After three days in the hospital, Mother was becoming more like herself. She was feeling better and communicative. The doctors were pleased with her progress and felt she could be ready to be released in a couple of days. St. David’s had an acute care rehabilitation hospital that had an excellent reputation, so I began working with the social worker to try to get Mom approved as an inpatient.
The rehab facility will send a representative to do an evaluation, as well as, review the medical records and previous therapy notes (if any). I cannot stress enough how important it is that a family member attend these evaluations, especially if your loved one is a stroke victim. These reps that perform the evaluations could be a head nurse, therapist, or another social worker. They will put the prospective patient through a battery of tests and questions. You want to make sure they get accurate information.
Since it was not an option to me for Mom to go back to that skilled nursing rehabilitation facility, I felt I had to be an advocate for Mom. A week or so before she was hospitalized, I had tried to get her approved in a different acute care rehab facility that I had toured. I was not present when she was evaluated. I was just informed by the therapists at her current facility that she had not been approved. The acute rehab place based their decision solely on her records and her current condition (which at the time was not good). I was determined to not let that happen again. I requested to the social worker of the St. David’s rehab facility to please have the decision maker talk to me before they made a final decision. They honored my request. I used every bit of my sales ability to convince them that Mom was capable of doing the work and did have obtainable goals. She was approved!
She was transferred via ambulance two days later. Due to the MRSA, she was still under restrictions. All attendees, doctors, nurses, therapists, and visitors had to wear the protective garments. She had been approved to stay the maximum allowed time which was about 3 weeks. It was time to get to work and Mom said she was ready. She was much more like herself. It was obvious she was happy to be there. She liked her private room and she smiled and cracked jokes, which was such a relief to her family.
After a similar admission evaluation, the therapy began. She was on a strict schedule of when she was to be up and dressed, ate meals, had speech therapy, occupational therapy, physical therapy, and rest. She had at minimum of 3 hours of therapy per day. I tried to be there for as many of her therapy sessions as possible. This meant as much as 2 hours at the hospital some days, but I felt it was important. I could see her progress and what things the therapists were having Mom do. She settled in and was responding to the therapy. She was able to stand and with the help of an aid, she could transfer from bed to chair without the need of a lift or second person. She was communicating better and her accuracy was getting better than 50%. She was even able to walk down the halls with the aid of a therapist pushing her still paralyzed right leg forward and shifting her weight to step with her left leg. Towards the end of her stay, she had undergone another swallow test and was approved to go back to a normal diet, with the exception of thickened liquids.
During the three weeks that she was in rehab, I had to start searching for a more permanent living situation for Mom. I had been told about a gentleman who offered a service to people looking for long term care places. He worked much like a real estate agent. He would take you to tour facilities that were in the geographical area and assist in the decision process. It was free to the client. The long term care facility paid him a referral fee. I toured three different assisted living facilities and heard about their services and fees. Mom had exhausted her threshold with Medicare for long term care, so she was going to be faced with a self pay situation.
The places I toured varied in cost. One place, that had many less amenities, charged about $3500/mo. + prescriptions and incontinence fees. A second place charged about $6000/mo. + prescriptions. These were not private rooms and neither one offered any type of rehab services. The third place was new and was a “memory-care” assisted living facility. It was very impressive and boasted a ratio of 1 caregiver for every 3-5 residents. They had on staff nurses and activity personnel. While I was there, a dance troupe was performing in the main dining room. The residents seemed to be enjoying themselves. They also had a therapy room and therapy services. There were no private rooms available. I was told there was a long waiting list to get one. A semi-private room cost $235/day + incontinence fees of $450/mo. Prescriptions and doctor visits would be filed with insurance. You could also sign up for in-house hair salon services, which would be extra. Transportation to doctor’s offices or outings would be charged by the mile. If you do the math, this added up to over $7500/mo. To top all of that, each place required a reservation fee of anywhere from $2000 to $4000 (non-refundable unless the patient was not approved).
I felt Mom would get the best care at the third place and enjoy the atmosphere and activity. It was important to get her back into socializing. She had gotten used to isolating herself in her room or in bed for hours every day. I signed the documents and paid her reservation fee in hopes that she would get approved. There were some obstacles to overcome. Assisted living is different that a skilled nursing facility. Even though they have caregivers and nurses, they only are allowed to do certain things. Assisted living facilities have different regulations and less restrictions than skilled nursing facilities. Mom had to be completely off the feeding tube and eating on her own. She had to be able to transfer without the aid of a lift. She had to be retested for MRSA to ensure it was no longer active. Since it was a “memory care” facility (which means they cater to residents who suffer from alzheimer’s and dementia), she had to get approved due to her aphasia. Since aphasia often leads to memory issues, it was likely to get approved.
The social worker and head nurse from the memory care assisted living facility worked with St. David’s Rehab in order to make sure Mother was capable of meeting the criteria. A few days before her discharge from the acute rehab, Mom was approved. The next post will tell the story of assisted living ………