Should my dad go to a nursing home for rehab?

my dad has been in the hospital since Sunday and the Dr. says he can probably be discharged by the weekend. He will get a p.t. evaluation but these people don't know him so how they give him a fair assessment? They don't know what he can and can not do. Anyone who has been in bed for almost a week is going to be weak. My dad is not even aware of what the Dr. wants him to do. He is having a lot more memory issues lately but some of it might be due to being so sick. He really wants to come home to be with my mom who has severe dementia. They do have a live in caregiver to help him at home. Does anyone know about Medicare ? If he comes home and after a few days really does need to go to rehab, will Medicare pay for it ? Or does he have to go straight to rehab in order for it to be covered? I want to do the right thing but I am afraid that either way things could go wrong. If he goes and hates it, he will blame me. Been there, done that, last year with him. And if he goes home it could be an accident waiting to happen. I am so confused right now. I am emotionally exhausted from all of this. Please, I need some advice!!!!!

 Answers 1 to 8 of 8 

Octavia, my heart goes out to you and realize how exhausting it is. I've been through the hospital to rehab experience more times than I can count with my mother, father and MIL. Personally, from what you have described it appears that your father would benefit from going to rehab. You have to have been in the hospital for 3 full days in order to go to rehab and have Medicare pay for it. If he goes home first, Medicare will not pay for rehab if he needs it. You have to go directly from the hospital to rehab. Despite what the doctor recommends regarding P.T. etc., I would talk to the social worker at the hospital and voice your concerns. She can then speak to the doctor. Better to go to rehab now then miss out altogether. You didn't mention why he was in the hospital. But, if he is weak, rehab would build him up and most likely he would benefit from physical therapy. Medicare will pay for rehab as long as the patient is improving up to 100 days. I know your father will only be there a shorter period of time; those are just their conditions for payment. My MIL had been in the hospital for a heart condition and she was weak and had poor walking/balance problems to begin with. The doctor was going to send her home. I called the social worker directly and told her we thought MIL would benefit from rehab. I've also talked to the doctor myself about rehab. I know your father might not like it; but in the long run, it could reap great benefits. I know first hand what it is like when they don't like being there, but learned to ignore it as it was something that needed to be done and they get over being angry and appreciate home so much more when they go back. Good luck to you and hope things work out. Blessings to you and take care.

You've gotten some advice, from his doctor. Dad is not sick enough to justify the cost of the hospital room, but he is not well enough to go home, in the doctor's opinion. There is an in-between option called Transition Care Unit, where he can continue to rest up and also get some rehabilitation services. I believe that for Medicare to cover this it must be Transitional -- that is, be the step between the hospital and going home. Talking to the medical social worker at the hospital will clear up questions like this one. Of course anyone who has been in bed for a week is going to be weak. That is one of the reasons they don't want him to go directly home, but to be in an environement where his activity can be monitored and assisted. Ask the social worker what services are available if he goes home. Can he get some PT and OT services at home? Also try to assess what the caregiver can reasonably take on in addition to your mom with severe dementia. Either way, things could go wrong. Dang! If only we knew for sure the consequences of our decisions ahead of time we'd all make far fewer mistakes. Talk to the social worker. And if he does go into transitional care, try to arrange it so it isn't your decision and he can hate the medical staff for it, not you. Good luck!

thank you so much for the info. My dad has bacterial pneumonia. They have him on the nebuliser treatments 4 x a day. He is very confused, and right now I don't feel the hospital staff can care for him the way he needs to be cared for. I am going to talk to the social worker at the hospital today. He has parkinsons and uses a wheelchair and a walker. I was told that the p.t. department could not even get him out of bed yesterday, but he told me he had a workout. That is just part of how confused he is. I know it will be a lot of work for their caregiver to take care of both my parents with my dad being so weak. I am also considering a geriatric care manager to help with all of the decision making. What my sisters fail to see is how stressed I am with all of this and I have chronic pain which is getting worse due to all of the stress. Their worried about my parents money and how much they have left. My concern is what is best for my parents. The goal has been to keep them at home as long as possible, but they are both deteriorating very fast

I'm sorry you also have to deal with relatives on the sidelines. Being concerned about parents' money is a legitimate part of caregiving, if the focus is on "will they have enough to cover their care the rest of their lives?" Making sure that they have some left over to pass on the heirs is a totally inappropriate basis for making decisions, in my opinion. I don't know whether your father has dementia, or if his confusion is a temporary reaction to the illness and the hospitalization. The kind of dementia most often associated with Parkinsons, Lewy Body Dementia, is characterized by large fluctuations in cognitive abilities. (Some good days and some bad days, rather than a steady decline.) My husband's definitely got much worse each time he was hospitalized. Therapists told me that was his new baseline, but it wasn't -- he eventually recovered to his former baseline. I just share this to give you encouragement that your father may improve considerably, but it will take time.

I am married to a wonderful Physical Therapist who works in a nursing home. He knows that the patients are weak and your father's PT will evaluate your father and make up a treatment plan. In my opinion, your father will get the best care in a nursing home for rehab. My mom was recently in a nursing home for rehabilitation. She had home health therapy for awhile and they were very limited on what they could do for her at the house. The equipment in the nursing homes are much better then what they can do for patients in their house. The PT's are trained to talk to the patients throughout their therapy and explain what they will be doing and how it will help them when they return home. They are talking them through each step and continuously encouraging the patients to strive to get to their goal. I know my husband really enjoys working with the elderly and he knows that many of them have loved ones who are waiting for them at home. The rehab part of the nursing home is usually separated from the rest of the nursing home. The people that are at the nursing home are of all ages. Patients usually have a lot of freedom and enjoy going to the dining area for their meals, play games, watch tv, read the paper, etc... The first person who responded to your question was correct when it comes to what Medicare will pay and when they will pay. I am sorry about your father. I am in the same situation and I know it is very hard and so very emotionally exhausting. Please know that you are not alone and we all know exactly what you are feeling right now. One day at a time. Cry when you need to and know that it is okay to laugh. I hope that I helped a little and keep us all posted on how YOU and your family are doing.

Thank you so much for your kindness and caring, it means a lot to me. After seeing my dad yesterday i am sure that he needs rehab. He is extremely weak, has developed another DVT and is still very ill. He has not gotten out of bed yet because he is to weak. Now it appears that he will be in the hospital longer than the Dr. told me, I am waiting to talk to him today. I don't know if he will recover from this, it has taken so much out of him and he is more confused and forgetful Thank you for sharing your thoughts with me. I don't feel so all alone in this anymore, just knowing people care helps a lot.

OK - I am sitting in my dad's hospital room in the same situation and having stayed up with my dad each night since the nurses arent coming in oftn enough to care for his mind that seems to get worse at night. He needs rehab - but finding one is so scary. Just found one and then read in the newpaper that the hospital attached to it is being shut down for surgeries til the nursing quality issues are resolved. Back to the drawing board. Wish he could jusy go home and so does my mom - but my mom is like yours. He broke his hip, got pnemonia and is very weak. Since it has been a little while since your original post - let me know how you go through it. I cant see the end - and cant stay with my dad throughout the day and night to make sure he is cared for. HELP!

It will be okay to put him in a nursing home. Don't be afraid, a nursing home is exactly what you are describing that you need. You can be with him but you can't be with him 24 hours a day. You will still need to check on him often but you won't need to be there with him all day and all night. You can check him out of the nursing home during the day if you wanted to bring him home for a few hours. You can bring in photos and plaster the walls with family photos. . My mother was very confused and the photos didn't seem to help her confusion (being honest here) but it helped me knowing that they were up on her walls. We brought my mom's dog up to the nursing home one Saturday. You can bring in his own bedding. My mother was in a nursing home and although they will do the laundry, I would take my mom's laundry home and bring them back the next time I went to visit. They had two monitors on my mom. If she tried to get out of bed the monitors would go off. Don't get me wrong...I wanted these monitors on her. She needed them because she often went looking for us. My mother was pretty swift and caught on quickly how to turn them off. I went to the head nurse and suggested they put a wandering guard on her so if she went out the front door an alarm would go off but they never did. They said if it came to that point then they would put one on her but they felt like they caught her every time she went out of her room. You may think I am not being so encouraging about the nursing home but not true. I am just being "real". A nursing home will allow you to get sleep. You can not function on not enough sleep. Everything is 10 times harder to deal with when you are sleep deprived. I went to see my mom almost every day. If I wasn't there then my dad or my sister was there. We were able to concentrate on loving her. My kids went to see her and we ate in the dining room with her. You still need to be aware of your dad's health. Be aware of when they gave him a shower last. Encourage him to get out of his room and go sit outside. Be aware on what medications he is taking. You will see if your dad has a decline in health and will be able to talk to the nurses and the doctor. He will still go to see all the specialist's that he normally would make an appointment with. The nursing home will take him or you can take him to his outside appointments. It isn't easy, and I was in your position not too long ago. My mother past away on September 11, 2012. I went up to the nursing home and she was not looking good at all. My dad had just been up there that morning and ate breakfast with her. She was fine but when I got there at 11:00 she was not doing well. They sent her to the hospital and she past away a few days later. All I can say to you right now is that I know what you are feeling. I know that you are overwhelmed. You don't see an end to this and you may have kids, family, and a job. The fact that life doesn't just stop while we take care of our parents is so hard. USE THE HELP YOU ARE GIVEN! Call his friends! Ask them to go sit with him for awhile whenever they can. Don't try to do it all on your own. If you have kids....call up those parents and don't be afraid to ask them to watch your kids while you take a little time with your dad. Many people want to help. They may not come out and say it because they are so wrapped up in their own lives that they wouldn't ever see you struggling but if you reach out to them....people WANT to help. I know exactly what you are feeling. When my mom was in the nursing home, I brought books with me and I just sat with her and read my book or magazine while she slept. Tell you dad that you love him as much as possible. Do a living will with your dad. It was necessary for me to do one with the nursing home my mom was at. When she past away, I was so glad that I knew exactly what she wanted. With my phone, I videoed my mom telling me about the the day she delivered me. I miss my mom so much. If I could turn back time and have her in the nursing home...I would spend even more time with her. It wouldn't have been easy for me to spend this quality time with her had it not been for the nursing home. Don't think that the nursing home is it forever either. He can rehab and get stronger and be sent home in a matter of months! Plus, if you don't like it...YOU CAN MOVE HIM to another one. It isn't set in stone on the home that you choose. I would just like to mention to seriously talk to your dad about being a Do Not Resuscitate. Your dad's doctor may have already asked him or the nursing home might ask. Talk to him about what that means. If he gets an infection and needs to be on a breathing tube until the medications kick in...they won't do this for a DNR. I would NOT have let my mom sign the DNR had I have known then what I know now. Actually, I didn't let her sign the DNR. The nurses asked me (while she was in the hospital not the nursing home) to have her sign the DNR. They kept coming in the room every few minutes and asking if she had signed it. I stayed with my mom 24 hours a day while she was in the hospital because she was also confused and I didn't feel like they were taking good care of watching her. The moment I left my mom's hospital room to go get a coffee they told me the doctor went in and had her sign the DNR. However, once in the nursing home, we did the 5 wishes Living Will together and she then changed her mind and said she did not want to be a DNR and she was to be a Full Code. Make sure the nursing home is aware that your dad is a Full Code and should he need to be sent to the hospital, they are to send record of him being a Full Code. Once my mom signed the DNR, it was hard to get rid of! It kept appearing in electronic records everywhere. My personal opinion for myself is that I want to be on a breathing tube for so many months before they take me off. I just feel that the doctors give up....they wash their hands to a DNR. It may not suppose to be this way but in my opinion...that is what happens. So, know ahead of time what your dad's wishes are so you have no regrets in the end. I hope I am not upsetting you but I would give anything to turn back time and know THEN what I know now. Talk to him. It will be very very hard but most nursing homes need this information so that is a great way to approach it. They ask it from everyone...not that this is what is in his future. Keep us posted. I will pray for your dad and your family. Take a lot of photos! You will treasure them.

 Answers 1 to 8 of 8 
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