Mother in law fell at home and spent two weeks in the hospital diagnosed with dislocated shoulder. She went to rehab had another fall there and was sent to ER received staples in laceration of her scalp. Now discovered that her initial fall also caused a fractured wrist that went unnoticed at the hospital right hand is now compromised and limp. She has been in rehab for one week and have been notified They will discharge her after 10 days which appears to be too soon. She is frail, needs to regain her strength and her husband is limited to caring for her at this time. She also has a diagnosis of Progressive supranuclear palsy
Also, for what reason was she in the hospital for 2 weeks for a dislocated shoulder?? This doesn't sound correct (my husband has dislocated his several times and it is a trip to the ER where they pop it back into place and then you go home). Worst case is that they have trouble getting it back in easily so she'd need to be sedated or put under first. But still, she should have gone home the same day. I would question the doctor and hospital about this admission.
Tell the discharge admins that she is an "unsafe" discharge and don't go get her. Talk to a hospital social worker about transitioning her directly to a facility (LTC?).
If your Mother-in-Law is being discharged due to a Medicare or a Medicare Supplemental insurance decision, you can appeal. Her social worker at the center should be able to provide the number to call. In my case, the number was on the notice of pending discharge. I appealed my discharge date and was denied. I requested a second review (again by phone) and about 5 days later I received notice my stay was extended by 30 days. Unfortunately, I was already home.
Make sure your social worker at the Rehab Center sets up home health care. My care included in-home doctor visits, occupational and physical therapy, and personal care by a CNA three times a week. Good luck!
I appealed her discharge through Livanta and won. I suggest you call them and appeal - the worst they can do is say no.
https://www.livantaqio.com/en
I have seen this happen with Medicare Advantage plans in particular (as opposed to traditional Medicare). I'm sure it happens with private plans too.
These decisions are profit driven, like much in health "care." A close friend of mine was discharged from a Seattle hospital without proper care in place. That very night she fell and fractured her pelvis. She died about 4.5 weeks later.
In-pt rehab. is extremely limited and once they transition to home care that is extremely limited too. The therapists are under constant pressure to discharge. Often I was asked to set their discharge date after seeing them one time.
Overwhelmed, clueless families aren't told to start discharge plans from rehab. before they even arrive. Insurance rules, I can't tell you how many times I heard "but we have good insurance".
I would talk to them, ask for a family meeting or talk to your MIL’s therapists about why she is being discharged and what she needs set up or what her options are. They are giving you time to get things set up and make decisions by telling you 10 days ahead. Typically they aren’t the bad guys in this scenario it’s burocracy and rules that aren’t made for individual cases that are the culprit, the rehab staff are the ones that have to ride that line between actual people/patient's and the rules.
My mother has done this many times, I disagree and lose every time. She detests hospitals and all facilities and does everything she can to get out. She also expects the rest of us to take care of her, which is not possible, we cannot pick her up or carry her, and we are working and cannot be here all the time. Now I should not say all is bad, our health systems do their best to give her good support at home, but she has a lot more risks in living at home than she would in a facility which is my concern, but not hers. As well aging at home is less costly for everyone.
She does tell me why, when she is in there she cannot sleep, they are constantly testing her, interrupting her, she cannot smoke...and various other reasons for wanting to leave. I do not think you can fight this, you have to accept it. You can ask for services for aging at home from the health system, they are available just hard to find. And you can have a conversation with your mother and tell her that the services she needs to be safe at home are her decision, she cannot expect her husband to care for her, although I do not think she will listen, my mother does not.
Good luck.. sensitive topic for me. My mother has checked herself out many times.
In my father's situation, I think he was in rehab for about 4 weeks - I can't recall the exact amount of time, but when the case worker called to let me know that he was being released, I pushed back hard - and also spoke directly with the Administrator. You have to really be forceful to state your case of why she is not ready to return home - and the liability to the rehab in releasing her too soon. In his case, they kept him there for an additional week, or so, but it still wasn't long enough - but at least it was something.
You can contact the facility administrator and case manager and be as assertive as possible - also check with Medicare the length of time that is allotted for rehab. Wishing you all the best in this ~
If a patient comes in and they are anxious to get home and ready to do the work - and prepared to be compliant with the requests of the PT and OT - if they have any capacity to improve - they will make a lot of improvement.
If a patient comes in and they tell the PT and OT every single day how much they hurt and that they can't possibly do what they are asking - then PT and OT won't ask. They can't risk hurting the patient. My FIL used to say "I'm doing everything they ask me to do." Well yeah...but they stopped asking you to do more than point your toes and wiggle your fingers because every time they walked in the door you immediately began telling them how much pain you were in and how you didn't think you could do much that day - so they began taking you at your word and scaled back their plan until it was down to nothing - so sure - you did everything they asked - because they didn't ask you to do much of anything! Often the patient doesn't even really get that they sabotaged themselves. With my FIL, I don't think they ever directly told him that he was being relegated to "skilled nursing care" until discharge. He just enjoyed not having to work so hard and getting to sit around and watch tv without anyone bothering him.
It wasn't until we got him home and read his discharge papers that we would understand that he had basically "failed out" of rehab for lack of trying.
And then there are the patients that come in at a baseline that can't be improved upon. Those that really are already at the best that they can be - and extra PT and OT may not really make any progress. That's where we were this last time with my FIL. Rehab could not get him anywhere further than where he was.
So it really depends on where your MIL was before she fell, and how much damage the fall really did - physically and mentally. She could be scared to try. She could be scared to be home alone. She could have been needing more care at home for a while now and this is just the catalyst.
But rehab typically knows if a person is going to make progress or not pretty quickly.
If you feel that you cannot care for the LO, this is the time to place them into an AL or LTC.
What does your H think, since this is his mother?
This is one of those tragic situations that doesn't have a happy ending. Please avail yourself of all the advice you can get from rehab about finding a living situation where she will have all the help she needs 24/7. That seems like long-term care to me.
I hope you don't have wishes to bring her to her home or yours and provide all the care she needs. It is unlikely to be possible for mere humans to do that.
I am assuming your Mom will be returning to your home? Or is she being discharged to a facility. Her frailness is unlikely to be helped in rehab, and she may never regain strength. Strength is a factor measure in over all health, age, debility, balance, and a dozen other factors.
I am sorry you feel your mom is being discharged too early, but once rehab decides on the advice of their OT and PT people that further progress is unlikely they cannot get coverage for further time in facility.
I would request conference if you are POA so that you can fully understand their reasoning regarding discharge. I surely wish you AND your mom healing and the very best going forward.