The Hospital knew we take care of my husband at home and made all the necessary arrangements. After only calling three nursing agencies, they were explaining he was high care and making it seemed worse than what it was, just to get a no answer to justify they made an attempt but not due diligence. They declined to call anybody else or accept any of the companies that I found that would be able to do the Medicare intermittent RN nursing that Medicare already approved for 28 hours a week.
Long-term acute care hospitals (LTACHs) like RML serve patients with complex needs requiring longer hospital stays and highly specialized care. LTACHs are designed for patients who need intense, extended care for more than 25 days.
From this definition it sounds as if he must need intense care. Perhaps your care plan was not a safe discharge for him. Twenty-eight hours is nowhere near 164 hours in a week, that is necessary.
Are you saying that you weren't called and told he was being transferred to a facility? Wouldn't this be considered rehab anyway. Never heard of a hospital having the ability to place someone without the family being involved. There is money involved here. Private pay if Medicaid not involved. If you could prove that going home was a "safe discharge" thats all they care about. In the two states my daughter has worked in, Hospitals in those states are not obligated to make sure its a "safe discharge". Only rehab/nursing homes cannot send a person home if not a "safe discharge".
Anytime my Mom was in the hospital I got a call that she was going to rehab and here are the places that have beds. I had the right to turn down rehab and take her home. I could have requested therapy at home. Really need more clarification on how things went in order.
"He is full care in a vegetative wakefulness play the tracheostomy baclofen pump G2 suprapubic catheter and other needs."
How did the hospital make it seem worse than it is?
How would 28 hours' nursing care a week be adequate? What about the other 5.83 days out of 7?
I understand how disappointed and frustrated you must be that your husband can't come home where you had already been caring for him. But what crisis took him to the hospital? Surely it's better to wait until he really is stable enough to be safe at home?
Regarding L-TACHs, an example of them is Kindred Hospital Group. We have Kindreds in my state (Louisiana ), I know they are in TX as well (late MIL was in one at the end). It’s lots of locations nationwide. They tend to be a several multi floor “hospital” adjacent to or nearby a big full service hospital. It’s admit via referral only, there’s no ER or walk in like a regular hospital.
Like Glad posted, they specialized in the beyond 25 days type of patient who needs specialized care because of something way, way not the usual. For the one where MIL was in, patients seemed to be like
- on drugs that required specialized knowledge to do a procedure daily or multiple times a day, like for some cancer patients.
- needing equipment that’s super specialized to do a procedure daily or several times a week. Like HyperBaric Oxygen Treatment wound care management. The HBO units are actually pretty few & far between, as $$$ and seem to need a minimum of 2 chambers for a facility to offer this level of care. Plus trained staff. HBO care is expen$$$ive and you need to pass the preauthorization screening for insurance to pay.
- on drugs that are high risk, like if they are on Fentanyl lollipops and also other BLack Box drugs or infusions. The lollipops have had deaths of family members who handled the stick or in a couple of cases, kids who found one discarded, licked them and died. Anyways, I think now they tend to be dispensed under tight regulations, like in a LTACh
- TBI / traumatic brain injury care
- palliative care if there’s something that makes it not at all feasible to do palliative/ hospice at home or back in the NH. This was my MILs situation as she was super septic, infectious and had cascading organ failure happening too. She went from super ill at the NH to the ER then admitted to hospital got even beyind super ill and then to the Kindred where she died slightly less than a month. The nursing staff was super great. A lot of the patients were on the younger side, cancer related.
For HBO wound care tx, hubs got an assessment as a routine consult from our insurance after he got an infection in one of the “caves” left from lymph removal after melanoma surgery. I was able to do the wound care at home, it was like reverse stuffing super disgusting pork chops over 5 weeks. Hubs was good on paying attention to his activities, his incision area skin in good shape. FUNtimes! But I think for some folks it’s not at all feasible for spouses or family to do wound stuff at home, or the patient is not healthy or competent enough to behave to get wound care done properly at home, so they go into a LTACH till ok to do more routine at home care. Btw the O2 treatment is anywhere from 1-3 hours in the unit too, I can’t see someone with dementia being suitable for it. The preauthorization / assessment questions were pretty intense & I can see load of folks not being able to score high enough to get the preauthorization done to have insurance pay.
The OP has another thread. May help understand what is going on.