Article one describes the basics on how to succeed at your Rehab stay. Now it is time to get into the good stuff. For most, the ultimate goal is to be discharged to your goal location, and without many bumps in the road. This could be home, or maybe you have come to realize it’s time to look for more help? This could be with assisted living, or possibly staying in that nursing home or a different location. Some stay with family members, or friends. Others still go for a short-term respite in an assisted living facility until they are ready to go home. There are patients that go stay in hotels even. No matter where you go, we all just want it to go smoothly and successfully.
Insurance Coverages:
Where things end up depends greatly on what has landed you in Rehab in the first place. Let’s look at one example: The vast majority of patients who come to Rehab are there due to a broken bone. As discussed in the first article, this often can come with changes in your weight bearing status. If your surgeon tells you that you will be non-weight bearing for many weeks or months, it is time to start getting creative. Are you plenty strong and live with support in a one level roll in house? Do you have lots of open space to tool a bout in a wheelchair? If not, then your discharge might become more complicated.
Understanding this realization is important from the first day you are there or even while you are in the hospital. In this specific case, understand that your insurance is likely going to cover say maybe 10-20 days of Rehab stay depending on your situation and your insurance of course. However, you are non-weight bearing for 3 months from the date of your surgery. Unless you are under 60 and healthy, please understand you are not likely hopping around on crutches all day or hopping/bumping up steps either. So, you may have to go home in a wheelchair. This may require a ramp, removing furniture, removing doors. Or like described above going somewhere that wasn’t your first choice.
Now obviously not everyone’s situation is that complicated, but the main point remains for each of you. Your stay could be cut shorter than expected by your insurance. If you have Medicare or a subsidiary, then the Insurance company has to give you 48 hours before you are cut. If you are under 65, then the time drops even shorter! At this point, you have a few options. You can scramble last minute to find a safe discharge plan. Leave against medical advice; or stay at the rehab and continue paying out of pocket. Understand this can cost north of $500-600 a day; but you can try and appeal their decision. Since going Against Medical Advice (AMA) is a horrible idea, you are left with the one other option. PLAN AHEAD.
Begin talking to your Therapists and Social Workers especially, regarding what they see as your outlook from as soon as the first day you are there. Most seasoned Therapists can see the writing on the wall after a few days of treating you and can start to guide you as to how things are going. Not only is it important for you to hear this information, but it is also important for any loved ones who might be helping you in the future. Most adult children are in complete denial that you are no longer indestructible. A good rehab facility will keep everyone in the loop, and if family needs training, they will set that up for you. The most important thing is not to be shocked by premature cuts by insurance, or shell-shocked families not aware of your needs at discharge.
Getting the most from Therapy:
The big points of advice to give you about getting the most out of your Therapy, doesn’t really have much to do with your time with Therapy. The most important thing is to be ready when its time. This means up and dressed (unless the OT wanted to do that with you). It means being properly medicated if pain is a limiting factor for you. You’ve eaten and gone to the bathroom. Now of course you are at the mercy of those who help you with these things but try and be proactive if you can.
When with the Therapist, of course try not to say no, and give it all you can. Understanding you will have lots of down time later for rest. Communicate with your Therapist about what you are feeling. Are you in pain, are you nervous? Do you feel short of breath, are you dizzy? Now is not the time to keep this a secret. Let the PT/OT know if the exercises they are giving you are too easy. I don’t typically have to advise to complain about it being too hard.
Maximizing your Non-Therapy Time:
Therapy will likely take up 2 hours of your day at most. So how can you maximize the other 22 hours to work toward discharge? Ask your Therapist what exercises you can do in your room when they are not there. If allowed to do so, walk to the bathroom with staff instead of being wheeled in. Get out of bed as much as you can tolerate. It is important that you start making your days as close to what it will be like at home as possible. Do you typically lay in bed all day in a hospital gown? I hope the answer is no. Start getting up and dressed, get out of the room. Have your family wheel you outside for some fresh air or change of scenery. As long as it isn’t interfering with Therapy times. Conversely, rest and eating healthy are important for your recovery.
Expectations:
Close your eyes for a second and imagine that you and your loved ones just walked into a very glamorous hotel lobby. There is champagne and mimosas being handed out. Your luggage is being eagerly taken by the bell hop who calls you sir. You look down from the giant crystal chandelier to the very friendly receptionist who confirms that your presidential suite is $650 per night.
Now let’s open your eyes to what healthcare has come. Your stay will cost (hopefully your insurance) company roughly that much per night. However, be that the case, your expectations may not line up with reality. Being that you just stayed in a hospital, you likely have gotten used to some realities of the situation. With staffing issues and changes to nursing home reimbursement, facilities have had to spread workers thin, and you will likely feel the effects of this. Like in any profession you will see those who are passionate about providing good care and those who are not.
So, what can we do about it? First let me say that no one should ever treat you poorly. Nor should you have to wait for hours on end to have someone answer your call light. If you do decide to make a complaint, try to remember the name of the person and which shift it was on. If you can, wait until a weekday day shift so that the regular nursing supervisor is on. Ask (a different) employee to speak to them and let them know your experience. Otherwise, when they arrive, stick to the facts, and try and keep it simple. Overwhelming the nurse with multiple issues, makes it harder for them to help facilitate solutions to your problems.
Of course, if something very serious happens you should deal with it immediately. You can also file a complaint with the state department of health if you felt you were abused, neglected or mistreated. Have your family advocate for you. It never hurts to have visitors with you; it may help hasten response times. With that being said, remember that you catch more bees with honey. Overbearing family members can cause the staff (and yourself) unnecessary headache.
Best of luck at your rehab stay, I hope these articles have helped answer some questions for you and prepared you for what is yet to come.