By Erin Kershaw, CCA Certified
Many of my client’s family members are often frustrated by the fact that their loved one has been denied a stay at a skilled nursing facility for rehabilitation. People often think that a hospital stay of any kind will earn you a trip to rehab. The truth is you need to be in the hospital for three midnights and have a skilled need such as IV antibiotics, wound care and or the physical, speech, and occupational therapy.
Although most people can benefit from PT, OT, etc. it is not always approved by Medicare and other Medicare Advantage insurance plans. In order to go to a rehab center for PT one must show during their hospital stay that they can participate in PT and OT. If, during their stay, the person refuses PT when offered, or just can’t do it, Medicare most likely will not approve their request for a rehab stay. Once you are in a rehab you have to meet the goals set for you by Medicare so you can continue to meet their guidelines for an approved stay.
Don’t be upset if your loved one does not meet the criteria. Often going straight to an Adult Family Home or Assisted Living Community with home health will accomplish the same thing. Home Heath is also a Medicare and Insurance benefit that provides nursing oversight as well as PT, OT, Speech therapy, and access to a social worker. Essentially this brings the rehab stay to the patient, instead of the patient going to rehab. For people with dementia this can be a real benefit, since moving from the hospital to a rehab center and then to an assisted living Community or an Adult Family Home can be confusing. People with dementia often do better in a smaller setting, and usually the sooner the person moves in to a setting where they will have long term full time care, the better it is for all involved.
If your family member is denied a rehab stay don’t view it as a failure or that the medical community is giving up on them. Instead, embrace the idea of individualized therapy and know that they can have the same opportunity to rehabilitate as the person who did go to a skilled nursing facility for rehab.
