My mom had a fall and I took her to the ER. They determined nothing was broken but she sprained an ankle and was having kidney issues that resolved with IV fluid. She was admitted as an outpatient under observation status rather than an admitted patient. (I didn’t know this.) Because of this, she is only eligible for Medicare to pay for acute rehab (3 hrs a day), not rehab at skilled nursing (SNF 1 hr a day). Acute rehabs are rejecting her case because she doesn’t have an acute diagnosis. The case manager says they will just send her home with home health care. That would be an unsafe discharge because she needs more support than her assisted living can provide right now. Her case manager was under the impression she lived in independent living, zipping around with a walker. This may be because mom gave this wrong info during the handful of hours I went home to shower and nap after being up for 36 hours. I told her SNF sounds more realistic for mom’s prior baseline, which was supervised limited walking in community spaces, support with bathing, and wheeling her to meals. Mom could only walk about 40 feet before needing a break or hitting exhaustion.Has anyone had luck getting the hospital to retroactively change a patient’s status from under observation to admitted? This would make an SNF stay possible. They are really fighting me and I don’t understand why. Mom has a comprehensive medigap plan just for this sort of thing.i have a call with the nursing director at her AL today to discuss what the parameters are for returning to AL. I will call her primary to ask his opinion of whether her prior baseline can tolerate acute rehab. I will talk to the attending doctor to make the case that the kidney issues and ankle sprain are qualifying diagnoses for a hospital stay.I want to support mom’s mobility as much as possible, but we are also in the stage where we are prioritizing comfort and rest, nearing palliative care. If a good acute rehab accepts her, I assume they will work within her limitations and she will be okay. But I’m not willing to put her in a poorly rated one or one very far away. She has vascular dementia and is vulnerable. The SNF is highly rated and right down the road from me.
You need to start thinking about how to pay for long term care, if that's where you think she will be best served. If she doesn't qualify for Medicaid because of her income and assets, then you will need to spend down her assets until she does qualify for Medicaid.
After more conversations with her care team, everyone agrees ALF is the worst option at the moment, but with rehab she may be able to return. It’s just a matter of either finding acute rehab that will accept her, or private paying for SNF.
Her dementia impacts her motor planning and judgement but she can engage with PT and is willing to do the work.
You state your Mom has vascular dementia. How old is she? How far along is it? Maybe she now needs MC (based upon her possibly not being aware enough to drink the fluids she needs to maintain basic health). Or LTC? Would she even cooperate with any PT?
Maybe consider taking her to her primary doctor and describe how she can barely make it past 40 feet, give her a more thorough exam and see if she has any other medical issues going on. In the ER they only treat what they can see in a brief discussion or overview of basic testing for the problem that caused the person to come in the first place, and then if the testing points to anything else. This is not a comprehensive exam and not being able to walk more than 40 feet could be cause by any number of issues not suitably diagnosed in an ER.
Maybe consider hiring an aid to be with her in AL for a while until you can figure out what your Mom needs going forward. Hopefully you are her PoA? If so, you need to have your documents with you so that every medical staff will know you are the decision maker/communicator, and not your Mom (due to her dementia).