this is how it all started.. she’s 77 healthy except she has a bad knee, doesn’t have a primary doctor, doesn’t ever go to doctor for anything cause like I said, she’s healthy. Well on sept 25 she got up during the night to use the bathroom and when she went to sit back down in her recliner she missed it and fell on her bottom, my son that lives with her helped her up and she went was fine and went back to sleep. Later when she woke up and stood up her knee gave out and she fell again, after that her leg was numb. We convinced her to go to er on the 27th. They ran all kinds of tests and admitted her saying she had a mini stroke. She stayed in the hospital 4 days then they moved her to their rehabilitation center for 10 days. They gave her all the therapy’s and had her to walking 240 feet on her last day there.. she has in continent so she wears diapers.. the doctor in charge had everything ordered for her return home, a bed, commode, walker and wheelchair.. but the case manager convinced me that due to her incontinence she needed to go to skilled nursing for 20 days. I picked one that I thought would be a good place, nope.. they did some therapy every day, but never had her walk or stand or help her use a commode.. basically just sat or laid around in a diaper, nothing that helped her situation at all.. the case manager there was very rude wouldn’t answer any questions that we had about Medicare or her therapy. And the case manager from the hospital would not answer or return my calls.. we took her home when the twenty days were up.. the nursing home case manager did everything last minute.. basically just sent her home.. she said she could order her a wheelchair that Medicare would pay for and we could pick it up in two days.. it’s been 2weeks haven’t heard anything.. they sent home all her meds did not explain any of them.. they kept her pain pills.. I have tried several types of pull-ups they all leak, I had to find her a primary doctor and her appointment is in two days and she’s worried about going afraid she will be peeing and leaking all over herself.. I don’t know what to do.. will Medicare pay for her to go back to a skilled nursing home? I feel like she needs more therapy? How do we get her medical equipment she needs at home and will Medicare pay for it? Who can I speak with that will help me??
I can't really imagine what is happening her and what the full scope is. How long your mom has been basically chairbound, with some incontinence or if all of this is new.
I am so sorry, I can only suggest you have good medical followup and get a fully clear diagnosis of what happened with Mom, when, and why. I haven't a clue what is going on with her at all. You are definitely in medical expertise territory here, and I sure wish you good luck.
It's GOOD that you are seeing her PCP. Go with a list in hand of questions to ask.
One thing I have learned is to follow up with calls, to the point of being almost obnoxious when someone has said "Oh, this and such will be delivered in 2 days"--if it isn't, then I call. Also keep a call log--whom you called, what the ? was that you asked and then get the name of the rep who talks to you.
Sadly, sometimes you have to be a squeaky wheel to get things going.
As far as the incontinence--bring extra 'diapers' and put a fresh one on her right before the Dr visit. Tuck a couple of incontinence pads inside the diaper and hope for the best. Maybe even a fresh pair of pants, or even a muu-muu, which would make changing the diaper much easier.
Get as much info out of the Dr and maybe ask for a new care coordinator. Sounds like the one you have has checked out on you. SO annoying!! As far as the meds--GOOGLE can answer a LOT of questions about those. I always check out any new med that a Dr. prescribes. OR, better yet, ask the pharmacist. They know stuff drs don't know.
The dr would be the one to send he back to a rehab facility, but since she has already done the requisite 20 days, IDK if they'll qualify her for more.
Does she need pain pills to keep the pain under control so she can DO her exercises? Since it was a fall that started this--they will be stingy about anything that makes her a fall risk. But if she is in pain, she won't be able to work out and then everything comes to a standstill.
Good Luck--you're probably going to have to be a little more aggressive in stating what mom needs and how to get it. You might also need to learn how to help her (brother should too!) do her exercises.
It's too bad that so much time went by after the stroke before she was dxed. If you can get someone to the ER and they 'qualify' for a clot buster drug--it's a miracle how quickly someone can return to baseline. Don't beat yourself up about that, my mom had several mini strokes and never got to the ER in time to do anything helpful.
And, if it helps you feel better-report the lousy care at the rehab and the lack of follow through by the SW.
Good luck with this!
I think she needs to see a Neurologist, too, to see if there has been a stroke.
I am confused about Mom being sent to skilled nursing. I am under the impression that Medicare only pays for Rehab. The first 20 days 100%, the 21 to 100 days 50%. Sending to skilled nursing happens when the 100 days is done and its felt the person needs 24/7 care and its an "unsafe discharge" to send them home without proof that 24/7 will be provided. You better make sure Mom is not paying for the days in a SNF. Medicare usually does not pay for skilled nursing.
Ask the doctor if she/he can set Mom up for in home therapy. They can help determine what she needs. At 77 she should not rely on a wheelchair if therapy can help strengthen her.
As far as your medical equipment and medicare coverage, we found out that (in Florida, at least) all the "Durable Medical Equipment (DME)" came from her primary care doctor. Her doctor would put the order in and then whichever vendor was providing the equipment would either call to schedule delivery or just show up. We were never charged for anything that the doctor ordered because she has DME coverage through Medicare.
I would encourage you to work with your mother to find a primary care doctor who specializes in elder care to help navigate the Medicare supplies and coordinate any specialists she may now need (neurologist, PT, etc.). We had to choose a new primary care doctor after my mother was released from Hospice and used google reviews for our area to find someone close that is a very good match with her needs. She now only goes every 6 months unless there is an issue that arises in between.
I wonder if once your mother was released from the facility her need for equipment may have gotten lost in the shuffle a bit.
You could also contact your local Elder Affairs, they provide information and assistance about state and federal benefits, as well as available local programs and services and may have contacts to help you get the equipment you need for your mother to age in place. They are really good about home modifications and support services.
The other thing that sounds reasonable to me is that when mom fell on her butt, she pinched a nerve which caused the incontinence; that is not unusual to have such a thing happen after a fall.
IDK if Medicare will pay for her to go back to the SNF for more rehab, but I would think not. Normally there has to be a hospital stay involved before rehab is prescribed, and then a certain amount of time in between hospital stays before the patient can go BACK to the SNF for rehab.
Once mom gets a PCP, s/he can write a prescription for a wheelchair. 1 device (like a wheelchair or walker) Medicare will pay for once every 5 years. There's probably a co pay, there was for my mother, I think it was $65; depends on the Medicare plan. Craigslist or Facebook Marketplace is a great place to look for durable medical supplies at a low cost, too.....in case you're in a rush and getting a run around from the powers that be ....gee, whoever heard of such a thing? :(
Ask the PCP about in home physical therapy, too. And buy some adult booster pads for mom's incontinence briefs if they are leaky and you can't find a brand to absorb all the urine. Here's an Amazon link:
https://www.amazon.com/s?k=adult+diaper+doubler+booster+pads&crid=3TP87Q4SHFJEW&sprefix=doubler+pads%2Caps%2C378&ref=nb_sb_ss_pltr-ranker-engagementacceptance_3_12
Depends also makes an overnight brief (Night Defense) that has a better absorbency to it:
https://www.amazon.com/DependsWomen-Overnight-Disposable-Underwear-Large/dp/B07SH1Z1FG/ref=sr_1_6?crid=2FK5052GKK9GD&keywords=overnight+depends+for+women&qid=1668461956&sprefix=overnight+depends%2Caps%2C138&sr=8-6
If all else fails, pull up's may not be ideal for your mother's body size and situation; she may need tab diaper type disposables instead. Those you can adjust for a snugger fit whereas you cannot adjust pull up's.
I hope you can find a good geriatric PCP for your mom who can help you navigate this journey ahead. It's not an easy one, God knows, but you're in the right place (here) for advice from those of us who have either walked this path in the past or who are walking it now.
Wishing you all the best of luck.