Father has cancer; suffered a brain bleed--hospital for 4 days, rehab center for 6, got UTI. They want to send him home. How do I fight it?

He has rehab coverage through Medicare IF he is making progress; it sounds like he is not.

There is an appeal process for discharge. Appeal right away.

If he is in for rehab and he is refusing rehab services (like PT) they can discharge him as a non-compliant patient. YOU can push back and say that this is an unsafe discharge; perhaps he needs to be admitted as a private pay, Medicaid-pending Long Term Care patient, as opposed to rehab?

The appeal goes to Medicare, not to the staff in the home. The therapy staff does not have a lot of wiggle room when it comes to the progress/no progress standard.

Perhaps he should be back in the hospital for the UTI to be treated?

https://www.nolo.com/legal-encyclopedia/expedited-medicare-part-a-appeal-discharge-order-from-facility-other-than-hospital.html

Ask the attending doctor if he qualifies for a long term care hospital.  

Unfortunately, I think patients are being sent home too quickly, but the guidelines of Medicare seem to be more important than the patients' health.

Also, start working right away on getting home care in.  The social worker can give you brochures and data, but do your own research as sometimes their choices are limited, and the brochures are speak to the wonder and miracles these home care companies perform, when some of them are terrible.

If you find  a good home care company, the nurse and therapists can help your father adapt, more slowly, and in the comfort of his own home.

You might also contact his oncologist and ask if she/he has any home care recommendations, since cancer care would be a part of home care.   If he's getting chemo or radiation, the chemo staff might also have recommendations.

You can fill out forms to challenge the medicare denial of further rehab days; it is extremely unlikely that you will win.
Father now needs to have either nursing home placement or skilled nursing. Rehab is approved for PT and OT and other modes to rehab a patient for physical improvement and activities of daily living. That is to make one function better with mobility, cooking, etc. When someone is too ill to participate in rehab activities the staff is beholden to truthfully chart that; medicare will not cover someone inappropriate for this level of care.
As I said, you can ask to fill out the forms to contest this decision but it is unlikely you will win and meanwhile it can go to private pay which is very costly.
If father is now too ill to return home please tell the social worker that you need placement for at least temporary care until he improves.

Just need to make things clear...the days Medicare pays are not a guarantee. A patient can be discharged at any time if Medicare feels they should be. Can be the patient hit a plateau, not cooperating or just not able to do what asked of them. When it comes to the UTI, the rehab is only following the hospital orders. So in hospital for 4 days Dad should have been given IV antibiotics. When going to rehab, he may just be given pills. In 10 days there should be some sign of clearing up or gone. Yes, the facility Dr. can make changes but hospital recommendations are usually followed.

Medicare pays first 20days at 100%. 21 to 100 days only 50% with the patient paying the balance unless they have a very good supplimental.

I would say that Dad was sent to rehab because he had a 4 day hospital stay. He was sent to rehab to get his strength back. A UTI can be taken care of at home after the initial IV is given. Not sure if rehab can do anything about a brain bleed. They are not equipped like a hospital. It may just be sending him home and watching for any symtoms. If they resurface, then off to the hospital again.

LB, I developed a checklist of questions, used it first to weed out facilities that didn't meet standards or didn't want to ask questions, then went to visit the facilities.

I think the checklist is on an old computer, or perhaps saved offline; I'm not sure where it is.    But it included topics such as staffing ratios, whether meals were prepared on site or sent in, how many PT and OT staffers?    What activities existed, including music and animal therapy (dogs are the best therapy!).

Are there pianos on site and can visitors use them?  This was important to us. 

When I toured I looked for cleanliness, people in  their rooms, sitting at tables with heads hanging down on their chests, or engaged in activities.    I asked where is the (library?) (cafeteria?) questions of staffers I met just to see how friendly and responsive they were.

I did make a mistake though; one of what I thought was the best was actually the worst.   I toured on a Sunday; when I moved Dad in on a Monday, it was like all hell broke loose.  Staffing was insufficient, the food was prepared off site and brought in, probably a few days old b/c it was inedible.   Dad's chart got lost, no one could find it, he didn't get his Coumadin and his PT/INR was unacceptable when I pulled him out 2 days later.  It was a nightmare.

The Alzheimer's Assn. has good lists; from then on I got lists from them, called, inspected, tried to interview, and fortunately I lucked out.   I also found the best place ever:  a Catholic run multi level group.   They were outstanding.

Referrals from the hospital were either very good or very bad.  One was a rehab facility where people were known to come in and leave in body bags.  Seriously.  Even an ombudsperson warned about that highway to a funeral home.

Before I found the Catholic group, I did find that those home care agencies with reps in hospitals were better; they had better outreach, better reputations and better interaction.  When a problem arose, I contacted the "recruiter" first and used her support to deal with the staff.    Since she was in a front line recruiting and presentation position, it was advantageous to her that the company provide good care.  And she was always willing to intervene.

Is your father a Vet?  If so, is he registered to get any care?   

I wouldn't consider hiring an attorney; that could just get everyone's "back up" and increase hostility toward you.    What I've found that works is to ask for their suggestions, advice, brochures of care agencies, etc.   Flatter them; that's better than mentioning an attorney.

Ask the hospital discharge planner for advice (even if you ignore it) and a list of rehab facilities they recommend.  But know that there will be jerk outfits on the lists; you have to wade through them.    Raise the issue as I did of onsite representatives; they come directly to your father's hospital room.  I had hour long interviews with each of the two companies I interviewed, and eventually used both of them.  

You can also play naïve and ask them what range of activities each home care person would provide; how assessments are made, how duration of care is determined, what happens if there's a personality conflict with a home care therapist, how emergencies are handled, etc.     Watch their responses; if they're friendly and responsive, that's good but I've seen some that find paperwork more interesting than my questions.

If you start your interviews quickly, and have questions about something a rep has told you, just post back.  

Good luck!

First of all you can appeal Medicare’s decision, but that is difficult. However, I would recommend that you meet with the Rehab staff doctor(s), and plead you’re case for more time. Medicare based it’s decision based on the reports from the Rehab Center. They usually can cite something medical to keep him for a little additional time. Perhaps your father is not cooperating with rehab assignment sessions, then you need to talk to him about it, and gain his cooperation. Also, Medicare will also cover in-home rehab visits if is approved by the doctor. (You also need to be able to compromise.)

No need fir a Lawyer at this time. If Medicare will pay for 60 Days. Then refuse to pick your Dad up. Tell them that at this time you do not have a safe place to have him cared for and he needs to stay there or help you find a place for him if you don't plan on having him back at your house.

The best place for him is with a loved one where he will feel safe and loved.

Check with his Insurance and find out what your options are and what they pay for if he is put on Aspire, Home Health Care.

These Services are paid by the Insurance but they don't pay for Care givers.

The Home Health will send a Nurse to check on your Dad once a week for the 1st month then it's like twice a month and once a month the nurse will come out to change your Dad's Cathiter if he has to keep it.

They will send out an Aide to give him a bath, shower clean him up twice a week.

No matter what anyone threatens, stand your ground. You are NOT going to bring him home for whatever reasons......do NOT do it. They will have to put him somewhere. In the meantime, talk to a good eldercare attorney and the doctor to see what will happen.

First discussion would be with the doctor. If you are unable to care for him in the home with his issues, you simply can't do it. If returning home, due to lack of caregivers to handle his care, you can't do it. There are alternative solutions and the doctor (and social workers at facilities and hospitals) know what they are and how to admit to appropriate facility. Medicare decisions are usually based on notes from the doctor and facility staff.

If you get no where with these folks, contact the Ombudsman's office for your state/area.

You can appeal the decision with Medicare. They can’t let him go while the case is being appealed.

What is their reason for sending him home? Why sent to Rehab and not home from hospital? Are all those reasons given by hospital met? What was his care plan at Rehab, are all those items met? I would want to know if Brain bleed has resolved itself and he is safe for home. Home is usually best for our elders. The longer they remain in institutionalized care (hosp, rehab) the shorter their life. People recuperate quicker at home.

HeLLO my name is Dorothy and this hospital has no right in discharging you father he has the required benefits
You nerd to speak with the hospital Administrator who pretty much has the last decision on your dad to release him. If he is that sick you let them know you will be in touch with dcf, florida elder care, if je had a case manager get in touch with them asap, call medicare. let them know if something tragically happens to your father if he is discharged while he is that sick. you will have every media at their doorstep as we'll the best known attorney in town.
i was in insurance for 45 years and they will do anything to save money. also let them know president trump will know about this.
if you need further assistance please gmail me i just hate what healthcare does to our elderly i will go to bat.
thank you god bless pray to our lord the blessi g will come. i will pray as well

Imho, under no circumstances is he to be discharged from the rehab to home. The rehab center of the SNF that my mother was in told her that "she was too well to stay there." They were very much wrong as she suffered a stroke there 48 hours later. My mother passed away.

Just REFUSE TO TAKE HIM HOME. Those of us who have been through this know the hospital will pressure you but they have social workers whose job is to find a placement for him. They can get Medicaid for him for extended care in a facility.