Many patients believe they should either be in the hospital or be back âhomeâ - whatever âhomeâ is for them. Medicare will only pay for rehab during a particular time period and only if the individual is progressing.
I have worked for a skilled care/rehab facility (I worked strictly admission nursing assessments the last two years in rehab) and have seen where people refused to come to rehab from the hospital, and then fell while getting out of the car at home because they needed rehab. Some have been at home for a few days, and the family has decided that THEY do not want to do the work that the rehab facility can provide with personal care â and their loved one has not had PT/OT/ST evaluation. Usually people need the PT and OT (the OT will help with things like being able to advance with skills like showering with less assistance to potentially no assistance).
Each state has its own regulations on assisted living. I guess it was needed to be probed on exactly what is gained in rehab and what is beneficial to go back âhomeâ with additional help.
The problem is that rehab benefits (PT, OT, ST) with Medicare are tied to having the need for rehab and being provided in-patient.
During my assessment and talking to the patient and sometimes family - I can often get them to go through the next dayâs PT/OT/ST assessments. Then they can weigh out what the benefits are to staying.
Our well run and higher rated rehab facility is picked off a list by patients/families from the hospital â a list of facilities is shown to patient/family and then they check on room availability.
Some patients donât want to stay, no matter what. However if they were still in the hospital, a family member would say they need to stay (do not want to usually discharge AMA - against medical advice).
I had a late 80âs lady complaining to her son. The daughter lived closer to the facility so she was directed by her brother to pick mother up. Obviously the daughter was not happy. The son told me on the phone âI am not going to have my mother somewhere she does not want to be.â I did talk to the daughter about how the mom may be more motivated to ârehabâ at home because she wants to be there. The mom was a small woman, so she would be easy for one to assist her physically - but I can imagine she could be quite a demanding personality.
Wow on being bedridden and still qualifying in state for assisted living.
I have seen older (and not so old) quite large/morbid obese people that have moved at home from recliner to bathroom to bed (needing a bed to accommodate someone over 500 lb) and due to knee problem or broken hip having to ârehabâ. One guy had a petite wife who I am sure was âdemandedâ to bring him unhealthy food and oversized quantities of food. The bed we rented could be used for someone up to 550 lb. The guy complained the bed wasnât as big as his at home which could accommodate up to 650 lb.
I have seen people that have put in the effort to improve their health and mobility. It just takes so much effort when one has gotten to such a horrible place with their weight.
One woman under 60 had brought in unhealthy snack foods and was quite hostile about cutting back on these snacks (she was also diabetic in addition to being morbidly obese) âI have been doing just fine the way I am livingâ. She was not uneducated â she had a degree in social work and just allowed herself to gain weight raising a family and being a homemaker - IDK how long she had gone from being a bigger woman to being obese to morbidly obese to super morbidly obese. A few weeks later, she had a cardiac incident, and she died in the ambulance on the way to the hospital.
Rehab often involves a lot of work to regain mobility and regain ability to care for themselves or get back to status before hospitalization.
Families and patients often have difficulty with declining ability and hard decisions that need to be made about where to live safely. I understand about a world shrinking when I had aggressive stage III cancer and my world shrank big time from a long list of things I was use to doing to barely getting off the couch during the worst of the chemo.
Working in health care is not easy work!