The Kaiser staff are all over the map about when Dad will be discharged from the hospital and moved to a rehab facility. The discharge planner called me yesterday afternoon at 2:50PM, just as my husband and I were going into a meeting that would last the rest of the day. She said that Dad would be discharged in the morning (that is, this morning!), and that she had the name of three facilities I needed to look at immediately. Yeah, right. I figured she was wrong, but was deeply upset anyway at their expectation that I could make a decision on such short notice.
This morning one member of the neurosurgery team told me that if Dad gets too strong in the hospital, he might become overqualified for a skilled nursing facility. So I decided that it's time to take a look around and identify a first, second and third choice, so that I would have those ready when the time comes. Discharge sometime next week is definitely a possibility. Two of the three facilities Kaiser gave me were too far away, and my choices are limited because of Kaiser's involvement and because of Dad's tracheotomy hole, which requires specialized facilities called "sub-acute". Here's what I'm looking at:
1. There's a beautiful facility about 1/4 mile away from me -- I stopped in on my way home from the hospital this morning. Kaiser would pay none of the costs here, which would run over $5,000/month plus physical therapy. But the facilities are excellent, and he would be 5 minutes away. But this is not a sub-acute facility, and I can't even consider it unless the trach hole goes away.
2. There's a Kaiser-contracted facility near the hospital, about 15-20 minutes away from me. It's a sub-acute facility, and Kaiser would pay 100% for 100 days. No one is giving me any kind of estimate about how long to expect Dad to need this kind of facility.
3. There's a third option, a Kaiser-contracted sub-acute facility slightly further away than Option #2.
Since Option #1 isn't an immediately viable option because of the trach, I'm going to look at #2 and #3 today, and veto anything that is outright unacceptable. I can tell from the locations that the neighborhoods won't be great -- #3 is a semi-industrial area, with a big Home Depot and a Fed-Ex warehouse nearby. Not a beautiful area, but that can't be my primary concern -- the quality of the facility inside the doors is more important. I'm a little worried about whether there would be a consequence to moving him to a non-Kaiser contracted facility in the event he should require a return to the hospital. I don't think that's entirely out of the question, and I don't want to get into a situation where the two facilities point at each other when it comes time to billing. Long-term it's a safer option to keep him within the Kaiser system, though that eliminates my first-choice option. My gut tells me that a month or two from now Dad will be self-sufficient again, or perhaps ready for home (his or mine) and a visiting nurse. But I need to plan for a longer stay in case I'm not right.
I'll look at them, and talk to my brother, and try to make a decision by Sunday.
Tomorrow is the big cleaning day at the house in Fullerton, and fortunately Uncle Bob and Diane are coming up again that day, so I can rest assured that Dad won't be alone while I'm down at the house.
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2 comments:
Don't you just love Discharge Planners? Doesn't "planning" require some time, and information?
Is the plan to leave the trach in for awhile? Do they just routinely put him back on the vent at night, or do they wait until he has breathing problems and then hook him up?
In NY, nursing homes and other facilities are visited by the Health Department every year, and the results of that inspection are supposed to be displayed so anyone can see what they were cited on, and how and when the problem was remedied. It's also available online. I don't know if CA has anything similar. DOH looks at all sorts of things that are interesting, and may help you decide on a facility. When you read that bedsores were found in 40% of the patients, I wouldn't be sending any loved one of mine there. Or if they closed the kitchen down because of evidence of rodents. Hopefully, CA will have something similar, and you can add that information to what you see on your visit, and make a good call. Nothing will be perfect.
I can't imagine that he would need an extended stay in a sub acute facility. He'll need to increase his ambulation, and also his food intake. That'll take some time but it's certainly do-able. The need for the vent is the biggie though. And everything hinges on that as far as I'm concerned. I have had patients who had trachs, and they were taught how to care for them at home. The vent though. That's a whole different story. I'd try to find out more about what the plans are for that.
Cousin Carole
Discharge planners can be the pits or they can be great. I just had lunch with a friend who's mother was very ill and needed rehab. Her mom is in the Washing DC area. They did the same thing. One day they said that they were discharging her to a nursing facility the next day and they ment it. Laura who was out there with her mother had about 6 hours to pick a facility. Thankfully she found a good one. Not the one the discharge planner recommended that happened to be one of the worst. The next morning at 0900 they moved her Mom. So it can happen. I'm glad you're checking out the different ones. I imagine it wont be more that 2-3 months before Dick is ready to leave there. He makes progress all the time. Before long he'll be able to be at home with physical therapy.
Good luck.
Maryanne
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