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My dad was recently moved to a well-rated subacute facility following a stroke. He is on day 5 of his 20-day stay covered by Medicare. When my mom and I toured the facility we were told he’d have approx 2 total hours of therapy per day (PT, OT, and speech). However, he hasn’t even come close to that. He has only had 1 30-min PT session, no OT, and the speech therapist has covid so he may not see her for a week or more. We have complained to the administration, but what else can be done? Medicare is only covering for a limited number of days and my dad is regressing in some of the progress made in acute rehab. How can we get him home if he’s not getting the rehab he needs? He’s motivated and not refusing, but can’t get home until he can master transfers with my mom’s help and get some strength back.

DIRTY LITTLE SECRET - an empty bed = no revenue and rehabs / nursing homes will keep that bed filled as long as possible.

My mom had broken her arm - went to one rehab and then to a hospital for issues contracted in that rehab. After her hospital stay she ended up in another rehab for a few more months. When she first got there, they were leaving her in the bed and I had to intervene - SHE WAS TO GET OUT OF THAT BED EVERY SINGLE DAY and I didn't care if they were short staffed. This type of 'care' only keeps patients dependent and weakens the little stamina they may have.

Some CNAs get minimum wage and as a result, patients get subpar care. During the week nurses are on shift and give great care but on weekends 'agency' employees come in to care for patients and that is a different situation.

My mom was there for physical therapy but it was hit or miss. They had a walker in her room and was told her not to use it and to stay in the wheelchair. She was not to go to the bathroom by herself (yet no one would respond when she buzzed for help - they said 'just use the diaper). They would use a Hoyer lift to get her in and out of bed instead of helping her stand on her own.

I told mom she NEEDED to tell them NO MORE HOYER or she wouldn't be able to go home (a rule of theirs). She got her fight back and started going to the bathroom on her own. I finally told them she WAS coming home on the Thursday before Mother's Day.

Things I learned:
1. ADVOCATE ADVOCATE ADVOCATE for your loved one.
2. SPEAK UP if you see something wrong and if there is no resolution GO HIGHER until you GET a resolution.
3. VISIT as often as possible - I went every day but if you can't do that, HIRE someone to check in on your loved one.
4. DO NOT accept whatever is said - QUESTION EVERYTHING
5. TAKE NOTES and ASK for printed out reports of patient progress
6. ENCOURAGE your loved one to SPEAK UP if they are able to
7. Don't always GO BY THE RULES - they are intended to keep that bed filled
8. Hire an ELDER CARE ATTORNEY if needed
9. Do not GIVE UP
10. BE A PAIN IN THE ASS - the squeaky wheel gets the grease. Many times I went into closets to get clean bedding, towels and supplies Mom needed.
11. DO NOT BE INTIMIDATED by ANY worker there - they are hired to do a JOB
12. Educate yourself on patients' RIGHTS

I hope my long comment helps - Update on mom: she came home (she lives with us) a year and three months ago and is completely recovered. She is making her meals, chatting to friends on the phone, doing laundry and performing self care. I am extremely PROUD of her and grateful we got her home.

There is no situation that cannot be made better - don't give up... even if your loved one is not able to go home things can ALWAYS be improved.
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Reply to orangemonster99
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Tashi5 Aug 6, 2024
Well done! So sorry you & your mom had such a difficult time in her 'rehab'-but you turned it into an opportunity to help make her stronger.
Inspiring!
Sending love and congratulations and wishing you well.
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After my late husband had a massive stroke in 1996, he too was placed in what was considered one of the top rehab centers in our city.
And he received great daily therapy I believe because I was there with him every day to make sure that it happened.
I do recall while I was sitting on the sidelines in the therapy room that the CNA's would wheel some of the older patients in and they were just left sitting there where no one worked with them at all.
However no family members were with them either. Now it's a shame that you can't trust the therapy to happen unless a family member is there to make sure it does, but I witnessed it first hand, and that was back in 1996, so I can only imagine that things have gotten even worse.
So my question to you is....is your mom or someone else from the family spending a lot of time at the rehab facility with your dad to make sure that things are getting done as they should? If not, there is your answer right there.
If your dad can't advocate for himself right now, then you and your mom must do it for him.
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EPEverett Jul 30, 2024
Thanks for your reply. Yes, my mom is there every day and has been advocating for him. The response she keeps getting is that the 3rd party company that employs the therapists is having staffing issues. They send subs in where they can. The inconsistency in the therapy itself and the therapists working with him is just really frustrating. It’s slowing his progress. We have a meeting with an administrator later today and hopefully they can resolve it, provide extra therapy to compensate, and/or extend his stay. Thanks all for the feedback and advice!
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oh, and so what if speech therapist has COVID? These places should have contingency plans for those kind of things Surely there are temps out there. You are paying, or at least via your insurance a lot of money and you should expect and get full services.
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Daughterof1930 Jul 29, 2024
Good point. There are therapists who work PRN (as needed) jobs who sub for others, just as there are PRN staff in the medical field.
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Is there another rehab to arrange transfer to? If he’s not getting therapy as recommended and promised, it’s your right to move him to a place with better services
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On one hand I agree with Daughterof1930, on the other hand I wonder if there are any better rehabs. We took my mom to one which all the reviews said was very good, yet while there have been friendly and helpful nurses and aides, sometimes its terrible.

My mom was put in a room right across from the nurses station because of her propensity to get up and walk, even though she is not supposed to. (that is not rehabs fault) . But I went back and she was wandering around while the aides in the station just across the hall were on their phone playing games.

So if OP could find a place that truly was better, sure. But how do you know? Then are issues where Medicare or the Advantage or Supplement plans dont cover all places in the area.
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Reply to Karsten
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If the rehab facility is not doing what it is contracted and paid to do, you should be able to complain - ombudsman, APS, state authority? I'd suggest that you go to Admin and ask for information about how and who to complain to. The request may jerk them into action, without even having to follow through and do it. If there is a manager who doesn't seem to interested, ask for details of the company that probably owns the facility, so that you can contact them and inform them that a complaint is in progress.
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EPEverett Jul 30, 2024
Thank you! We have a meeting with an administrator later today and hopefully they will resolve it. I appreciate your suggestions.
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20 days is what Medicare pays for 100%. He could be in there longer than that where between 80 and 100 days Medicare pays for 50%. Dad pays the other 50% or maybe his supplimental insurance will cover it.

If he is not getting his therapy, then tell them to find a facility that has a speach therapist. If they will not do that, then you find one. Everyday that Dad is not getting therapy isca step back for him. I may even as if he can get "in home" care. Talk to his PCP. You are under no obligation to stay in a Rehab that the hospital recommended. Be aware though, his 20 days does not start over in a new rehab, it just continues.
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RedVanAnnie Aug 6, 2024
I think supplemental will only pay when Medicare has already approved and paid its portion. If Medicare payments are over, so is supplemental. Supplemental only "supplements" Medicare; it does not replace it.
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Same circumstances for my brother last summer! Rehab plan seemed to be based on what little staff they had, which was sparse. Facility contracted with a PT/OT company who either couldn’t find or keep employees (one who was transferring to another town spoke with me candidly), and they were especially short on speech therapists, so they quickly downgraded the amount of sessions. He had been through stroke rehab 12 years ago, so we knew what should be happening intensively. This is rural Minnesota, which sometimes seems like a health care desert. My MD sister was on the phone with someone nearly daily trying to figure out what to do, and I flew out there to be on site. It was awful. However, the PT and PT assistant were wonderful, as was the nursing home staff.
All I can say is advocate and be pushy. A transfer decision can be especially difficult in those rural circumstances!

What made my brother’s situation especially frustrating is that the PT at Mayo, where my brother started out, was cutting and pasting his old notes into his charting, so as social workers at facilities were making decisions, they were seeing an incoherent blob, rather than someone who was making an effort and progressing. So his applications to choice facilities were ignored for nearly two weeks before we realized what was happening and demanded that the PT update his notes. Then he was accepted immediately.

Be sure that someone in the family is present at some of the therapy sessions and knows what is being reported. What they put in their notes matters for continuing therapy as you move ahead.
Could luck, I’m with you!
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Zookie Aug 7, 2024
Cutting and pasting in the old notes should be illegal! That's so wrong!
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Wow. IMO. These places that suck the Medicare money but don't provide the services should be reported.
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Reply to southiebella
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Please file a grievance with his insurance company. You can have him transferred to another rehab.
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