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Ask a care manager: Leaving a skilled nursing facility

Do I have to stay in a nursing home? I broke my hip several weeks ago and was sent to a skilled nursing facility for rehabilitation. I have been receiving physical therapy and occupational therapy several times a week and am improving. My family is worried if I go home, I may fall and break another hip. They’re encouraging me to stay here but I want to go home. What should I do?

When a person breaks a hip usually as a result of a fall, going into a rehabilitation facility makes good sense. The frequent, intense rehabilitation available in a rehabilitation unit of a nursing home can facilitate a quicker recovery. The recovery depends a great deal on the person’s age, physical condition prior to the break. Other health issues and individual motivation all impact the degree and length of time it takes to recover. If you were admitted to a hospital for a three-day stay or more, Medicare will pay for your nursing home stay while you’re eligible for rehab. This is usually two to three weeks. The staff will notify you when Medicare coverage ends at which point, you can either be discharged home or pay for your care in the nursing home privately.

If you are competent to make your own decisions, you need to advise your doctor of your decision to go home following your rehabilitation. Your doctor along with nursing home staff can help you start the process. Note: Even if your doctor advises against going home, you don’t need his/her permission to leave. It is your decision but should be made wisely.

What should I do once I decide to return home from a nursing home?

Talk with your doctor’s office first and then the nursing home staff. If you’re still receiving physical or occupational therapy regularly, tell your therapist of your goal of returning home. They can help you become more independent knowing your intention. Don’t be in a hurry. Set a date to work toward that is doable for you. It is possible to set everything up to coincide with your discharge so you’ll have all the equipment and services in place to help you in your home.

Can I set up services and order equipment i.e. wheelchair, hospital bed ahead of time?

Yes, in fact the best transitions are those that put in place the needed equipment and services so the move is a smooth one. Ask the social services designee/social worker at the nursing home to help you if you don’t have a family member available to help you.

My family is against my decision to move home because they’re afraid I may fall again. They will not help with getting the help I need. Is there someone who can help put all this in place?

Yes, people leave nursing homes all the time. It is important to have someone to help coordinate all the resources necessary to assure your move home allows you the safety and security you need. A friend or another family member can help you. If you wish, you can hire a professional geriatric care manager who will meet with you at the nursing home and help you put all the necessary resources in place as well as making sure the transition works well for you.

I’m worried about getting around my house when I first get home. Can I have the physical therapist or occupational therapist come to the house?

Yes, if the doctor writes an order, therapy can come out and work with you to adapt to your home as you rehab with your hip. They will do a safety check of your home too, making helpful recommendations and/or ordering adaptive equipment to live on your own. These valuable therapies at home are short-term and paid for by Medicare or other health insurance.

I know I’ll be better eventually but how can I find some help with cooking, getting groceries, changing my sheets and transportation? Do I have to commit to a certain length of time?

Private home care is available in most communities whereby a contract specifies duties to be performed and costs to the client. Most agencies can set up the terms of employment with a fixed date or giving notice to end services. You may need more care when you first return home but as you improve your need for assistance may lessen and the agency can adjust the schedule accordingly. In the long run you may very well find that hiring a home care provider is money well spent as it can help you gain your strength and independence which will ultimately give you the freedom to remain at home.

Depending on your income and resources, you may qualify for public services. Most low-income programs use Medi-Cal or SSI as the basis for financial eligibility. Veterans Services may also be available through the Aid & Attendance program to eligible veterans and their spouses although the application process can be lengthy. If individuals have purchased long-term care insurance with a community-based benefit, this insurance may help pay for care once you file a claim with the insurance company.

Do you have questions we can help with? Send your questions to carol@elderoptionsca.com and look for them in future columns. Carol S. Heape, MSW, CMC is executive director of Elder Options Inc., serving Sacramento to South Lake Tahoe; elderoptionsca.com or call (530) 626-6939 or (916)391-8083.

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Posted by on Nov 12 2013.
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