Hello,
I’ve gotten so many good answer from this forum and now I have my own question to ask. My dad has been in a SNF after a hospital stay after a fall. The hospital treated him very well, but it seems to be very typical that the care provided in the SNF’s is lacking. He was just transferred back to the hospital again last night for a reoccurring issue with blood in the catheter. But one of my major concerns is the fact that he is barely getting any time during the day to be mobile. My hope is that he can moved states to be close to me and live independently as he was in his own house before this trip but with more help. However, the SNF puts him in a incontinence brief and cleans him instead of opting to respond to call bells in time for assists to the bathroom (this would be for BM’s only as the hospital sent him there with the catheter-although he did not have urine retention at home). He doesn’t even want to sit in the recliner when asked because one night they left him there for hours and would not respond to requests to help him get back in bed.
So basically my question is this: has anyone has experience with hiring a private aid to come into the SNF and help with things like transfers to the bathroom or transfers between chairs and beds?
I’m trying to coordinate all his care from another state while working full time. I’m an only child and single so there’s just my paycheck coming in. But when my dad can regain mobility I can help him from here after the move. I just need the SNF to help him get back up on his feet and so far I’ve had to be on top of them for everything and I still don’t feel he’s getting an acceptable level of care. We are looking into a different SNF when he leaves the hospital, but I’ve heard this is an issue wherever you go. Any advice or experience you have is appreciated. Thanks!
ITo me, it’s important that you understand what is probably going on for him as it pertains to health insurance paying……. If your dad is in a NH as a custodial care resident, he will not be getting required rehabilitation level of interactions with rehab staff (the PT, OT & ST). What he can get & that Original MediCARE as health insurance will pay for is for activities done by the rehab staff to maintain capabilities and maintain function. What this usually means is that he will go down to the rehab sector/room to do “gait training” and hand mobility exercises maybe twice a week for a 15-29 minute session. That this exists is due to Jimmo vs Sibelius lawsuit.
Gait training tends to be walking in between parallel bars (flat or an incline). Hand work done at one of those tabletop mini bicycle wheel & if they can a mini wheel done with their feet. What’s important in this is the elder has to want to participate…… so if the staff comes by and says Mr RCE do you want to go to rehab today? and he says no or not today, then it will not happen. He has to be self directing & actively participate. Jimmo is about Medicare paying for services to maintain function
But if he had MD orders for rehabilitation, that is a different situation. Rehab is either in-patient or outpatient. If he’s a custodial care resident then he would have to get outpatient orders for this to be done. The issue probably is that he’s past a recovery stage and he’s realistically just capable of doing maintenance not full on rehab.
Inpatient would be those that come into the NH after a hospitalization with discharge paperwork to be a rehab patient in a SNF that does rehab. All of their stay while rehab patient is paid by health insurance. The rehab stay is based on the insurance codes tied to what their hospitalization is like. So post hip surgery tends to be 20-28 day rehab paid by Original Medicare as health insurance IF THE PATIENT IS PARTICIPATING. If he switched to a Medicare Advantage Plan, those tend to have a much tighter “participation” and will shut off rehab asap.
It’s different than out-patient in that health insurance (original Medicare) is only paying for in-pt specific timed action, like gait training 20 minutes). But all his other costs, like his room & board, is NOT covered by health insurance. It’s paid by private pay, or if he has LTCI, or if he’s on LTC Medicaid, as he’s a custodial care resident in this facility.
Circling back…. so if he were t leave the hospital and go to a different SNF/NH and the same things happen, to me, it’s telling me that he is past any recovery/ rehab efforts, that this is his new normal.
I think the rules on private duty CNA's depend on facility. I see them all the time when I am visiting in facilities in Florida.
In Maryland I asked about the ability to have private duty CNA's with Mom in a facility and I was told they could sit there but do nothing more.
You need to ask if it is allowed at Dad's facility.
Also if you hire private duty CNA's you need to spell out what you want them to do....i.e. walk with your Dad to the end of the hall twice a day etc.
I know when my Dad moved to senior housing, he wanted the caregiver who helped him when he lived alone, to be there to help him in the morning. The facility needed to vet the caregiver, and since she worked for a private agency she was allowed.
The private agency had already done the background checks, and made sure their caregivers had the required vaccines before working with clients.
Once a senior starts falling, their lives can start to decline more rapidly since it just continues to be an issue: elders often never rehab to their prior level of ability. My Mom (now 96 and healthy) started falling a few years ago and now her falls are occuring closer and closer together. This past year she fell twice in 8 months, breaking bones each time. I had to hire in-home aids at $46 p/hr for a very reputable agency to provide quality aids. Do either you or your Dad have that kind of money?
Facilities and SNFs are where expectations meet the disappointment of reality. HIs care going forward is always going to require a lot of oversight. If you are his PoA and willing to provide that oversight for probably many years to come (and more and more oversight as he declines with age) then I would definitely try to get him moved closer to you (but not in WITH you). You will need to know his financial resources (all of them). You should consult with an elder law attorney and/or estate planner together.
You might want to consider a faith-based facility where they view the care as a mission rather than a business. My MIL was in LTC on Medicaid in such a facility and she had excellent care for 7 years until she passed.
More details from you would be helpful.