Short-term rehab wants DH out; Aetna Medicare Advantage could stop at any time?

OhDear

My DH gets agitated and fell twice trying to get of the house - ended up in the hospital and the second time I said that I couldn't care for him at home. The hospital released him to rehab facility. Three days later, the rehab asked that he go somewhere else. I have been here from 10 am to 8 pm every day. He's told me that he's scared to death and started crying, pica, stopped eating or drinking much. The facility said that when I'm not here, he yells, gets up out of bed, resists the aides dressing him and, this morning, "lunged" at a nurse. They said that they had tapered back the Seroquel. The physical therapist said he was very cooperative. The facility practically accused me of trying to dump him under false pretences. (They didn't blame me claiming my husband fell and then bringing him into the ER. Then saying that I really wanted long-term care all along.) They said that Aetna would probably stop paying any day now! I'm beside myself - the hospital said to take him to rehab and "use the time" to prepare for next steps. I'm scrambling - Do I try to quickly renovate the house and arrange HHA? Or try to expedite a long-term MC facility? just starting the Medicaid eligibility that the social worker said is required. They advised I be here all the time…

M1

I am so sorry. Do not agree to take him home under any circumstances. You cannot safely care for him at home, and you need to say that repeatedly. And don't worry about payment at this point, that's a scare tactic.

Even if it involves being sent back to the emergency room, request psychiatric evaluation. He may well need inpatient treatment on a geriatric psych ward to stabilize on medication so that he can be evaluated for a memory care facility. It may be costly to hire sitters, but that's what you may need to do.

jfkoc

Please include your private physician in the decisions!!!

BPS

I have very little experience In this situation, but a situation involving drug use instead of dementia the person involved had to do exactly what M1 said say repeatedly over and over that they could not provide the needed care at home (the primary care Dr told them to keep saying it). The facility told them they had to pick up the patient, but they kept saying they could not provide the needed care at home and they finally worked it out. It would be very hard to say that about your LO but that may be the only way to get the help you need. Sorry

housefinch

This might be a minor issue here, but why did the facility taper the Seroquel dose? Was it not working? Agree he likely needs Geriatric Psychiatric inpatient admission to stabilize before MC admission, but—-would resuming the Seroquel at a safe pace and hiring a sitter until it’s at the effective dose be an option to try first?

OhDear

Thank you all - great advice! I wish I had read the replies before getting beaten down - but I was exhausted. I should have reiterated that I couldn't take him home, but it got lost on the transfer to rehab. My DH is home and it has been very difficult. I am in Hudson Valley NY and was told nearest geriatric psych inpatient was White Plains/Valhalla or Sleepy Hollow both >1 hr's drive; I had asked for a consult when in the hospital but was told it wasn't needed. (?) Since I was spending >12 hours a day taking care of DH at these facilities, because he was unmanageable if I wasn't there, I decided that I might as well bring him home and care for him. I was told that the Seroquel was tapered to keep him alert for PT. At least I know what he's getting now.

I've learned from this experience for sure - I just wish they hadn't focused on the "falls" but treated the real problem: Alzheimer's agitation.

housefinch

The doctors tapered the Seroquel, which was preventing unmanageable behavior, so he would be alert for PT? Heavens, if that’s really what happened, I would be really upset as a family member. I am struggling to understand how a dementia patient can comply with PT anyway, for meaningful improvement, and particularly how a now-agitated patient can. Please excuse my bluntness here. It just seems like the physicians didn’t look carefully at the big picture. Maybe @M1 can add a more helpful perspective. I’m very sorry you and your loved one had to endure that.

M1

I'm so sorry it's come to this. If you can't manage at home, you can't, and you still have the option of taking him to the emergency room. Let him be hospitalized even if it's at a distance. No idea at all why they would have tapered the Seroquel.

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