Is it standard practice that Medicare approves discharge from a rehab facility too soon?

JColl,

If your husband is re-hospitalized within 30 days of discharge from the rehab facility, it it VERY bad for that facility - Medicare will "red flag" them. If they get too many of those, Medicare will no longer use them, and there goes the business. You can put a little fear in them by telling the Director of Nursing that you do not feel your husband is ready to come home and will likely end up back in the hospital very soon. Hospitals won't keep him just because you want them to, as you likely know. And I would appeal, as it takes a bit of time for that process to be completed.

GOOD LUCK!!!

JColl,

If your husband is re-hospitalized within 30 days of discharge from the rehab facility, it it VERY bad for that facility - Medicare will "red flag" them. If they get too many of those, Medicare will no longer use them, and there goes the business. You can put a little fear in them by telling the Director of Nursing that you do not feel your husband is ready to come home and will likely end up back in the hospital very soon. Hospitals won't keep him just because you want them to, as you likely know. And I would appeal, as it takes a bit of time for that process to be completed.

GOOD LUCK!!!

Just need to say something here.

If someone is ill, a rehab/nursing facility is not where you want them to be. They are limited in what they can do. My daughter says there are many times a hospital releases a patient to rehab that she evaluates and sends back to the hospital. They have no pharmacies on site like hospitals. Meds have to be ordered thru an offsight pharmacy and can take 24 hrs to receive.

Rehab means a person is able to do Therapy or needs a little more care. If they get ill in the process, they should be hospitalized.

Insurances determine your stay. Hospital and rehab. Thats why some people are released too early from a hospital. Insurance determines the length of your stay, not the doctors. When my MIL was in rehab, we were told if she refused therapy 3x they would have to discharge her. Doctor saw my Mom on a Thurs morning, she was to be discharged to rehab on Fri. When I went in on Friday she was just about breathing, her pause ox was 90. Sent a picture to my daughter, she thought Mom was dying. I kept telling the nurse there was something wrong, was told Dr. signed the discharge papers. Yes, 24 hrs before. Finally, they called the dr. and he was able to get her one more day. Daughter came, thought Mom was dying. Checked her antibiotics .... it had penicillin in it. Moms records showed she was allergic/sensitive. Daughter had it changed and Mom perked up. In the condition Mom was in, she never should have been taken to rehab. Why, they would have carried on the same thing the hospital did and Mom would have probably died.

So, what I am saying is that rehab may not be the best place for DH. Keep a close check on him and question, question, question. You can tell them you want him back in the hospital. Get his primary involved. TG I have a nurse in the family. She walks in with her scrubs on and they listen. If something doesn't seem right, go with that feeling.

JColl, so glad that got resolved! Glad to hear from you and keep us updated.

So far, I did appeal the “Non Coverage” status. That may take up to 3 days but he is covered during the appeal process. Meanwhile, the SNF informed me he tested positive for C-diff and will be isolated in his room for 10 days while receiving PT & OT in his room. I guess that means insurance will cover it BUT still must wait for official decision. I’ll keep all updated to let you know how it turns out. BTW appeal process was relatively easy on my part...a phone call to an “advocate” who took down all the particulars and explained the process to me.

Seguing off Alva's response, what WAS the purpose for rehab?   I.e., was it to recover from sepsis, or from C-Diff, or for cardiac issues?  The reason for being there, and whether adequate results have been achieved, drives the discharge decision.

I would talk to the DON tomorrow and find out specifically the purpose for his stay, whether that's been met and/or still exists, whether or not the treating physician at rehab plans to recommend home care (which I think sounds necessary), and why they feel he's ready for discharge.   

If you can't get to the DON, type up the notes (then they know you're serious) and ask the social worker to locate the appropriate people and get answers.

You could also ask her for brochures on home rehab, PT, OT, nurse, aide, etc. and make sure that she arranges for your chosen home rehab company to start either the day of or the day after he returns home.  

I've been through similar situations when I thought my father was being discharged too soon.   I didn't investigate an appeal, b/c at that time I was getting fed up with their lack of interest in his care and didn't feel there would be any benefit to being there any longer.  But I did make sure I got a referral for home care.

I can understand how frustrating this must be for you.   It takes awhile to learn how to play the games of ensuring that you get the care you want. 

And as to appeal, I'm only familiar with appeals from hospital discharges.

I wouldn't rely on them to make that call. In your shoes, I would call his PCP and ask what her/his opinion is about whether he needs to be readmitted.

Or get hold of the Director of Nursing and ask her directly what she would do if this was HER loved one.

Your problem is he is in rehab. Medicare will not pay if, like said, he can't participate. Maybe you can have him transferred to the NH part which means private pay or apply for Medicaid. Explain that you cannot take him home in the condition he is in. I would have him taken to the ER.

What facility is this? My mom wasn't discharged from Nursing home because she had C-Diff. They may do the same for your husband.

I think I'd ask for him to be taken to the ER and re-admitted for his acute cardiac issues.

Maybe he's not well enough for rehab to be effective? Maybe he needs to return to the hospital until his digestive issues and heart rate are resolved.

Medicare will not cover rehab when the patient cannot or will not improve.

Based on the issues he has...it sounds like rehab isn't going to work....heart rate all over the place.... Medicare bases their decision on the medical assessment of the facility.

Are they saying they "approve" discharge, or is Medicare actually ASKING for discharge? Do they call where he is "rehab"or "skilled nursing facility". By that I mean is he there for rehabilitation through physical therapy and occupational therapy, or specialized wound healings and etc. or is he only in need of more nursing care. Truth is that no one gets to stay in nursing care in hospitals for any amount of time at all anymore, and seems that time in rehab, if they are not actively able to participate and improve they are said to have reached their plateau and to have therefore been discharged from medicare's qualifications list for rehab. I hope against hope this isn't C-diff. It is so hard to cure and it can just be almost literally a killer. If it comes to it research fecal transplants; they are sometimes the only answer, hesitant as MDs are often to even discuss them.
Good luck on the appeal. Some on the forum have done it and won and hope that they are around to walk you through; I am sure there must be key phrases to use like hospitalization key phrase being "unsafe discharge".
Hope you will update us.