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Who are you caring for?
Which best describes their mobility?
How well are they maintaining their hygiene?
How are they managing their medications?
Does their living environment pose any safety concerns?
Fall risks, spoiled food, or other threats to wellbeing
Are they experiencing any memory loss?
Which best describes your loved one's social life?
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I. How We Work in Washington. Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services. APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid. We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour. APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
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V. Complaints. Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights. APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.I agree that: A.I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information"). B.APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink. C.APFM may send all communications to me electronically via e-mail or by access to an APFM web site. D.If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records. E.This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year. F.You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
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Mostly Independent
Your loved one may not require home care or assisted living services at this time. However, continue to monitor their condition for changes and consider occasional in-home care services for help as needed.
Remember, this assessment is not a substitute for professional advice.
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Not knowing all the details about your wife and her condition after surgery and how able you are to care for her, I would just say that if you don't feel that you can at this point care for her at home properly, let the rehab social worker know that and they will have to find a nursing facility to place your wife in until she is better able to care for herself. Places often times will bully folks into taking their loved ones home knowing full well that the patient can't be cared for properly there, but it's one less thing that they have to be concerned about. So stand your ground if necessary and make sure that your wife is getting the best possible care whether at home or in a facility. Best wishes.
Be aware that what your wife expects of you may be beyond your capabilities. What you expect of yourself may kill you. No matter how good your intentions, you may find that it’s much more difficult than you’ve been led to believe.
When discharge discussions begin, be sure to find out exactly what home care requires. Then multiply the difficulty times 2 or 3 or 4.
Wife went from hospital for spinal surgery directly to NYC snf/rehab center has been there 2 weeks how and when will a discharge plan be discussed -very confused as to next step-Any ideas would be appreciated to take her home
I understand more of your question now: Yes, you should definitely ask what is involved now in home care. Is physical therapy needed and will they come to your home, or must you do transit to rehab? What will be her limitations? What are the chances that you two can manage care at home if you yourself have some limitations in helping? What progress is expected going forward. Should there be some temporary SNF placement? Tell the team that it is very crucial now for you to understand what your wife is capable of doing, and what her limitations are, and can home care safely proceed. Ask them what steps you take if something goes wrong, if home care isn't proceeding well. Definitely ask about pain management, and see to it you have stool softener prescribed if she is requiring any constipating pain meds (many ARE, and patients have been known, in hindsight, to complain that constipation was the worst part of their after care.
Typically, in my experience with rehab, they need to be able to assess the patient's needs and begin mapping out a plan for care before they meet with the family. But generally, unless my FIL was unresponsive (meaning he transferred and was unable to get out of the bed period, as he was the last time he was in rehab) he was typically assessed and had begun PT and OT within a week of arrival. And we typically had a family plan of care meeting within two weeks of arrival.
The only exception was this last time - as I mentioned - he transferred from the hospital unable (or unwilling, we were never sure which) to get out of the bed. He was lucid and awake and talking but he just wouldn't or couldn't get out of the bed. So they couldn't assess him. He stayed in the bed for over a week before he was finally able to get out of the bed with assistance. They were able to assess him and finally start some basic OT and then PT. After that we were able to have the family care plan at about 3 weeks in.
If she has already started her PT and OT I would definitely contact the Social Worker and ask for a meeting. Even if she hasn't, I think you are well within your rights to contact them and ask about progress and next steps.
You should have had a care meeting before now. But I think ur jumping the gun when it comes to a discharge plan. This can't be determined until they see how your wife progresses. Medicare pays 100% the first 20 days. 21 to 100-50%. After 100 days its private pay or Medicaid.
You don't mention your ages. Age is a factor and so is your wife's willingness to do what needs to be done. They may set up some "in home" care but that is not permanent. Discissions can't be made this early in therapy.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
Places often times will bully folks into taking their loved ones home knowing full well that the patient can't be cared for properly there, but it's one less thing that they have to be concerned about.
So stand your ground if necessary and make sure that your wife is getting the best possible care whether at home or in a facility.
Best wishes.
edit your post with your response to your post for clarification of what you are asking…
Be aware that what your wife expects of you may be beyond your capabilities. What you expect of yourself may kill you. No matter how good your intentions, you may find that it’s much more difficult than you’ve been led to believe.
When discharge discussions begin, be sure to find out exactly what home care requires. Then multiply the difficulty times 2 or 3 or 4.
Yes, you should definitely ask what is involved now in home care. Is physical therapy needed and will they come to your home, or must you do transit to rehab?
What will be her limitations?
What are the chances that you two can manage care at home if you yourself have some limitations in helping? What progress is expected going forward.
Should there be some temporary SNF placement?
Tell the team that it is very crucial now for you to understand what your wife is capable of doing, and what her limitations are, and can home care safely proceed.
Ask them what steps you take if something goes wrong, if home care isn't proceeding well.
Definitely ask about pain management, and see to it you have stool softener prescribed if she is requiring any constipating pain meds (many ARE, and patients have been known, in hindsight, to complain that constipation was the worst part of their after care.
Wish you good luck, BOTH of you.
The only exception was this last time - as I mentioned - he transferred from the hospital unable (or unwilling, we were never sure which) to get out of the bed. He was lucid and awake and talking but he just wouldn't or couldn't get out of the bed. So they couldn't assess him. He stayed in the bed for over a week before he was finally able to get out of the bed with assistance. They were able to assess him and finally start some basic OT and then PT. After that we were able to have the family care plan at about 3 weeks in.
If she has already started her PT and OT I would definitely contact the Social Worker and ask for a meeting. Even if she hasn't, I think you are well within your rights to contact them and ask about progress and next steps.
You don't mention your ages. Age is a factor and so is your wife's willingness to do what needs to be done. They may set up some "in home" care but that is not permanent. Discissions can't be made this early in therapy.