Can a rehab facility require that a wife follow their careplan upon discharge?

2 answers | Last updated: Sep 13, 2016
Agonizing asked...

My husband has used a walker to come to meals, but otherwise has spent the last 2 years just lying in bed. After treatment with various antidepressants to no avail, MD's have decided he has vascular dementia. He recently fell near his bed several times late at night and ended up in a rehab facility. Even there he just lay in bed except for the few hours of OT and PT each day. He is to be discharged in 2 weeks and I was told that he should go to an assisted living facility or have 24 hour care at home. He is incontinent and needs help changing and bathing, but I have cared for him safely at home for the past couple of years and want to continue doing so with a few hours (not 24 hours) in home help a day. Can anyone make us follow their care plan and hire 24 hour help before they release him?

Expert Answers

Merrily Orsini, MSSW, was a pioneer in the business of providing geriatric care managed in-home care. She currently serves on the board of the National Association for Home Care and Hospice and is Chair of the Private Duty Homecare Association. She holds a master's degree in social work and is a nationally known writer and speaker on aging, elder issues, and in-home care.

Plans of care are subjective. An assisted living facility does not provide the right care as you have described, so it should not even be an option. Adult protective services in most states require that care be administered so that a person is not being harmed, or is not harming himself. Skin breakdown is an issue with someone who is in bed so much. There are some great products that help keep skin breakdown from becoming an issue. Also, it seems that if your husband can still use a walker, he should be encouraged to get up and get more exercise. Can you find a local occupational or physical therapist who would help you plan for ways to strengthen him somewhat? The longer he stays in bed, the more his body will fail and the harder his care will become.

Community Answers

A fellow caregiver answered...

If they say he "needs 24 hr care" doesn't have to be just at home. It sounds like he needs nursing home care. Assisted living usually charges extra for everything, and the costs can end up more than a nursing home. If he has dementia, it will get harder for you. Mom fell twice in a year. (broke things both times) She passed 6 months after the last fall. Dad is now in dementia unit of nursing home. Ask for referrals for help at home if that's what you want. You usually can pick what help you want or don't want. But I'd start looking for a good nursing home, with a dementia unit, if I were you.