Talk to me about rehab facilities for PT for elderly

[PeterPan]

So I've shared some of my dad's saga in the past. He has a lesion, fractured vertebrae, etc. and declined with the covid/pfizer vaccine to the point of being in a wheelchair and now in bed in pain. The doctors and social worker at the hospital want to put him in a rehab facility. What do you know about this? Are these places pleasant when they're for the 70+ or are they essentially nursing homes? What do I watch out for with placement? Does size or private vs. hospital make a difference? How do you assess quality?

And if he's having sciatic pain, why are they telling me they'll do PT but not allow chiropractic for inpatient? This makes no sense. Can PT solve the pinched nerve??

They said the social worker is going to call Monday, so I think I'm going to be put on the spot to make a decision quickly. He's in the hospital now, but they want him out and into a rehab facility instead. 

[Harriet Vane]

With my fil I learned there us a difference between nursing homes and PT focused rehab centers. All of them will say they do PT. It takes digging into each one individually to find out really truly how much PT. 
 

Also check into whether insurance will give in-home, daily PT.

[PeterPan]

2 minutes ago, Harriet Vane said:

With my fil I learned there us a difference between nursing homes and PT focused rehab centers. All of them will say they do PT. It takes digging into each one individually to find out really truly how much PT. 
 

Also check into whether insurance will give in-home, daily PT.

The assisted living where he lives had tried to provide PT, but it was scattershot and not getting him there. I talked with the doctor and asked about doing it outpatient, but she said he's not up to that, that it has to be inpatient. They really want him up and walking again. 

So you're saying ask specifically about how much PT. It sounds like then getting a "bargain" just means less therapy. 

I don't want him in a nursing home vibe because I want him motivated to get up, participate, etc. 

Thank you for what you sent me btw. I am looking forward to using it.

[TechWife]

Go for a rehab center that does rehab, not a nursing home with rehab. They are much more experienced with actually working to rehab a patient as opposed to maintaining. They are sometimes affiliated with hospitals, but not always. We found that the ones affiliated with hospitals had better staffing ratios, including more RN’s, and were better resourced. Depending on where he lives, there may not be much of a choice, if any, if there is a rehab bed shortage in his area. Go visit these places in person, or send a trusted friend. 

[jen3kids]

My mil was assessed, and subsequently declined, to move into a focused rehab center.  Instead she had to move to a long-term care home.  She was deemed ineligible for the rehab facility because of her many underlying health conditions that they felt would negatively impact her rehab.  From the research that I did, the rehab facility would have been more intense and focused. The PT she'll be getting at the LTC home will be less intense, but hopefully effective and maybe she'll get into the focused rehab center once she makes some progress.

 

Definitely do research on each option and make them give you time to do that.  Once he's in a place you should be able to see the care plan for him and be able to ask specific questions.  

[TechWife]

Also, yes PT helps with pinched nerves. It’s something they commonly work with and in our family experience, have good results with. 

[cintinative]

21 minutes ago, Harriet Vane said:

With my fil I learned there us a difference between nursing homes and PT focused rehab centers. All of them will say they do PT. It takes digging into each one individually to find out really truly how much PT. 

This is what I have noticed when comparing my mom's experience post surgery (she had a major spine surgery correcting lateral scoliosis at age 78) with other people's parents. Mom's facility was a dedicated rehab center. She did hours of pt and ot every day. They had a regimented schedule, and they kept to it. My impression, which is largely anecdotal and based on what friends have told me after their parents had surgery and went to a nursing home, is that the nursing homes are much, much less aggressive about pt and ot. 

ETA: the facility she was in was around Dana Avenue off of I-71. I am not sure how far you are able to travel, @PeterPan  Mom had heard good things about the facility from a friend.  I appreciated how they gently but firmly dealt with mom's hesitation and her OCD. Mom had complaints, like not getting all the showers she was promised, but they really did a lot for her. Mom is very high-maintenance.

Edited May 8, 2021 by cintinative

[prairiewindmomma]

PT can absolutely help with sciatica. I found way more relief there than which chiropractors.

Rehab facilities are more intense and offer more specialists IME than nursing homes. You have to qualify to go to rehab showing that you are likely to improve and are capable of doing the exercises for insurance to pay. Nursing homes can do PT also, but it is usually fewer hours a day and less focused in goals overall.

[KSera]

33 minutes ago, PeterPan said:

And if he's having sciatic pain, why are they telling me they'll do PT but not allow chiropractic for inpatient? This makes no sense. Can PT solve the pinched nerve??

PT has more evidence base behind it and doesn’t carry the degree of risk that chiropractic can. 

[PeterPan]

11 minutes ago, TechWife said:

Go visit these places in person

Ok. Any tips on what to look for or is it obvious?

6 minutes ago, jen3kids said:

make them give you time to do that.

I've been doing HBOT daily, but I may have to miss a session to make the trip. I've made a lot of progress, but I still can't play a board game without fatigue afterward. I can play the board game (an improvement), but no resilience, sigh. And this doesn't sound like it's going to wait for my head, haha. 

**Ok, so now for a question I haven't sorted out. How long will he be in and do I remove his stuff from his assisted living or keep the contract? The social worker is going to call with more info Monday. That's actually my biggest stress. This seems like 6-8 weeks, not a short thing.

6 minutes ago, TechWife said:

Also, yes PT helps with pinched nerves. It’s something they commonly work with and in our family experience, have good results with. 

That's helpful, thanks. The doctor I talked with said it was evidence based.

5 minutes ago, cintinative said:

at age 78) with other people's parents. Mom's facility was a dedicated rehab center. She did hours of pt and ot every day. They had a regimented schedule, and they kept to it.

Wow, if they did that, yes he should make some progress!!

5 minutes ago, prairiewindmomma said:

PT can absolutely help with sciatica. I found way more relief there than which chiropractors.

Rehab facilities are more intense and offer more specialists IME than nursing homes. You have to qualify to go to rehab showing that you are likely to improve and are capable of doing the exercises for insurance to pay. Nursing homes can do PT also, but it is usually fewer hours a day and less focused in goals overall.

Yes, yes!! This was the problem. The AL was getting him PT and it was just palliative, not intensive, not enough.

Well if your experience is PT was better than chiro, that's good enough for me. And yes, I think everyone thinks he has the potential to be walking again, at least with a walker. No one is happy at his current decline and the AL couldn't line up the intensity of what it was going to take to turn it around.

The doctor would not bite on the timeline of the vaccines and this decline, even though it's stinking obvious. It didn't seem to change care in her mind either.

If this is 3 months or something, that's a long time to pay for his AL residence and not be there. Maybe they'd give a break for not eating? Haha. That's going to be the social worker chat, because we need some sense of his correct placement after he's done with this. No point keeping the AL apartment if he can't return there, sigh. But that to me would be the best outcome, if he could.

[PeterPan]

1 minute ago, KSera said:

PT has more evidence base behind it and doesn’t carry the degree of risk that chiropractic can. 

Yeah the chiro was a long shot. His back situation is complex.

[TechWife]

24 minutes ago, PeterPan said:

They said the social worker is going to call Monday, so I think I'm going to be put on the spot to make a decision quickly. He's in the hospital now, but they want him out and into a rehab facility instead. 

Don’t let them rush you into making a decision on the spot. They will probably tell you which facilitates have open beds and give you contact information. At this point, you will need to move quickly. This becomes your job for the next 24-48 hours. Beds tend to get taken quickly, so you want to make a decision as soon as you reasonably can. If you can, go visit. If you can’t, send a trusted friend. If they aren’t allowing visits due to COVID, or there is no one who can go, they may have some type of video tour available and you should be able to talk to the intake/admissions person at length. By length, know that it took us at least an hour to see each facility and ask questions. They should expect to spend a reasonable amount of time with you. Once you have settled on a facility, let the hospital social worker know. Be sure to ask the one you talk to on  Monday who you should talk to if she/he isn’t available. Once they know, they will send your fathers info to the facility and request that they admit him. The ball is now in the facility’s court, but they will move quickly. Once he is accepted to a facility, expect him to be transferred within a day, two at the most. Avoid Friday admission if at all possible. Based on our experience, there are delays in starting treatment and even sometimes in getting the correct medication on site if it is a stand alone facility. 
 

Between both of my parents, we did the rehab route at least four, .maybe five, times. I’ll try to answer any specific questions you might have. 

[prairiewindmomma]

TechWife is spot on in her advice here; it has been our experience also.

[prairiewindmomma]

Locally, the facility we try to get elderly relative into is a step down facility. They have a rehab arm inside of a facility that has skilled nursing, nursing home, and assisted living in it as well. 

[J-rap]

In our experience, stand-alone rehab facilities are consistently nicer than a facility that has both long-term care with rehab in one wing, for example.    However, it really depends on the facility.   My father was once in a rehab wing of a facility that was mostly a long-term care building, and his wing was actually quite nice.  Maybe not quite as new and modern as the stand-alone, but it was just four blocks from their home which meant my mother could easily drive there every day and visit him.  She could even have lunch with him.   (pre-Covid of course.)

Rehab generally includes the options of PT, OT, and ST.   At the most, they'll provide all three sessions in the morning and again in the afternoon, depending of course on what's needed and the condition of the patient.

Because they vary so much, I would strongly advise you to tour them ahead of time, or talk to people to get word-of-mouth recommendations.

[ktgrok]

38 minutes ago, TechWife said:

Also, yes PT helps with pinched nerves. It’s something they commonly work with and in our family experience, have good results with. 

Yup. My PT works to realign stuff all the time, as do the others. That is part of their training (not all PTs have that training, but it is part of what they can do). 

[TechWife]

Many of the questions you ask will have consistent answers between facilities because there are regulations they have to follow. You’re looking for an overall impression as you ask them and hopefully you will gets some answers that help you develop a preference. So much of this is a judgement call, and you may have an unsettled feeling no matter what you choose. It’s just hard to leave our loved ones in the care of others when they are vulnerable. 

Some questions to ask: 

Resident to nurse ratio (they are called residents, not patients in these facilities) - day and night

how many RN’s on duty at a time? How many LPN’s? 
Do staffing ratios change on the weekend? How?

Who gives medications? RN, LPN or other? Who is allowed to do this varies by state law.

How do they verify they are giving the right meds to the right person at the right time? 

What pharmacy do they use? If a new medication is ordered, how long will it be before it is actually started? 
 

Who is their attending physician? How often does the physician round? It’s shocking to most, but monthly rounding is all that is required. To keep it in perspective, remember that the residents aren’t sick, they have varying degrees of disability and age related health issues, but they don’t need daily monitoring by a physician. Residents who need more frequent physician involvement don’t qualify for rehab. 

When will he be first assessed by PT, OT and ST? 
When can you expect a treatment plan?  This is regulated and I think it’s within ten days, but I’m not sure anymore. 

What is a typical day like? 

Do they have an activity director? What activities are available and how often? Does the activity director seek out people to participate?

How often is bathing done? 
What are mealtimes? What snacks are available? 
How do you cue staff to hearing loss? 
are hearing assisted devices available for tv’s?

What is the cleaning schedule like? How often are sheets changed, floors mopped? 
 

Ask them to provide a copy of their most recent survey - this is a big deal and by law they have to let you see it and give you time to read it. Note any violations and ask how they were addressed. 
 

Ask for the name and phone number of the ombudsman. This person looks out for the interests of the residents and is usually employed by the state or is a trained volunteer with the state. Either one is fine. Call the ombudsman and ask about overall impression, any complaints they have received- what kind, when and resolution. Ask if they would want to be a resident there. Know they may not answer that question due to ethical concerns, but if you’re on a video call, body language says a lot. 

If you go - things to observe

cleanliness

odor - contrary to common misperceptions, nursing homes should not smell like urine. Those odors only occur after too much time has elapsed (think about your own baby’s diapers). Likewise, fecal smells are temporary and shouldn’t linger. 

accessibility - can wheelchairs, walkers, canes be used everywhere? Residents shouldn’t have to regularly ask for things to be moved while accessing routine activities, items or locations. 
 

How does the staff interact with patients? Don’t let loud voices on staff worry you, hearing loss isn’t unusual. Instead, pay attention to tone and body language. Do they seem over tired, frustrated, gentle, kind? 
 

Ill post more when I think of them. 

 

 

[Harriet Vane]

55 minutes ago, TechWife said:

Also, yes PT helps with pinched nerves. It’s something they commonly work with and in our family experience, have good results with. 

I agree. Both dh and I were able to avoid surgery in recent years by dedicating ourselves to PT.

[Carol in Cal.]

One thing about the PT—he can’t refuse it much, nor can he fail to progress, and keep his insurance for it.  Medicare is very strict about that.  They don’t pay for custodial care but they pay for medical care, and it’s the progress and cooperation that make the difference between the two.  Once he is considered stable (as good as he can get) then Medicare coverage is stopped.  You have to be ready to move him very quickly when that happens or the OOP expense skyrockets.

[TechWife]

oh - also check to see if residents are neatly groomed. In rehab they should be wearing clothing, not nightclothes. 
ask about laundry services

ask what he needs to bring with him. You may need to go shopping for easy to pull on clothing, like sweatpants, or extra underwear. Someone will also need to put his name in his clothes. If you aren’t able to go, ask them if they will do this for him when he arrives. You can also ask the hospital social worker. If no one can get clothes for him, ask if they know of any volunteer organizations that could help you do the shopping. 

Length of time is usually 21-30 days. There will be discharge planning, they can’t discharge without notice. As far as paying for assisted living, you will need to check the contract. For my mom’s AL, they charged the rent for the room but there were no care charges. There was a time limit on how long they would allow that to go one, maybe 6 weeks? It was all spelled out in the contract. If you don’t have easy access to the contract, just call them and ask. 

Browse websites for the facilities before you talk to them for background information. 

Go to Medicare compare to compare places. Choose rehabilitation from the drop down menu. 

https://www.medicare.gov/care-compare/#search

Here are some helpful resources. You will find some useful information, including questions to ask in the following links. For the purposes of lingo - rehab facilities and nursing homes are both called long term care facilities. 
 

https://www.medicare.gov/sites/default/files/2019-10/02174-nursing-home-other-long-term-services.pdf

https://www.nia.nih.gov/health/how-choose-nursing-home

I apologize for the lack of capitalization. I am typing quickly on my iPad and my fingers aren’t keeping up with my thoughts.

Edited May 8, 2021 by TechWife

[TechWife]

How Medicare covers rehabilitation facilities: 

https://www.medicare.gov/coverage/inpatient-rehabilitation-care
 

 

[PeterPan]

54 minutes ago, TechWife said:

Beds tend to get taken quickly, so you want to make a decision as soon as you reasonably can. 

Ok, I hadn't caught onto the timeline on this, so thanks for saying it in plain english, lol. I will talk with my dh so we can sort it out. 

 

29 minutes ago, TechWife said:

Resident to nurse ratio

 

30 minutes ago, TechWife said:

What pharmacy do they use?

That's interesting. His care is very complex. When he checked into the VA hospital, he brought his meds and they didn't want them. They have all his scrips on file and handle it themselves. Hopefully this social worker will give us good suggestions capable of handling this, because you're right botching it would be bad.

32 minutes ago, TechWife said:

but monthly rounding is all that is required. To keep it in perspective, remember that the residents aren’t sick, they have varying degrees of disability and age related health issues, but they don’t need daily monitoring by a physician. Residents who need more frequent physician involvement don’t qualify for rehab. 

ok

32 minutes ago, TechWife said:

What is a typical day like? 

Do they have an activity director? What activities are available and how often? Does the activity director seek out people to participate?

How often is bathing done? 

 

33 minutes ago, TechWife said:

Ask them to provide a copy of their most recent survey - this is a big deal and by law they have to let you see it and give you time to read it. Note any violations and ask how they were addressed. 

Hadn't heard of this.

My head is spinning now btw. There are a lot of issues here.

10 minutes ago, TechWife said:

oh - also check to see if residents are neatly groomed. In rehab they should be wearing clothing, not nightclothes. 
ask about laundry services

ask what he needs to bring with him. You may need to go shopping for easy to pull on clothing, like sweatpants, or extra underwear. Someone will also need to put his name in his clothes. If you aren’t able to go, ask them if they will do this for him when he arrives.

So I had just bought him clothes and was trying to get pull on pants and he had wanted to keep zip/dockers style, sigh. He has a couple pull on and we could get more. They would be way more practical. I hadn't thought about the laundry thing. It's very low key in AL (do it yourself or ask the worker who puts it in a small machine, not commercial shared huge style)

12 minutes ago, TechWife said:

Length of time is usually 21-30 days.

Ok, then that's easy. 

 

4 minutes ago, TechWife said:

How Medicare covers rehabilitation facilities: 

https://www.medicare.gov/coverage/inpatient-rehabilitation-care
 

 

Yeah I'm not sure what part will be medicare and what part will be VA. 

Well you've given me a ton to think about. There were issues I hadn't thought through, and it definitely sounds like he's going to need us there to make this happen. And it sounds like you say like a two day thing, because we tour one day, move in the next. Or at least we have to allow for that possibility.

[PeterPan]

Private room. The medicare site says this is upcharge. Guess that's something to talk with the social worker about. It might limit options, but I can't imagine my dad being wise in a shared room. Maybe I'm crazy. Are you not in there much and it doesn't matter? He has significant mental health issues and does not need anyone else's stress on top of his own. 

[TechWife]

1 minute ago, PeterPan said:

Private room. The medicare site says this is upcharge. Guess that's something to talk with the social worker about. It might limit options, but I can't imagine my dad being wise in a shared room. Maybe I'm crazy. Are you not in there much and it doesn't matter? He has significant mental health issues and does not need anyone else's stress on top of his own. 

Some places don’t have any private rooms, some have limited private rooms and some have all private rooms, in which case they are not allowed to upcharge. Ask the social worker if he would medically qualify for a private room due to his mental health issues. I’m not sure if it’s a thing, but it might be. It’s worth it to ask in any case. 

[Carol in Cal.]

3 minutes ago, PeterPan said:

Private room. The medicare site says this is upcharge. Guess that's something to talk with the social worker about. It might limit options, but I can't imagine my dad being wise in a shared room. Maybe I'm crazy. Are you not in there much and it doesn't matter? He has significant mental health issues and does not need anyone else's stress on top of his own. 

Some of the so-called shared rooms are cramped like hospital rooms while some are more spacious and have a significant divider between the two areas.  This is something to watch for and ask about on the tour.

If he is doing intensive rehab, that might be a PT and an OT session each day.  He would still be in the room much of the time.

[TechWife]

I need to go do some other things, I’ll check in later to see if I can offer any more input.

[J-rap]

40 minutes ago, PeterPan said:

Private room. The medicare site says this is upcharge. Guess that's something to talk with the social worker about. It might limit options, but I can't imagine my dad being wise in a shared room. Maybe I'm crazy. Are you not in there much and it doesn't matter? He has significant mental health issues and does not need anyone else's stress on top of his own. 

If a facility has a mix of private and shared, it's our experience that they'll charge anywhere between $35 and $60/day out-of-pocket to be bumped up to a private with no medical reason.  We've always done that when possible, although it isn't always possible.

[TravelingChris]

I was so happy that my recent hospitalization was in a hospital that has all private rooms. This was my longest hospitalization (a week) and my previous longest (4 days) was in a shared room and really, really bugged me. Plus dh couldn't stay with me in the shared room but could this last time.

[matrips]

7 hours ago, PeterPan said:

So I've shared some of my dad's saga in the past. He has a lesion, fractured vertebrae, etc. and declined with the covid/pfizer vaccine to the point of being in a wheelchair and now in bed in pain. The doctors and social worker at the hospital want to put him in a rehab facility. What do you know about this? Are these places pleasant when they're for the 70+ or are they essentially nursing homes? What do I watch out for with placement? Does size or private vs. hospital make a difference? How do you assess quality?

And if he's having sciatic pain, why are they telling me they'll do PT but not allow chiropractic for inpatient? This makes no sense. Can PT solve the pinched nerve??

They said the social worker is going to call Monday, so I think I'm going to be put on the spot to make a decision quickly. He's in the hospital now, but they want him out and into a rehab facility instead. 

His doctor has to be very specific for the PT prescription- if he wants 2x/day, 7 days a week, the doctor has to spell it out on the prescription (and get a copy of it). Many rehabs in my experience are busy and will try to get away with 1x/day and never on weekends or holidays. So check the rehab staff.  Also, if they come to get your dad and he says he doesn’t want to do it or isn’t ready, he may be forgotten for the day.  

Which brings the issue of the CNA staff into place.  Visit at various times (especially evenings if you can). My mom stayed in one place with some seriously witchy cnas.  I mean NASTY! Sometimes you can hear the way they talk in the hall to each other.  The admin staff was very nice, but it’s the cnas that the patients have the most dealings with - for dressing, toileting, meds, general help. How well staffed is the place (how many vacancies?).  Are people mainly in their beds all day?  In wheelchairs lined up in the hall?  Busy doing things?  What are the interactions the staff has?  Smiling and chatty and friendly?  Or ignore and walk past?

if you have to pick a place quickly, do your best and then plan to be there, a lot.  

does he need OT?  Many times the place will give PT and ot and count that as two therapies a day if they’re busy instead of giving two PT sessions.  My mom hated OT and thought it was such a waste. But the place makes Medicare money from it. Ask his doctor to be very clear in prescribing what he needs and doesn’t need.

[PeterPan]

24 minutes ago, matrips said:

Ask his doctor to be very clear in prescribing what he needs and doesn’t need.

Hmm, interesting. I'll be talking with the doc again before this goes down, so now I know what to ask. 

[matrips]

One other thing to ask his doctor- how much time should your dad spend up, in a chair, walking with a walker, versus back in bed.  Elderly lose a lot of muscle and ability very fast.  Sitting requires more core muscles and strength than laying in bed.  

Is he continent now? If so, insist that they get him up to use the bathroom instead of diapering him. Otherwise he will likely come out of rehab incontinent and needing depends full time. The staff generally finds it easier to change depends than get the elderly folks to the bathroom because they change them at a time of their choosing.

they won’t feed him, so he needs to self feed or you help him.

give him a cell phone so he can call you, if he doesn’t already have one. Check to make sure he’s been up, dressed and given breakfast by a certain time each morning. The cnas and PT staff don’t always work together well to ensure patients make it to their appointments. 
 

there are excellent staff.  It’s just that I’ve seen more bad and ‘meh’ staff than terrific staff. It’s hard, messy, and underpaid work.

[TechWife]

It's been our experience that after completing evaluations, the rehab facility writes the treatment plan and the doctor signs off on it. Physicians typically don't know the details of what exercises need to be done & how frequently. If they have questions about the plan, they contact the facility and work it out. The family has input on the plan as well. There should be an in person meeting or a phone conference with the care team, both are common.

PT evaluates gross motor skills;  OT evaluates fine motor skills and ADL's (activities of daily living), speech will evaluate speech and eating (chewing & swallowing). They will all write their separate pieces of the treatment plan and then it all gets put together.

[PeterPan]

17 hours ago, matrips said:

Is he continent now? If so, insist that they get him up to use the bathroom instead of diapering him. Otherwise he will likely come out of rehab incontinent and needing depends full time. The staff generally finds it easier to change depends than get the elderly folks to the bathroom because they change them at a time of their choosing.

Oh my. I would have naively assumed bathrooming on his own was a goal, mercy. 

17 hours ago, matrips said:

how much time should your dad spend up, in a chair, walking with a walker, versus back in bed.  Elderly lose a lot of muscle and ability very fast.  Sitting requires more core muscles and strength than laying in bed.  

Yes, this is why he has declined so quickly, because he hurt and found it easier to stay in bed.

[PeterPan]

Ok @TechWife or @matrips or anyone who cares to answer... I have basic logistics questions.

-athletic pants--How many? Is it the norm to rewear pants or do they want fresh every day? So 8 pairs or 5? How often do they do laundry?

-socks and sneakers or something else?

-pajamas? I don't think he normally sleeps in them, so I bought him a pair of pj pants and a tee. Didn't want to frighten the neighbor. 

-slip on shoes or slippers for going to the bathroom or are not necessary? 

-light indoor jacket

Anything else? Is the laundry likely to ruin clothes? How casual/dressed are these places? I have both normal short sleeve shirts with a collar to pair with the athletic pants and simple t-shirts. Are the t-shirts more appropriate or should he have both? 

I don't want to take too much and confuse/complicate things, but I won't be close enough to easily take more and need to get it right the first time.

Should I stay for a day after he is settled? He seems kind of looped to me from the pain meds. His last move several years ago was very (extremely) stressful, but this time he almost seems checked out. I want the hospital to do the transport. We just have to get him in and into a routine.

Is it wise to bring any personal effects to make it cozy? Might he need a blanket/afghan? He typically keeps his assisted living apartment 74, so I don't know how this place will compare. With it set at 74, he doesn't need extra clothing or layers.

I'm now realizing this has a whole trajectory that I don't understand, but I'll ask the doctor about all that, sigh. 

Thanks in advance

 

Edited May 9, 2021 by PeterPan

[prairiewindmomma]

They want fresh clothing daily, and maybe extra sets.  As to laundry, ask the facility. For sure, label everything. Don't send anything too precious.  Sweatpants, tennis shoes, t-shirts and zip up hoodies or sweatshirts.  Elastic waistbands make it easier to dress, and they will be doing a lot of stretches and gait training with him. 

I would block the day of the move and the day after on your schedule, and plan for phone calls or other interruptions the first week as things get sorted out.  This is a Thing.  I would expect some disorientation and some unhappiness about the rehab schedule, especially if there are other mental health issues at play.

[PeterPan]

10 minutes ago, prairiewindmomma said:

They want fresh clothing daily, and maybe extra sets.  

Ok, that's what I figured. I got up to 5, so I need to hit some more stores. He's a hard size, 3XLT. And actually this is stupid but if his pants slump under his belly he needs them shorter and if pulled up he needs the tall. So he's technically a 34 inseam but when they droop needs 32 for dockers/chinos. But with the elastic waist (only one pair) he was able to pull them up, meaning the tall is fine and looks nice. But if they droop, they'll be dragging while he's trying to walk. 

In other words I'm losing my mind.

I can look and see if Walmart carries tall for him. I sorta doubt it. I've been using DXL, because I can walk in and buy stuff and get help. So it's stupid $$ but it's done. 

[PeterPan]

I'm going to rant/vent. I need some sleep or to be nice to myself or something. I'm feeling sorta frazzled. I'm not as done with my HBOT as I wanted to be and this is a long/hard trip and if my mother hadn't divorced him it would be her job. And I have to do it by myself because dh is busy. Unless it waits till Wed, but I don't see how the social worker calling Monday results in this waiting till Wednesday, right? What is the gap between when they call and when they want him out? Am I taking this too literally? Like when they call, they want a DECISION, yes? 

These meds must make people loopy, because my dad doesn't remember things from yesterday even. He just seems happy, haha. So he's like oh, don't stress, wait for the call, lah de dah, and I'm thinking no I'm 4 hours away and they're going to want this done and I have to pack your stuff, find/buy more clothes, tour all these places, on and on. 

[TechWife]

Yes, I think an afghan is a good idea. It’s practical, but it’s also a homey touch. Something familiar is nice to have. You might want to bring a picture for his bedside, a favorite book, if he’s a reader. Just remember that everything that you take to him will have to be moved out with him, too, so don’t go overboard. Don’t take anything valuable or anything that he would be heartbroken to lose if it gets lost. 
 

You’re doing great picking out clothes. I agree that the minimum would be one set each day. If his pants drag the ground, they will remind him to pull them up. Late in his life, my dad wore suspenders to keep his pants up, he said it was better than a belt. Of course, he wore a belt at the same time, but habits are hard to break, so we just grinned! 

Also, don’t forget Amazon. You can have items delivered directly to him once you have an address. Speaking of that, encourage everyone he knows to write him as often as they can. 
 

Don’t forget his toiletries. Shampoo, toothpaste, toothbrush, shaving cream, razor. Bring enough for a month. Find out if he uses eye drops for dry eyes and make sure they are provided. Some facilities consider it medicine and it comes through the pharmacy. Insurance doesn’t pay for it, so you can ask if you can bring it to them and have them put it on the med cart. Whether or not they do that might depend on state pharmacy laws. 

Slippers will be good - get ones with rubber bottoms, they are less slippery on the floors. Also, get ones that come up the back of his feet like shoes, not the open back ones. He’s less likely to accidentally walk out of his, which could cause a fall. 

[TechWife]

27 minutes ago, PeterPan said:

I'm going to rant/vent. I need some sleep or to be nice to myself or something. I'm feeling sorta frazzled. I'm not as done with my HBOT as I wanted to be and this is a long/hard trip and if my mother hadn't divorced him it would be her job. And I have to do it by myself because dh is busy. Unless it waits till Wed, but I don't see how the social worker calling Monday results in this waiting till Wednesday, right? What is the gap between when they call and when they want him out? Am I taking this too literally? Like when they call, they want a DECISION, yes? 

These meds must make people loopy, because my dad doesn't remember things from yesterday even. He just seems happy, haha. So he's like oh, don't stress, wait for the call, lah de dah, and I'm thinking no I'm 4 hours away and they're going to want this done and I have to pack your stuff, find/buy more clothes, tour all these places, on and on. 

Self care is paramount! Having older parents is a marathon, not a sprint, so pace yourself. Remember you can send just about anything to him through Amazon if you forget to get him something. 

Negotiate with the case worker. Tell her when you can get there, see if it works. It’s worth checking on. I don’t want to pressure you unnecessarily, but you might want to plan on driving Monday afternoon or evening if you can so you can be fresh for the footwork on Tuesday.  But, if that causes more stress than driving Tuesday morning, don’t do it. You know yourself best. 

Typically the transition to rehab is driven by level of care required and reimbursement, because that is connected to the level of care. Yes, it’s an awful system.  If he isn’t in need of acute care any longer, then the hospital will want him transitioned to rehab accordingly. But, they should also  give you time to visit a couple of places. Timing is a delicate balance to walk for all parties concerned. Kindness from all involved goes a long way. 

During the time you are away from home, treat yourself to special things. It can be anything from a great piece of chocolate, dinner out, time to read, or a fancy hotel, whatever is in your budget. The good thing about rehab is that you don’t need to be there every second - so take meal breaks when he’s eating, go for a walk or a drive, and you can also do errands. 

You can ask the assisted living is they will let you stay in his room while you are in town to save on hotel expenses. My mothers did allow that. 

 

[PeterPan]

55 minutes ago, TechWife said:

Don’t forget his toiletries. Shampoo, toothpaste, toothbrush, shaving cream, razor. Bring enough for a month.

It sounds so obvious once you put it like that, lol. I think my brain got swizzled.

37 minutes ago, TechWife said:

If he isn’t in need of acute care any longer, then the hospital will want him transitioned to rehab

The timing finally makes sense to me. They are giving him 5 days of strong pain meds, and that probably is what you're calling the acute care. So the end of that 5 days is when they want him out, which is the day after the social worker is calling me. So that's the time frame, basically having him out by the end of Tuesday. It also means I'm unlikely to get it all done by Monday because even they aren't shooting for that. They actually want him there presumably till tuesday because that finishes out day 5 of the strong meds that they're supervising. Bummer is it means missing an appointment I had for Tuesday, sigh. That's just a whine. 

So thank you for explaining everything, especially this. The timetable finally makes sense to me. I knew I just wasn't piecing it together and was missing whatever was obvious to everyone else. 

40 minutes ago, TechWife said:

You can ask the assisted living is they will let you stay in his room while you are in town to save on hotel expenses. My mothers did allow that. 

I'll have to think about that, hadn't occurred to me. I'd at least have to change the bed. Might be a treat to find a hotel with a hot tub. I may need it, lol.

Thanks so much.

[matrips]

Sweatpants are the easiest (not the kind you tie but just elastic). I’d go for 8.  They often lose clothes or ‘can’t find’ them to wash 🙄. I took to doing my moms.  Nothing fancy or good for that reason.  T-shirt’s are fine if he can manage them.  And definitely a sweater, sweatshirt, blanket.  Many older folks find it too cold. Put his name on everything if you can. Non slip socks like you wear in the hospital are good.  Plus a pair of sneakers for pt- they need a pair of shoes for pt.

some people may dress a little nicer if they go to the dining hall, but I wouldn’t worry about that as long as there’s not a dress code at the place for the dining facility.

[matrips]

It is a lot to take on.  And even if your mom hadn’t divorced him, you might still be doing this.  My mom wasn’t quite capable when it got to this stage and these kinds of things.  I don’t know if it’s because it’s their spouse or themselves, or the age, but it was too much of an effort for her to get it organized and together.

[matrips]

When my dad got older, he liked ordering pants from haband.com

Lots of pull on type pants.  Not too expensive.  

[PeterPan]

26 minutes ago, matrips said:

Non slip socks like you wear in the hospital are good.

Ok, I ordered slippers, so now I need to find these socks. I get the logic, but he's a hard size, lol.

17 minutes ago, matrips said:

When my dad got older, he liked ordering pants from haband.com

Lots of pull on type pants.  Not too expensive.  

Oh that's smart! I'll look for the next round, when I have time. Right now I'm just trying to make sure he has stuff to walk in the door. For real I had just been there a month ago, picking him new clothes, and we were TRYING to tell him to go elastic, simpler, and he so wanted what he wanted, sigh. But it's fixable.

22 minutes ago, matrips said:

It is a lot to take on.  And even if your mom hadn’t divorced him, you might still be doing this.  My mom wasn’t quite capable when it got to this stage and these kinds of things.  I don’t know if it’s because it’s their spouse or themselves, or the age, but it was too much of an effort for her to get it organized and together.

Thank you, that is such a nice point and way to put it. It's definitely a better way of thinking about it.

 

28 minutes ago, matrips said:

some people may dress a little nicer if they go to the dining hall, but I wouldn’t worry about that as long as there’s not a dress code at the place for the dining facility.

I guess we'll see. These athletic pants are so snaz, I think just changing his shirt would be sufficient. He's not up to changing pants. I guess that would tell us the rehab is working, lol. I can look at the Habands with an eye to a month from now.

[matrips]

6 hours ago, PeterPan said:

Oh my. I would have naively assumed bathrooming on his own was a goal, mercy. 

Yes, this is why he has declined so quickly, because he hurt and found it easier to stay in bed.

Yes, I was greatly dismayed that going to the bathroom on their own was more frowned upon and discouraged, than encouraged.  Both in hospitals and rehabs.

Yes, and if he’s says he hurts and doesn’t want to get up, they may just leave him in bed.  And if he says he doesn’t want to go to pt because he hurts or is tired, they will not typically force it.  They say it’s because they do not want to force them against their will, but it also makes it easier on the staff.  And this is how some patients get worse in rehab instead of better.  Patients either need to advocate for themselves, or have an advocate.  Again, just my experience with some places; I hope it doesn’t hold true for you, but I wanted to give you a heads up.  
 

I hope you and your dad have a terrific experience.

[matrips]

1 minute ago, PeterPan said:

For real I had just been there a month ago, picking him new clothes, and we were TRYING to tell him to go elastic, simpler, and he so wanted what he wanted, sigh.

They are remembering their younger selves 💕. Same way I have pants I’ve long outgrown in my closet 😂

[matrips]

2 minutes ago, PeterPan said:

I think just changing his shirt would be sufficient. He's not up to changing pants

Button downs may be easier if he has trouble pulling stuff over his head.  

[Faith-manor]

I have four experiences to share, but no specific knowledge of the industry. When my grandmother needed PT after a stroke, she went to rehab only facility, and she got great care. It was very good, and that was all that was done there so everyone was specialized in assisting with recovery, gaining strength, OT, and PT right down to the CNA's. I loved how absolutely dedicated everyone was to each patient's recovery and common goals. It was a wonderful, cheerful place and I am sure it contributed to her working so hard to be able to come home.

When my mom needed PT after surgery on her ankle - two different times - she actually went to a smaller, county hospital with a swing bed. The outpatient physical therapy clinic was across the driveway, and staff was sent to her. I felt it was decent. But when the PT or OT was not on site, there wasn't such a singular drive for success or additional help with specific tasks per second, just general care. Her nursing staff was wonderful, yet not specialized, and it kind of showed. It was her choice. The surgical hospital offered to send her to the really good rehab that grandma had gone to, but she turned it down because it was 25 minutes away from home instead of 10 minutes and she thought my brother and I would not visit her because of the distance difference which was ludicrous, but no budging her no matter what we said. To be honest, I do think she would have come along further at the other facility. My brother then had a stroke, went to the good rehab only and they sis wonders with him.

Dh's grandma had a stroke and went to a nursing home that supposedly was also a rehab. Ha ha. What a joke. If someone spent even five minutes with her on a few strength exercises, I would eat my hat. This was followed later by uncle needing PT after an injury and surgery to fix. He was sent to a different nursing home that was supposedly a rehab, and yet again, a total joke.

 

[matrips]

8 minutes ago, PeterPan said:

Ok, I ordered slippers, so now I need to find these socks. I get the logic, but he's a hard size, lol.

They may release him from the hospital with a bunch.  Ask them for some extras.  It’s standard hospital footwear.  And if he likes slippers, he may not need them. My mom wasn’t a fan of shoes and the socks were more comfortable

[prairiewindmomma]

Because this is a Thing, it’s ok if you need to do things less than perfectly (not everything fully prepared upfront), because you are just at your own capacity limits. Naps, sensory work, whatever you need to get through this, do it. I hung out in the hot tub a lot this weekend and ordered takeout because my body fell apart this week while I was carrying a lot of mental load for others. If your brain needs breaks, give them.

I would look at Amazon for sweats. I just ordered some. :)