81 year old Mom in subacute rehab. Can we take her out?

Bumping this up in case others have some thoughts.

What does her doctor say about this idea? Do the nurses have any feedback for you about what they think is going on?

I can certainly understand your mom not wanting to be in the hospital anymore.

Hello
I am sorry for what your mother has been going through recently.
Unless your mother has been declared incompetent, she is an adult who can accept or refuse care. If she is not competent then her Health Care Power of Attorney has the right to accept or refuse care on her behalf.
So, either way she can leave when she wants, and if someone trys to pressure her or you to have her stay, that is a bluff and they cannot legally keep her.
If your question is about how to get the care she needs at home, that is a separate issue.
Help for that can be gotten by requesting a palliative care or hospice consult. Palliative care is available for anyone with a serious life limiting illness (you do not have to have a prognosis of death in the next 6-12 months for palliative care, and she can continue any treatments she is prescribed for her AML). This will connect you with services and resources. Hospice care is a wonderful option also, because it too will make many services available. But that also means that she will forgo any further curative treatments. I encourage you to go on the website for your hospital and see if they have a Palliative Care/ Hospice department, if not contact their Home Health Dept. and let them know you need services. They should be motivated to help you. And they can help arrange for physical therapy and equipment (bedside commode, etc) that may be needed.
Best of Luck to you
Margaret

It depends totally on the level of support that you will provide Mom after she gets home. If she only gets 3x per week physical therapy, then no. If you have someone live with her, get her on her feet several times a day, fix meals, do laundry, etc. etc. etc., then you can consider it. I did that for my Dad and it worked well. It won't be any less time than in the rehab facility, because they need TIME to heal.

My Mom was in rehab after a 4 day stay in the hospital. She maybe had rehab 2x a day the rest of the time she was in a wheelchair. I was told she wouldn't be able to walk without assistance. I told them I didn't know how anyone could rehab when they were in a wheelchair all day. Mom got back to the AL and was walking with her walker all over. I swore I would not rehab her again,

Your Mom was in 8 weeks. For every day in a hospital it takes 3days of rehab. Thats 168 days well passed Medicare paying. Medicare pays 100% for 20days, 50% 21 to 100. After that its private pay unless she qualifies for Medicaid. I know they come to you and say they r sending Mom to rehab but she can refuse. My Dad did.

Rehab will keep Mom for as long as they can. Talk to her doctor. Tell him she isn't doing well and can he help get her discharged and set her up with home therapy. You can work with her between homecare visits.

Unless you and your family can committ to consistently proving therapy at home - assist her to walk, assist her with ADL’ s including toileting and hygiene, don’t take her out of rehab.
If you are going to depend on home care PT those visits are 2-3x weekly with visits usually 45 minutes to an hour. That’s it.
Rehab has equipment to support her in re-learning to walk, etc. There won’t be any of those machines to support her at home.
It can take weeks to get her muscle groups in shape as she was immobile for 8 weeks while undergoing chemotherapy.
I know she will tell you she wants to go home. What if you take her and she gets home and does nothing or refuses therapy? She will continue to decline.
Try to explain that the harder she works at rehab to become stronger will in the end help her a lot when she goes home
Good luck!

Joann, I can only say that your experience with your mom was very different from my mom's.

After a stroke, she was in acute rehab for about 10 days (all therapies 2xday) and was then discharged to subacute for an additional 2 weeks. None of this lined up with how much Medicare she had or her funds (she could have private paid for a long time) .

She was evaluated by a local AL and deemed a good fit. She qualified for continued PT at the AL but unfortunately fell and broke her hip after being there a brief time. Surgery and anesthesia advanced both her dementia and frailty and she was discharged to a NH rehab, where they were able to get her walking again.

She lived contentedly there as a private pay patient for nearly 4 years.

TMCD, Shane makes good points, very realistic ones to consider. Home health care is nominal, disruptive, and often not geared to the level of the patient, even though that's what it should be. I've repeatedly told home health workers that PT and OT cannot be done on the same day; they listen, then ignore my concerns. One even argued with me, insisting that there's no reason why a 98 year old parent couldn't do both PT and OT on the same day.

Over a period of close to 20 years and experience with multiple facilities and home health care, I've just rediscovered the value of Catholic facilities and care. My father got the best hospital care when he was in a Catholic hospital in a city with a teaching hospital.

The best rehab, at that time, was in a commercial facility in the same city. Now I've just rediscovered an excellent rehab facility, owned and operated by some Dominican sisters. The staff is so much more professional but also compassionate. The Social Worker is very knowledgeable and helpful, unlike those of other facilities whose primary function seems to be to hand out brochures for home health care (seriously).

If you can, try to find out what your mother specifically doesn't like about the rehab facility, besides the hospital environment. Is there music therapy, pet therapy, a piano at which guests and visitors can play? These 3 functions make a world of difference.

Check out some other rehab facilities, but don't tell anyone who provides you with a tour that you're dissatisfied with the current place, or your guide will segue into a sales pitch. Make a checklist of what you want, be sure to ask about staff to patient ratio. The current one I'm using has a daytime s:p ratio of 1:8. One I interviewed had a ratio of 1:14.

Ratios are critical; if there aren't enough staff, patients sometimes won't get even the basic attention they need.

You can switch rehab facilities by asking the doctor who scripted for rehab to write a new script, explaining to him/her that the facility has proven to be not up to your standards.

Alternately, you can meet with the staff at the current rehab, review all your mother's issues of concern (perhaps uncaring PT/OT staff, lousy food, no interesting activities, and/or just laying in bed all day long w/o any diversion. If they can change the situation, they might....or they might not.

Good luck.

Assuming that you're not medical professionals, the answer to your question "(how can you) get rehab at home" is  that you shouldn't bring her home.

First of all the answer to your question is likely, yes. You can opt to take her home and get PT at home or if she is able at an OP facility. Some of this, your options that is, may depend on what state you are in, her doctors and how easily they work with you and what her issue is exactly. Is it just that she needs some help getting her strength back or isn't she able to get out of bed on her own at all? Do her legs work, she's just weak or is there a medical reason for her immobility. When they went over the options to prepare for her discharge from the hospital was going home and having VNA services come in one of the options or were they always talking about going to a rehab facility and it was a choice between acute or long term? Acute, at least in my mom's case is for just that, acute care and she was getting PT, OT daily with ST 2x a day (PT might have been 2x as well I forget) now the ST was what she really needed most but the point is she was very busy all day and for good reason. She hated the hospital surroundings too as she got better enough to hate it and did everything she could to get sprung so in a way that helped because it drove her to work as hard as she could in therapy. She didn't enjoy some of the OT in particular (she didn't really need it) but she did everything and more that they asked because she was driven to get out of there! In fact we wanted her to progress more slowly in either PT or OT because speech alone doesn't keep then there by Medicare standards and she really needed the intense speech therapy but so it goes! Anyway when she no longer qualified for Acute Care the options were NH (basically no speech available), home care (1hr or so a day with speech but therapist may or may not be specialized in speech and maybe once a week) or home and ambulatory meaning she needs to go to therapy rather than them coming to her (meaning we can pick a speech specialist and get her 3x or more a week). My point being that depending on her condition you have a couple of things to try, you could try the carrot of the more you work at PT the quicker you go home remember we chose the acute care to make the stay more intense but shorter...but until you can walk from y to x or go up and down the stairs (whatever it is) we just wont be able to take care of you at home. But if she is mobile enough and you are prepared enough to have her home and she is really that unhappy it might be better for her, frame of mind can make such a huge difference in the progress and outcome of a patient. If that's the way you go you can probably get nursing care at least a few times a week (not necessarily to stay with her long enough for you to do something if she can't be left alone) and PT at home for her until they feel she is well enough to not need it any more and or can go out to PT on her own. Be sure to talk to the coordinator and her therapists at rehab though first, have a family meeting to touch base about how she is doing in their professional opinions and the pluses and minuses of taking her home for rehab, be honest about why you are considering it maybe they will have ways to try and make her happier there even but getting their feedback as well as assistance in planning for her to go home whenever that is will be well worth it. Ok, should be well worth it.

This is all assuming she is well enough that the plan is she is going home. The way I read your question, her stamina is just low because she was bedridden for 8 weeks but her health is now good to go home this stop at acute rehab was simply to get her up and moving more to re-build her stamina than re-learn or heal anything. Some of the other responses seem to understand the situation differently so I am second guessing myself a bit.