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Long story short, my Dad had open heart surgery about two weeks ago. He was set up to go to an inpatient rehabilitation facility but the days leading up to him being discharged and then transferred he had a lot of depression and anxiety and he refused to go and participate and be compliant with the PT, OT, and refused to take any meds or eat because he wanted to come home and had no other choice but go take him home even though my Mom and I insisted that he was unsafe to come home and physically incapable of taking care of him. After a day and half of coming home, he was pretty sick (vomiting and incontinent) and my mom was completely worn out after not being able to sleep because she needed to care for my Dad and he has eventually gone back to the ER. The plan now is to hopefully get him back into another inpatient rehabilitation facility assuming the last one won’t accept in again OR a SNF because my Mom is completely incapable of providing the care he needs. I also spoke with my Dad and he has agreed that he will be cooperative in taking meds and eat and do what he needed to do to get stronger, if and when he goes. It’s been a very stressful last few weeks and we need help. I plan on speaking with another case manager to hopefully see how quickly he can get into a facility, whichever will accept him. But I’m so worried that because he’s already got so many red flags noted by the hospital, we won’t be able to get him into one. If anyone has any insight or advice, I’d be so grateful.

Just keep insisting to the hospital doctor and social worker, that your dad CANNOT return home as there is no one there to care for him and that he is an "unsafe discharge." They will then HAVE to find a rehab facility or nursing facility that will take him.
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Reply to funkygrandma59
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If the director of the facility won’t help than contact the facilities ombudsman or states ombudsman. They are there to help for this issue and anything else you may have a problem with where he stays . And have him checked out by a Dr. to rule out any reasons why he’s acting out . Could be a UTI or a toothache or something loud like tvs in the dining area .. maybe he doesn’t have his eyeglasses or hearing aids all the time .. check for bruises or cuts could be treated badly .. try everything before you allow them to over medicate him as well .
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Reply to Trixipie
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Talk with case management about your dad. Let that person know that dad is willing to cooperate and his fear/anxiety kept him cooperating the last time he was in the hospital. Ask doctor for a mental health referral while dad is an inpatient. Better to deal with his anxiety and possible depression now. Doing so will also help him in getting placed.
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Reply to Taarna
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cover9339 Oct 2, 2024
I think dad believes he needs to do the work so he can go back home.
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If he has not yet been placed into a rehab facility or for rehab in a SNF with a rehab unit, perhaps speak with the hospitalist (the staff MD for the floor or sector he is at in the hospital) for his care plan at the hospital to see if he could possibly be placed into an LTACH.

LTACH Long Term Acute Care Hospital. It would not provide for rehab services but could get him more time to get stabilized on medications, get his post surgery check ups and time to get used to the whole rhythm of how care facilities work while monitoring his post surgery status. LTACH tend to be either their own closed unit within an hospital or in a separate free standing building attached to the hospital by a bridge. You cannot enter an LTACH directly, it’s all by referral. Even if it was 2 weeks in an LTACH it might could be a good way to deal with his health and his fears. LTACH is by referral only so the hospitalist would be the one to convo with the other docs on his care team to see if this approach would be helpful and do the request to Medicare for approval. It’s a continuation of his post hospitalization so covered by health insurance. It’s time limited but gets renewed somewhat routinely.

Should he go instead into a SNF, if he goes in for rehab it’s a post hospitalization benefit paid by Medicare but only if he is progressing in his care plan. If he goes all out-of-compliance in attitude as he did the last time, the SNF will have to move him from rehab patient paid by Medicare & health insurance to instead consider him a custodial care resident. Custodial is private pay, maybe LTC insurance if your folks already have a policy or he files for LTC Medicaid. If it’s LTC Medicaid, imho mom needs to find a CELA level of elder law attorney to deal with this as she as the community spouse does NOT have to impoverish herself - only Dad does - but it’s complicated path for couples to deal with as their assets have to get segregated properly so he becomes impoverished and she is able to retain all that she can and get a resource allowance as well (if they are average assets & income). Realistically it is NOT a DIY if it’s couples with 1 in a NH and 1 exhausted overwhelmed living at the home spouse.

also personally I’d dial back any mention of mental health issues. ((Unless he has in depth mental health and behavioral stuff existing big time in his old health records, otherwise I’d just gloss over on this.)) If he has behavioral health concerns plus with medication management issues in his chart, most SNF will not take this type of resident. Finding a long term care psych hospital that can deal with post heart surgery patient will be hard to find in most areas of the US. To me, you don’t want to go there unless that’s really really really what he needs to be in.
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Reply to igloo572
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cover9339 Oct 2, 2024
Isn't LTACH intensive 30 day care?
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Your Dad was not " kicked" out. Medicare pays for Rehab and if he is not cooperating with his therapy, he gets discharged. From what I understand, they are given 3 tries and then discharged. He is there for the therapy, not for his depression and anxiety.
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Reply to JoAnn29
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He can admit from home to In-patient Rehab. However, most insurances will not cover SNF without a 3 midnight stay at acute care hospital and then directly to SNF from the hospital.
I agree with the person who said don’t say he was “kicked out” or that he has “mental health” issues. What he is experiencing is perfectly normal the fear and depression are a sign that he is realizing that he is not immortal.
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Reply to Kayleen
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No one mentioned that the food was most likely not fit to eat. My mom spent a long time in a rehab facility where the meals were served cold and tasted horrible. I brought in meals that she would enjoy.
I spent a lot of time with her and noticed that the facility, along with the aides, did not meet the standards one would expect from a rehab center. It was very sad to see other patients being dropped off with no family checking in on them.
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Reply to cw27519
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Your biggest issue is his depression and anxiety. Those need to be treated first. Then have hospital move him to a rehab facility that has good reviews. You have a lot of say in this if your town is big enough to have several. This should pave the road to a more successful transition and workable future.
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Reply to RetiredBrain
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I would suggest hiring a consultant re placement. They can often advocate with facilities for “tough cases” with a committed family and renewed patient commitment to recovery. Also, they can help w LT placement if necessary.

If you don’t have HCPOA and Fin’l POA, Advanced Directives, etc in place, this is a good time to get both your parents’ wishes documented. You can always revisit the docs annually to ensure the written plans continue to reflect your parents’ wishes.

You can either hire the consultant for rehab/LTC placement first and get a referral to an elder care attorney or vice versa.

The hospital should not discharge to home unless he is capable of largely independent care with minor assistance from your mother. YES, talk to case manager at hospital.

Three days in hospital for Medicare to pay for rehab. He will have a combined limited number of days (100ish, consultant will know specifics) — AND your father will need to show consistent application and progress toward PT and OT goals — in rehab before you need to go to private pay in rehab if he needs more time.

Hope this is helpful.
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Reply to NeedHelpwMIL
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LTHCH, referred to below, stands for Long Term Acute Care Hospital. These hospitals provide extended care for patients with serious medical conditions who require longer recovery times, often after an Intensive Care Unit (ICU) stay. They specialize in treating patients who need hospital level care for weeks or months, such as those with complex wounds, respiratory failure, or multiple organ dysfunction. They offer a range of services, including ventilator weaning, dialysis and intensive rehabilitation, bridging the gap between acute care hospitals and other forms of acute care.

Typically, a referral from a doctor is required.
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Reply to HaveYourBack
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Persimmon20: Perhaps you can speak to the hospitalist as igloo572 mentions. Thank you, igloo.
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Reply to Llamalover47
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Your problem will be if the new rehab calls the old rehab to see why he was discharged. When they find he was uncooperative, they may not take him. And hospitals, they don't try to find the gest Rehab, they find a facility that has a bed available. And be aware, that Dads days do not start over. Medicare allows 100 days and those are not guarenteed. Depends on how the patient progresses. If he has already used up the first 20 days that Medicare pays 100% for, he will start at 21 days at the new Rehab and then he is responsible for the 50% Medicare does not pay.

From what I read, Dad needs more than Rehab can do for him. Maybe Skilled Nursing. But that will be private pay or Medicaid if he fitscthe criteria.
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Reply to JoAnn29
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