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My mom had a small stroke back in June where we took her to the hospital from the hospital they told us that she needs to do go to a rehab center to have therapy. We accepted her and the first few weeks she was fine, but then have UTI three times already. It seems that it does not go away. We went to see the urology and they have to catered her because she was retaining her urine. Now at the facility they want to discharged her on Wednesday because Medicare does not cover anymore because she is not improving on her therapy of course she had three UTI and is not capable to do anything. I worked and my husband and who is taking care at home when we are working when she cannot even feed herself or go to the bathroom on her own. She has a secondary insurance champva too. What can you advise?

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The UTI issue needs to go to her urologist to solve.

If she is bedridden and can't do her ADLs, she may require LTC, which is covered by Medicaid (plus her SS). LTC needs to be medically assessed as necessary by her doctor.

Not sure what "champva" secondary insurance is... specific to your state, but is it a Medicare supplement/gap coverage? Or is it LTC insurance?
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Did you appeal the discharge?

Has she been back to see the urologist?

Clearly, she needs long term care for right now. The question is, will it be in a facility, either private pay or Medicaid, at home with aides and/or family?

Those are the choices.
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Rehab coverage is specific to rehabilitation, and that's how it is covered. Rehabs don't keep people for other illnesses.

These UTIs can be treated as an outpatient, troublesome as they are. Sorry for the needs for catheterization, as each time these have to happen it opens one to infection again.

Mom needs to keep in touch with urologist, keep to her medication schedule, be certain that good cultures are done to specific and correct treatment of the specific pathogen, and so on, but no rehab keeps someone for medical illnesses unless they were the reason for admission and part of the rehab.
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My opinion, she should be transferred to a hospital. Put on IV antibiotics and a culture done to make sure she is getting the correct antibiotic. Rehab can only give pills. There comes a time when pills are not enough.

If your Mom has been there since June, her 100 days are almost up anyway. The catheter can be a problem too. To keep her from getting UTIs my Mom was given cranberry tablets and a probiotic. Alva swears by D-Mannose. I would get Mom cleared up and on some type of maintenance. She should be totally voiding when she goes. This may mean her sitting a little while longer till she gets the urge again. Leaning forward while sitting helps. Drink water.

She really doesn't have that many days of Rehab left. Even if hospitalized now and in those 3 days, she will only start where she finished. She maybe able to get some in home therapy though. Maybe get some exercises from the therapist you can do at home.
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InFamilyService Sep 2023
Agree completely and it may be time to hire caregivers to help with the daily routine.
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UTI does not "justify" (the term used in order for Medicare to pay for care) staying in Rehab. Rehab is only justified if a patient is making progress in the specific condition for which he or she was admitted.
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Get her PCP involved to readmit her to hospital for UTI treatment and, further assessment of her current
" level of care needs" .
This may address her current infection and, allow time and input from hospital team including a discharge planner at the hospital when it is time to discharge her as to what level of care she needs: is is independent living ( doesn't sound like it); is is ALF ( ??), OR, does she need 24/7 facility care ? You can explain to discharge planner that either you can meet the demands of this care at home or NOT....do not be ashamed nor guilty to refuse letting them send her home.....if you know that you are not able, tell them and insist that they find facility placement for her .....
There is also always hospice and, people often overlook this or are afraid of it....but in reality remember that hospice is about living not dying and hospice care may be the answer wherever she is being cared for.....you have the right to request her PCP refer her for hospice assessment for appropriateness for admit to hospice. Are you POA?
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File an appeal with her insurance company.
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My mother went to the hospital twice for the same UTI. The second time she was confused from the UTI and fell out the bed. The second doctor in the ER admitted her because he didnt trust that the rehab staff could take care of her UTI properly. Most doctors don't like the care people receive in skill nursing facilities.
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JoAnn29 Sep 2023
You cannot go from Er to Rehab. There has to be at least 3 days in a hospital before Medicare will allow Rehab. My Mom was admitted because it was felt she needed antibiotics by IV.
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Why did you not say unsafe discharge when clearly she needs 24 hrs care and you both Ned to work? If you cannot be there for her every day then say so. The social worker could have been clearing the way to a SNF.
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Mcmarie: The three U.T.I.s are a separate issue from why she was originally sent to the rehabilitation facility - a stroke. They will have to be addressed by a urologist via a complete urinalysis.
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Converse with Elder Law, call the Area for the Aging . For assistance great agency.

Yet you tell them this magic words
" This is an Unsafe Discharge"
Workers don't like that message because you placed them on notice. Holding them responsible for mothers mishap

Then ask to convert with the Social Worker there, be insisted
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