One of my jobs as an advocate is to navigate the transition from a hospital admission to a rehabilitation facility to managing life once in the rehab facility. The most important role I can play during this time is to keep the emotions from erupting on both sides.
Patients and families are often told about rehab placement days before discharge by the social worker or discharge planner. The medical team has already informed the planner that medical clearance is soon. This starts the ball rolling and the discharge planner starts looking for beds. If you are not informed of imminent discharge, the planner will find a bed in a facility and let you know. Or 1-2 days before discharge, the planner will hand the family a list and say pick one. Medicare and insurance companies are notorious for refusing to pay a hospital if a rehab bed is available.
This is when the nightmare for the family begins. Rehab facilities are not equal across the board. There has been a shift in the last ten years for nursing homes to add rehab facilities because that is where the money is. Some nursing/rehabs offer actual limited rehab.
The burden falls on the family to notify a planner as to where the patient needs to be placed. This means going through the list and doing the following:
1. Decide the distant from home acceptable 2. Review website 3. Call rehab and speak with admissions or administrator 4. Review rating on Medicare.gov if also nursing home 5. If possible, visit facility and have a list of questions especially about what kind of rehab available. Speak to residents. Ask to kitchen area 6. Prioritize the list and give to the planner .
The most common response from the planner is, thank you but I will have to place in the first available bed. It is the same mantra in every hospital. Let them know you only want certain places and keep pushing. The planner only wants to get the person placed with little thought to the needs of the family/patient. It is the mandate of the hospital. Some states Department of Public Health or Hospitals allow you to appeal within 12-24hrs if you don’t agree with the placement.
Once you made it to a rehab center, it would be great if the family could relax. It is not the case. Rehabs are generally understaffed and stretched. Weekends there is usually no physical or occupational therapy. It is important to make sure the medications are being given appropriately especially for diabetics and proper diets are maintained. I have seen diabetics receive sugar drinks and desserts.
Recently a client of mine was transferred to a reputable nationally recognized rehab center. The second night he was there, he fell. His wife came int he next morning and found him restrained. Luckily, his wife was involved or else he probably would still be restrained. As a family member or representative, you have to keep the pressure on. It doesn’t matter if anyone gets annoyed. Rehabs position themselves as not acute settings and therefore don’t have the same expectations as a hospital. Patients may not have the IV’s or be critical but many of the needs are the same. Some of these needs are diabetic care, wound care, assistance with actvities of daily living.
Rehab clients complain often of having to wait to use the toilet if they need assistance. It is degrading and sometimes humiliating. I continually speak to staff about responding to my clients in a timely fashion. No one should have to wait an hour to go to the bathroom. My elderly clients will say, oh I didn’t want to be bother. I always emphasis it is not a bother for a staff member to be called.
An advocate’s voice is essential in the rehab setting whether it is from the family or privately hired. It is too easy to fall through the cracks and just not get the optimal care needed for recovery. I encourage all my families to be vigilant and continually apply pressure. Don’t give an inch!