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Rehab for a stroke
Debtn posted:
My mom has been in rehab for 1 month, now they are saying she isn't responding to rehab & Medicare won't pay for treatment. She is at a skilled nursing facility. The 1st 15 days after her stroke the hospital didn't do much rehab so she got really weak. Everything I have read says rehab can take upwards to a year after a stroke. I am not sure what to do now. Any help would be appreciated. We live near Nashville,TN.
Richard C Senelick, MD responded:
I am assuming that your Mom was sent to a Skilled Nursing Facility ( SNF) rather than an Inpatient Rehabilitation Hospital. This is a common, cost savings measure. The two are not the same and the intensity of rehabilitation services is much less at a SNF. Studies have shown that a patient who goes to an Inpatient Rehabilitation Hospital after a stroke is three times more likely to return home than one who goes to a SNF. ( Click on link)

On the other hand, patients will reach a plateau where their progress slows or stops and it is time to move to a less intensive setting. It is true that Medicare only provides a hospital or SNF with a certain amount of money to treat a patient. It is not a daily fee and therefore once a patient has stayed a certain amount of days, the facility is no longer getting paid to take care of the patient. Most facilities will keep a patient if they are making good progress, but it is a balancing act.

If your Mom is at a SNF, ask that she be evaluated by a Rehabilitation Hospital in the area- Nashville has excellent rehabilitation hospitals. They will send a nurse to the SNF to see if she is a candidate. If she is not and has to go home or to the nursing home side of the SNF, ask if she is a candidate for continued therapy from home health. Ask what time of home programs or maintenance programs they can provide. If all else fails, be sure that every month or two someone reevaluates her to see if there would be a benefit to restarting rehabilitation.

You are right that improvement can be slow and continues over a long time. The patient and family need to be taught how to continue the exercise programs at home or in the community.

A great resource will be Stroke Support groups in your area. The people who attend these meetings have been through what you are experiencing and can provide many suggestions. Here is a link to the American Stroke Association page that helps you find a group in your area.

Good Luck.
After your stroke you may be experiencing a new normal, but remember what George Eliot said- It is never too late to be what you might have been. You still can achieve new goals.
Debtn replied to Richard C Senelick, MD's response:
She was at a hospital rehab, their idea of rehab was to put her in a wheelchair each day & park it in front of the nurses station. After 15 days of this, they said we had to send her to SNF. My mom also has Ford Insurance thru the UAW, not just Medicare. She is now so weak that her uterus dropped & we see the ob-gyn doctor on Tuesday. She is in pain but the SNF says she can't have anything for pain because of her stroke. I had Skyline come out for an eval back in May, the day they came Sumner Regional over medacated her making her BP drop & she passed out. I contacted a Neuro Dr. at Vanderbilt, but they don't come to Gallatin,TN. The SNF has no Neuro doctors. She still is moving her arm alot also. I truly feel she fell thru the cracks of the medical system & the PPC Dr. acts like she is no longer his problem or his patient. Needless to say I'm mad as you no what with the whole bunch.

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