My mother in law was in a car accident and broke her hip and ankle. The plan is to have her ankle heal first and get upper body rehab to help her be more stabilized for the hip replacement. The insurance is stating they will no longer pay for her rehab as she can not put any weight on her feet. They suggested possibly applying for Long Term Care in hopes she will be accepted and if not she is pretty much on her own. We are unable to fully take care of her at home; do you have any other suggestions for support with this? Any advice would be greatly appreciated! Thank you!
I also had certain rehab facilities refuse to take my mother, but it was based on a facility that had a more rigorous physical therapy requirement, like 3-5 hours a day. Since my mom is 86 and has dementia, there's no way she could have withstood that amount of PT. BUT, these rehab places would not have kept her but 2-3 weeks at most, not 100 days. A nursing home with rehabilitation is what you need. Just make sure you go and check the places out prior to transferring her there, and it's a good idea to make sure the "short term" patients are separate from the "long term" patients.
If she's not making progreas (based on the report of her theraposts), she no longer qualifies for inpatient PT. Will her doctor acript in home pt, which would be less taxing?
There is a second level of appeal generally in Medicare denials of payment. I went that route in challenging meds directly billed by a hospital. Medicare took several months to deny the first appeal; I challenged and went to the second level. Medicare never did respond and the hospital just dropped the charge. It pays to be aggressive.
There are some attorneys who handle challenging Medicare, but you'll pay from $250 to $300 an hour, and there's no guarantee they'll win. There are also ombudsperson agencies that offer advice, but generally it's on rehab/facility issues. It wouldn't hurt to do some quick research and see if you can find some of these types of agencies in your state.
We also learned that some rehab facilities require "intense" participation, which some years ago was considered 3 hours of PT/OT daily. I've never heard of 5 hours of PT. You've have to be an Olympian to recover from surgery and do that much PT.
I would ask the social worker about the issue of "5 hours of PT daily" and see if that affects everyone in the facility. The ideal solution would be to find another facility that doesn't require such high levels of participation, but you'd have to do that quickly and it sounds as though there's not much available in your area.
I did find, however, that direct calling got me farther than relying on any discharge planner or social workers. In fact, I don't recall that of any of the facilities I called, there weren't any vacancies that would have arisen in a few days.
Sometimes it's worth it to go out of area though. When my father needed special rehab for ventilator weaning, I eventually found a facility which was 30 miles from where I was living then. It was a long drive, but well worth it. It was absolutely, hands down, the best rehab facility I've ever seen.
I agree also with Babalou that you could ask her doctor for home PT (and nursing and OT), which would allow progress at a more realistic pace, and in the comfort and familiarity of her own home.
An elder really has to be willing to accommodate a bit to the therapy schedule, it's sort of like going to school. Are there other reasons why she's so tired? Is this an acute rehab facility ? Maybe she needs a subacute facility .
i still hate health insurers but under yobamas directives they will spend 80 cents per dollar on services . many insurers are not expected to survive .