My family is going to destroy my dad's recovery, I swear.

[Deleted]

What does your Dad want?

[notsocreepylurker]

I have no advice but wanted to give you <BIG HUGS>

[Deleted]

May 6, 2013 13:18:12 GMT -5 @damnation said:

What does your Dad want?

This
andplusalso
does he have a POA?

[cst2cst]

Is your Step-mom willing to let you take some of this on? Are you willing to take it on?

You are absolutely right that most of the gain made after a stroke or any brain injury is made in the first 6 months and it is important to do the most intensive rehab during that time. I'm a hospital social worker and worked briefly on a Acute Head Injury Rehab floor.

If you can and are willing to get involved here's what I'd do. I'd call his hospital case manager and ask what his rehab options are, and what his attending is recommending. The hospital should be working on transferring him to an appropriate facility when he is medically ready. I would guess that they have been looking into it and likely have facilities they use often. If they agree that insurance is an issue, then ask to talk to the social worker. She will be able to discuss options like Medicare (which will likely cover acute rehab) and Social Security. Because your dad is 65 he will get SS retirement, not SS Disability. It would be important to talk to his HR to find out about his LTD through work first.

Acute rehab won't keep him for the whole 6 months. They have strict criteria of what progress needs to be made. Once a person reaches that level, they go home with home rehab.

Let me know if you have any questions I might be able to help with.

[orangeblossom]

May 6, 2013 13:31:28 GMT -5 cst2cst said:

Is your Step-mom willing to let you take some of this on? Are you willing to take it on?

You are absolutely right that most of the gain made after a stroke or any brain injury is made in the first 6 months and it is important to do the most intensive rehab during that time. I'm a hospital social worker and worked briefly on a Acute Head Injury Rehab floor.

If you can and are willing to get involved here's what I'd do. I'd call his hospital case manager and ask what his rehab options are, and what his attending is recommending. The hospital should be working on transferring him to an appropriate facility when he is medically ready. I would guess that they have been looking into it and likely have facilities they use often. If they agree that insurance is an issue, then ask to talk to the social worker. She will be able to discuss options like Medicare (which will likely cover acute rehab) and Social Security. Because your dad is 65 he will get SS retirement, not SS Disability. It would be important to talk to his HR to find out about his LTD through work first.

Acute rehab won't keep him for the whole 6 months. They have strict criteria of what progress needs to be made. Once a person reaches that level, they go home with home rehab.

Let me know if you have any questions I might be able to help with.

This.  Has your stepmother out and out said she doesn't want you talking to the nurses, caseworker, etc.  You are still his child, first marriage or not, and have a right to be involved in the decisions involving his care.  

Your stepmother is overwhelmed, and may actually welcome you taking some of this on.  You or your sister may have to just do tough love with her and say this is what happened and this is what needs to happen in order for dad to get better, what can you do and what can I do.  Being overwhelmed and not moving forward is not an option.  Precious time is being wasted.

Has your father ever served in the military, there may be some options there as far as aftercare.

Hugs.







 

[Deleted]

May 6, 2013 13:35:31 GMT -5 nuggetbrain said:

May 6, 2013 13:27:18 GMT -5 @mrsmarlowe said:

This
andplusalso
does he have a POA?

No.  That's the other thing, I want to make sure if something happens that affects his ability to make his own decisions something's in place that allows my step-mom to do that outside of the medical stuff (which she would already be able to do as his spouse).

But I think it should be you.

[kcr1972]

Check to see if there is a facility with Neuro Restorative in his area. It is primarily for brain injury/stroke patients. They take patients all the time with limited/no insurance. They have several long term facilities. It is a wonderful company!!!

[Deleted]

Trust me when I tell you you just can't start making phone calls to your dad's doctors and insurance about his condition and medical care. Patient confidentiality and all that you know.

I know you're pissed off but try to remember a couple things: your dad is still your dad even though he cant do some of the stuff he could just a few days ago. Don't treat him like he's not in the room. He needs to be included in any discussions about his care. Your SM is doing the best she knows how and is most likely really overwhelmed.

Can you find other ways to be helpful on this situation? Like find ways to take on some of the things your SM has to let slide right now like hire a cleaning person for her house? I don't know if you're near by but maybe take her out to dinner or do a load of laundry for her.

I get that you want to help your dad but he has plenty of people to help him right now so I'm just trying to say maybe go at trying to help him indirectly.

I'm sorry you're going through this.

[snickers]

I have no advice,
But I am really sorry.

[karmasabiotch]

I have a Step Mom who isn't the most helpful to say the very least. My Dad is in a different state and has severe dementia and she's doing all sorts of things I don't agree with, but there isn't anything I can do.

I don't have any advice other than to say you aren't alone. Hugs...

[cst2cst]

May 6, 2013 13:48:29 GMT -5 @damnation said:

Trust me when I tell you you just can't start making phone calls to your dad's doctors and insurance about his condition and medical care. Patient confidentiality and all that you know.

I know you're pissed off but try to remember a couple things: your dad is still your dad even though he cant do some of the stuff he could just a few days ago. Don't treat him like he's not in the room. He needs to be included in any discussions about his care. Your SM is doing the best she knows how and is most likely really overwhelmed.

Can you find other ways to be helpful on this situation? Like find ways to take on some of the things your SM has to let slide right now like hire a cleaning person for her house? I don't know if you're near by but maybe take her out to dinner or do a load of laundry for her.

I get that you want to help your dad but he has plenty of people to help him right now so I'm just trying to say maybe go at trying to help him indirectly.

I'm sorry you're going through this.

She could absolutely call the CM or SW and express her concerns for her dad's care/placement.  They wouldn't be able to disclose his condition or details, but they can discuss generalities and provide advice and direction on what to do.  I get calls from concerned family members all the time and do my best to address their concerns without violating HIPAA.

Nugget- That is a really tough place to be with regard to not wanting to overstep while feeling like they don't really have it handled.  Could you ask your SM and sister what you can do to help? Something along the lines of - I know there is so much going on and how hard this must be.  What can do to help?  And then maybe offer things that you want to do and think need to be done. "Can I arrange a family team meeting to go over his placement?  Can I talk to the CM and SW to see what they are doing for dad?"  Would that work?  Or you can throw the hospital under the bus if you think that would go over better, "I can't believe they are making YOU handle the insurance end!  That is their job and THEY should be working out his placement.  You are doing so much else, you don't have time for that. We need to have a family team meeting with his DR.s to make sure they are taking care of this."  

It does sound like they are overwhelmed and that someone should be following up with his work, benefits, and placement. When you are discussing this with your SM and she gives you a vague answer, can you say, "Is that something I can look into for you?"

[Deleted]

you've gotten good advice.

my other advice would be to kick everyone else in the ass, literally. but that probably wouldn't be productive. good luck.

[Deleted]

Hugs, nugget.

If you need any help with the determine whether or not he should be on Medicare (he should at least have Part A if he is 65+) you can PM me. If he has stopped working, it is probably a good idea. There are plans to cover what Medicare doesn't cover - including care in a nursing facility - and he could be subject to a guaranteed issue plan if he is coming off of a group plan, where he wouldn't have to answer any health questions, or anything about his history. And if your step mom is 65+ it is probably a good idea for her to be on Medicare too.

[feistypants]

The insurance may also be saying that he needs to go to a nursing facility because he's not physically capable of participating in intense rehab yet. A lot of inpatient rehab (IPR) places expect their patients to be in a place to medically handle at least 3 hours of rehab a day. If your dad is not quite there from a physical standpoint yet, a nursing home is a reasonable place to start working on OT/PT/ST goals until he's strong enough and medically recovered enough to be able to commit to 3 hours of rehab 5 days a week.

Also, a lot of insurance policies have caps on the number of days that they're willing to pay for IPR. If your dad's policy is like that and he's at all still having medical issues other than the stroke related ones that might make him not able to handle that level of therapy, it's really best to start at a nursing facility and then go to IPR. That way, he's not losing paid days when he's not able to make the most of his rehab because of things out of his control.

Definitely talk to the case worker/case manager assigned to your dad and explain your concerns. Also, if you can make it for rounds on Wednesday, that will give you a chance to discuss the big picture with your dad's attending and the rest of the team. Once you've verbalized to them what you're hoping for, they'll be able to help your step-mom (and you and your sister) formulate a better plan to make it there.

Oh, and one more thing. Sometimes, insurance companies will deny simply because there's not an updated recommendation from rehab services (i.e.: PT/OT/ST) at the hospital saying that a patient needs IPR vs skilled nursing placement. Ask the team that they be sure that your dad is seen by PT/OT/ST as frequently as possible so that they can determine the best placement for him and work on diminishing any residual effects from his stroke.

PM me if you need any more help.

[Deleted]

I would try and be there when your Dad's physical therapist comes in on Wednesday. What I'm learning right now (at least in my area) we are huge in the discharge planning process.

Sometimes the physical therapist is the biggest advocate for the patient. They can give you information on facilities in the area that can take on patients with limited/no insurance and they can also give you a realistic expectation of what his recovery will be like. Make sure that your PT justifies why skilled PT is necessary and how it can help his recovery in their progress notes that way the insurance companies can see it documented.

It doesn't sound like right now he's capable of handling the 3 hours of rehab per day required to get into a rehab facility but you could get him into a skilled nursing facility that perhaps can progress things along a bit - so I would specifically ask your PT, what does my father's discharge plan look like? What can YOU as a therapist do to make sure that he gets where he needs to be to qualify for a rehab facility.

I'm sure some of this is repeated information, but I hope it helps in some way. I'm so sorry that you're having to deal with this!

[pugz]

I have some suggestions but am mobile now, will add them when I get home! I'm a hospital social worker so am familiar with the insurance/rehab issues