn't enlarge a hallway or bathroom without moving walls. Query how your friend managed before?

I'm also surprised that someone from Admin did this so-called inspection. In my experience, it's been either reps from PT or OT or both. That was the situation when Dad broke his hip. However, and this is important, they made alternate, workable suttions.

In your case, I'm wondering if your friend uses a walker or rollator, which likely could get through smaller hallways. Grab bars are mandatory. Therapists are creative in finding solutions; they're the ones who should have been doing the home inspection.

If your friend's family isn't comfortable advising them that they plan to take her home, they could get an ombudsperson involved - they offer advice and guidance on situations with nursing homes. They could call your local Area Agency on Aging, or do a google search for ombudsperson agencies in your area.

There is another possibility and that's that what your friend believes is available in care at home is not what her husband and/or son want to provide. Do you know the family dynamics? Are the husband and son supportive of her desire to return home now?

One thing that might be interesting is to google the nursing home, then google the same name followed by complaints. Also check the Medicare web site with lists of facilities and see how it was graded. That might be ammunition for your friend's family to use to get her out of there.

You could also research elder law attorneys, check their websites and see which ones focus on nursing home malpractice and issues. For a few hundred dollars, a call from an attorney or a letter with a medical records release might shake up a few people and they'll find they'd rather release her than battle the family or an attorney.

Oh BTW, you can also check on the doctor who was insistent on going to that facility. Medicare just completed a large sting in which numerous people at different levels in the health care profession were rounded up for fraud and collusion.

Good luck. I hope the husband and son take a stand and stop this situation, if I'm reading it correctly and am also correct in suspecting some collusion.

Rehab admin may think that but when do they become our all-knowing parents with the power to assume and make decisions from those assumptions? That's the part that baffles me.

I would have thought that her doctor's approval to go home and PT approval would be sufficient but to think they now inspect your home, too?

I guess this is good for me to know -- that they have so much power over one's life --

There's plenty of beds in the other rehab places. Plenty. This is a small rural town far some 90 miles from the next town, which is the only city in the eastern part of our state. All else is tiny towns with many miles between each.. The other two rehab places are newer and very pretty . This one is old and, well, it has a bad odor when you walk in. In terms of distance, the entire town is only about 7 miles wide and the rehab centers are all within 2 miles of each other. The hospital itself is rather new and it's very quiet -- I've never seen more than one patient in acute care and I've never seen more than one baby being born there at a time.

So this isn't the city. It's small town rural, although we do have money in these parts unlike other rural communities.

The bone healing comment is interesting. I wonder if that also has to do with your health? I'm 62, a runner, a tennis player and more and I heal very quickly. Never even thought of that until you mentioned it. I can't speak for her but I do know she is in excellent health. Heck, my 93-year-old neighbor is even in great health -- takes zero meds, never gets sick, maintains her own home that sits on one-half an acre. She has never been hospitalized, amazingly enough.

Thanks for your thoughts. This is good for me to know as I'm a widow now with no family within 2000 miles. I will not go into a rehab. period. Yes, I would rather die than go into a rehab center! Yep.

But my poor friend... I am thinking the 8000 a month that they get paid is the incentive also......

One has to realize just because a patient isn't having physical rehab and no doctor visits that nothing is happening.... something is happening, her ankle is still repairing itself.... as we age it takes longer for the bone to regenerate, thus the more time we give it to fix itself, the better it will be.

Rehab might feel that your friend being released back home to a husband and son, that your friend might dive into doing all the chores once again.... guess what would happen?.... she'd be back into rehab because she re-injured her ankle or re-broke it [easy to do until 100% healed].

As to being placed in a certain rehab facility, it depends on who has an open bed. I know when my Dad had surgery and needed rehab it would have been great to have him in the rehab just down the street, but it was booked, and the closes rehab with an open bed was 40 minutes away.... he had no choice.

Recently I broke a bone, first time in my life, so this has been a new experience and quite a journey for me. That was 2 months ago, and the bone is still healing. My next step will be going to rehab on whatever schedule is needed.