Q: My mom is currently in the hospital, and I think she needs to go to rehab before going home. How can I best advocate for her?
A: When a loved one is in the hospital, they need you to be their advocate and ensure they get the care they need and want. It can sometimes be challenging to ensure you are getting all the information, speaking to the right people, and not missing anything that is needed.
If you feel your mom would benefit from going to a skilled nursing facility for rehabilitation before going home, then you do need to advocate for this level of care.
You will want to talk to your mom about this, as well, and ensure that she agrees. You are not in the hospital 24/7 with her, and sometimes staff may speak to her directly. If she says she prefers to go home they may take her word for it. Explain your reasoning to her and why you think she will benefit and get the best recovery with a stay in a skilled nursing facility.
Of course, if your mom has dementia, you may not be able to have this conversation with her. Ensure that the staff knows you are the one to be consulted about discharge and that you are the family caregiver.
There is a general rule with Medicare that a person must be admitted to the hospital for three days to qualify to be transferred to a skilled nursing facility. While there are a few exceptions based on insurance, you will need to understand this rule. If it has only been two days and the hospital is talking to you about going home, then you can advocate for another night and a transfer to a skilled nursing facility.
The hospital will assign a discharge planner (sometimes referred to as a social worker or case manager). This person is responsible for ensuring there is a safe discharge plan made after the hospital stay. You may need to explain to them why you believe a stay in a facility is needed. For example, the home may be multiple stories and not set up to accommodate her physical needs. Perhaps she lives alone and has no one to help her. Or it may be that you feel she requires more physical therapy to recover than home health can provide.
The discharge planner may not know the condition of your mom prior to admittance to the hospital. You may need to explain how she has declined and will need to gain strength or physical skills before she can return to her home.
Always be kind and polite and start with the assumption that everyone wants what is best for your mom. Allow the discharge planner to be your partner in ensuring she has the care she needs.
However, you also have the right to be clear and strong in explaining the need for care for your mom. Be a presence in the hospital and make it known that you are to be included in any discussion about discharge planning.
The discharge planner may tell you what skilled nursing facility can take your mom, but know you always have a choice. You can use the Medicare website to compare nursing home facilities and view their rating and any complaints against them here https://www.medicare.gov/care-compare/?redirect=true&providerType=NursingHome
You can provide the discharge planner with your preferred facilities. However, where she is able to go depends on her insurance, what services the facility offers and who has an open bed.
If your mom is unable to go to a skilled nursing facility, chances are she can qualify for home health care to provide some rehabilitation services at home.
Ask a lot of questions, be clear in your view of your mom’s needs and any safety risks, and be a presence in the hospital. Your mom is fortunate to have a caring advocate looking out for her needs.
Martha Shapiro can be reached at Senior Concerns at 805-497-0189 or by email at mshapiro@seniorconcerns.org.
