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My mom is back at rehab after another fall broken wrist and pelvis fractures. The Medicare 20 days are counting down but she needs at least a two month recovery according to her Dr.


Rehab is saying she has to go into SNF which she does not want to do. We have an apartment at AL that we’re paying for as well. Any suggestions? She has a LTHC insurance also, but my fear is moving her to a Longterm care facility is going to start another depression. She just wants to go back to AL (short staffed though)

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When my father was in rehab (located in a Skilled Nursing Facility), they wanted to keep him there in their long term care section permanently, because he wasn't making 'progress', according to the almighty Medicare guidelines. Problem was, I had my mother to worry about! They were married for 67 years at the time, so if I left dad at the SNF, what about MOM? So..........even though they INSISTED no ALF on earth would take my dad, I found one that WOULD. It was MY decision where he went, not THEIRS, is my point. They made a recommendation, I said No Thank You. I will say, the OT/PT did everything in his power to dissuade the AL from accepting my father as a resident...........but they didn't listen. Thankfully. So I was able to get BOTH of my parents into the AL together, which was my goal all along. Dad was able to get physical therapy at the AL but I did have to take him out to the hospital and the urologist for catheter care which they did not administer.

If your mother's AL is willing to take her back, then by all means, send her back to the place she wants to go!! If not, then you'll deal with that situation if/when it arises.

Good luck!
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AT1234 Dec 2019
Thank you, yes they are willing and she has friends there. She’s on second floor and They have found a first floor apt that would be more convenient. I really did not know I could just say thank you for recommendation but we’re doing something else. That sounds dumb but it’s true, I honestly did not know. Last fall they told me I’d have to repay all of Medicare’s costs if I didn’t do what the rehab said!!
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Check on your mom's LTC policy, and maybe contact the company before the Medicare days run out. My husband has LTC insurance, and we were recently in a situation where he needed inpt. rehab after hip replacement and our Medicare Advantage plan was refusing to certify him. While pursuing an appeal, I contacted the LTC insurance company and they would have been willing to pay for the "room and board" part of his stay, while Medicare would have picked up the therapy services as though he were an outpatient. As it turned out, the appeal was successful and Medicare Advantage plan did cover the stay. As Joann29 mentions, in our area rehabilitation is also generally done in facilities that have SNF beds, regular LTC, and sometimes regular memory care. There are almost no free standing rehabilitaiton facilities, and those are generally only for people with vry complex medical needs. A few hospitals have short-term rehab. units. My husband was in a "nursing home" but in a wing with predominantly short-term rehab. patients and he got daily OT, PT and speech services (5 days a week).

As an aside, another good reason to contact the LTC company, of your mom isn't already drawing on the insurance, is tha many companies have waiting periods before they start to pay. In my husband's case, it was 90 days, but we have friends who have to wait a whole year!
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AT1234 Dec 2019
Yes, we had a 180 day lead time. Met that last year.
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Medicare pays 100% for the first 20 days. 21 to 100 days Medicare pays 50%. If she has a supplimental they may pay some of the 50% Medicare doesn't. It may cost Mom $160 a day. If she continues to need therapy, and Medicare feels she does, she could be there the 100 days Medicare pays. After that 100 days, then it becomes private pay. If at that point, its felt that Mom needs 24/7 care and Skilled nursing is recommended that is now private pay. If Mom doesn't have the money then u can apply for Medicaid.

Medicare determines if therapy continues. The Rehab provides reports of patients progress. If the person has plateaued or not making progress, then Medicare will recommend a discharge.

In my area, rehab and a SNF are one and the same. Rehab is usually done in another wing. And as long as a person is undergoing rehab, they stay in that wing. So if Medicare determines that after 20 days ur Mom still need rehab, I don't understand why she would be moved to SN. She can receive therapy in a SNF. Does ur Mom need more care than this ome therapy. It can be done at the AL. Get the AL nurse involved. She maybe able to explain better why rehab is making this decision. When we had a Care meeting Moms AL nurse was on speaker phone. Call your Moms PCP. See what he thinks about homecare therapy.

I agree, SNFs are depressing. No matter how they try to make them better. I have told my DH its the last place I want to go.
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AT1234 Dec 2019
Thank you! I will do the speaker phone idea. I have not been told that PT doesn’t think she’s improving actually, not received any “official” report from anyone. All that was say so sorry the timing is bad bc of dr offices closed through holidays!?!
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