What rights do I need to have a rehabilitation center keep my mom after they decide her release date? I'm on appeal #2.

You need to realize that therapy can only do so much. Mom may never be able to do what she did before. She is 87 years old and broke the biggest bone in her body. Its their doing good until something like this happens. Its a shock to their system. Mom may have hit a plateau and Rehab can do nothing more for her. Medicare will not pay once this is determined. It may mean that Mom will need to be transferred to LTC.

Once a patient "stops making progress" in rehab, Medicare stops paying the bill and the patient is released. If fear is preventing mom from making progress, rehab is not going to do anything at all for her. She must be a willing participant in order to improve.

If your Mom is not progressing in her PT, not capable of doing the PT or not cooperating with the PT, then they will not reorder the PT no matter what. A doctor decides whether PT goes on or not, not the patient or their family.

Without further PT and being released back into her home, your Mom needs an aid in her home now, or she needs to go into a facility. If she doesn't like these options then she needs to know that she must do the PT (if she is cognitively able to follow instructions). You should discuss with the discharge staff that she would be an "unsafe discharge" if she doesn't have a care plan in place for when she returns home. You are not the long-term plan so don't give them the impression that you are her solution.

Also, make sure she is getting enough pain meds. If she isn't getting enough the pain will prevent her from doing the PT. If she doesn't succeed in rehab and becomes bedbound, she may need LTC placement.

I had the same problem with my mother. Fell several times and became afraid of falling. If the rehab team is an invested rehab team, they will continue to work with her and should encourage her to get out of bed. At times, I did have to encourage my mother to do the activities. When it comes to the appeal, you really want to focus on ADLs - that if she can't get up out of bed, use a walker/rollator/wheelchair, transfer from bed to chair, can't go to the toilet on her own, and can't dress and bathe herself, she is at a very real risk of falling again, or, worse, falling again and breaking a bone, including her skull. And, if she falls again, this will mean another hospitalization. You may also want to reference specific dates, especially, if there have been multiple hospitalizations. We had to do the appeal process several times. During my mother's last rehab stay, we were able to appeal it three times. Again, the focus is on ADLs. Medicare doesn't want her going back to wherever she permanently lives and falling again and being hospitalized again, which means them having to shoulder a good amount of the cost.

She may have progressed a lot due to her injury and she is likely unable to go further with PT or OT help. At that point release to care is necessary. I think you will have to make the trip to assist in looking for longer term care placement. How long has she been in rehab?

My mother started falling due to Parkinson’s disease.

She was unsteady on her feet and initially got by with a cane. She progressed to using a walker.

The doctor ordered home health and she improved some but due to her Parkinson’s disease she would still fall. Some falls were worse than others.

Fortunately, she never broke any bones. Actually, her bone density tests showed that she had strong bones.

She had one serious tumble where she fell backwards in the bathroom. She was standing up facing the toilet, doing something or the other, fell backwards and ended up hitting her head on the bathtub faucet.

She was bleeding. I took her to the ER where she received staples in her head. Her doctor ordered a therapist to start working with her while she was still in the hospital.

The hospital then transferred her to rehab. She was in her 90’s and worked very hard to improve her strength and balance. Balancing issues are extremely common in Parkinson’s patients and they tend to fall backwards.

At her care meeting, her therapist said that she could benefit from staying longer. Mom paid out of pocket for the additional days. Medicare paid the previous amount.

Her doctor ordered home health for when she returned home. Mom continued to use her walker and avoided being in a wheelchair.

Some people, like my mother are able to improve in PT. Others aren’t. The therapist told me how hard my mother worked. It’s hard and she was exhausted afterwards.

In my mother’s rehab they started therapy shortly after breakfast, then a short lunch break and back into therapy for a few more hours.

I saw what the home health workout was like and it is continual work. My mother had a great attitude and made a strong effort to get it done. Medicare paid for home health and rehab because she showed improvement.

I was amazed at what her occupational and physical therapist got her to do. They were fabulous and asked her if she liked any special music. Mom said, “Play Sinatra for me. My husband and I loved dancing together listening to Sinatra.” They played Sinatra for her!

Has anyone suggested home health for your mom? Do your research and find the best group that will motivate her. Do you think that she is capable of doing the hard work?

They will give homework as well. Mom did her exercises that they told her to do and I know that is what kept her out of a wheelchair.

As far as fear of falling. That’s natural. My mom was fearful of falling too.

Mom was mobile until shortly before she died in an end of life hospice care home. She died at age 95.

Best wishes to you and your mom.

All I can add is ask the care team for their honest professional opinion & listen to what they tell you.

Sometimes relatives are fighting hard for recovery but the actual patient has given up, or just can't.

Check in with Mom & find out how she feels about rehab.

Being her Advocate is a worthy role. It will continue past this rehab stay, for other help & care, possibly care accomodation one day too.

Nanakin, from your profile, it seems that you are planning to pick your mom up from rehab, drive her 8 hours to your home and become her caregiver.

Are you aware of how much care she requires?

Will you be able to continue to work, or are you retired with sufficient funds to support yourself?

What arrangements will you be able to make for caregivers to come in to help care for your mom so that you can get out for socializing, medical care and fun?

Will mom need to apply for Medicaid in the future? Be aware of all Medicaid regs in your state and don't co-mingle your and mom's monies.

Good luck with the appeal, but find out what the private pay rate is for the facility. Can mom private pay for another week or two?

My FIL had been able to make it just back to the point where he could come home each time in rehab - and I mean just barely - where he could come home and do the literal bare minimum (getting himself out of the bed and walking back and forth to the bathroom). My SIL and her DH lived with him and were taking care of most of his needs and DH and I were assisting as well.

ADLs were a joke - he could only do that one. Everything else was supplemented by us or outside assistance so we were hanging on by a threat to begin with.

Then he had a series of what were MINOR falls. Really minor. One even looked staged (believe me in this case they have happened before). But he had lost so much already that it was the straw that broke the camel's back.

This time he couldn't come back from it. At almost 90, when he went into rehab - he couldn't (or wouldn't) comply. Before he fell the last time - he was fine getting out of bed and now he was needing three people and a lift assist belt/strap OR a hoyer lift to get him out of bed. Where he was walking to and from with a walker at home - he wouldn't/couldn't go a step without a wheelchair AND someone pushing him.

He went in to rehab Round 1 12/1/2022. He was discharged on 1/31/2023 and that was being generous - they tried way longer than they really had to because he wasn't trying - but they got a late start because the entire first two weeks he wouldn't/couldn't get out of the bed.

He went home and was home for 106 HOURS and fell again and went to the hospital. They didn't even bother with admissions - they just sent him back to the rehab who put him right back in the same room. They kept him for another few weeks and discharged him again. We knew it wasn't going to go well but no one had enough backbone yet to tell him it wasn't happening.

He was home for 22 hours. The home health nurse came for her required visit. We got lucky - because it was a Friday and it would have been BAD if she hadn't scheduled when she did. She asked him to show her how he could get out of the bed and use his walker to stand up (things he SHOULD have been able to do). We still to this day don't know if he couldn't or wouldn't.

She just picked up her phone and called 911 and told them she needed a transport and then called the hospital and told them the situation and told them that they would just be holding him until he could be transported back to rehab.

Plot twist....the original rehab refused to take him back. They said they couldn't help him. So they had to find him ANOTHER place.

Thankfully - we had entered a new calendar year and he got new time and we were still covered somehow (the man is Midas I swear).

Meanwhile - in the background - I am BEGGING the rest of the family - HE CANNOT COME HOME. I actually gave my husband an ultimatum. I'm done -I'm not facilitating this anymore.

Basically - the last rehab....was a staging area. Until we could find a nursing home.

HE insisted he was going back home. HE literally demanded it. He said he would eventually get back to where he started from. He just needed more time.

But he wasn't trying. He had already had THREE MONTHS. And he had made no effort. More time wasn't what he needed.

24/7 care in a facility that was designed for his needs - THAT was what he needed.

Sometimes things change on a dime. They can be going along just fine and something - even something small - changes and no matter how hard they try (or don't) they just won't get back to where they started.

Maybe consider private pay at the rehab for a while to see if she improves? Otherwise....this may be the new normal unfortunately.

I have seen people doing aqua therapy or some call it hydrotherapy at the pool. It’s so much easier to exercise in water.

I know a woman who did it after being in a horrific car accident. She was in too much pain to do regular physical therapy.

I suppose that this type of therapy requires specific orders from a doctor or can a person request it? I have no idea how this works. Hey, if it helps a person ease back into being able to function again, I am all for it.

It did help the woman that survived her car accident. She did her therapy at an indoor pool.

NHWM, but how many of these falls are because of stubbornness. With my Mom it was Dementia. Hard to explain that she cannot pivet. She had neuropathy in her ankles. So not much u can do there. But in those that don't have Dementia, is the fall caused because they won't use a walker? They have been told to wait till they can be helped out of a chair. The Fall could have been prevented if they just did what they were told.