Getting your elderly parents the rehab care they need

Last month I mentioned that we’d start looking at real-life stories about families who did things the hard way—and after a few hard lessons, changed their tactics.

Here’s a common situation:

A parent is in rehab after a stroke or hip surgery, and the family needs to make some decisions, in co-operation with hospital staff. How can families work most effectively to ensure parents get the maximum help they need, the service they deserve and the outcome everyone desires?

 

Let’s eavesdrop on a real-life situation:

“Why don’t you just admit it – you want his bed for someone else! I’m not leaving here until I get what he deserves!”

The speaker – an enraged adult child. The listener - a frustrated hospital Discharge Planner. The subject – an 88-year-old man recovering from a stroke. The atmosphere – poisonously unproductive.



As the consultant assigned by the son’s employee assistance program, I was caught in the middle. The next day I met a social worker at busy downtown hospital for coffee and advice.

 

Q: “What exactly are the rights of a patient in rehab?”

A: “First, remember the objective of rehabilitation – it’s a transition from an illness to recovery, with physical, emotional, social and spiritual components. It’s a process that is initiated in hospital but continues long after the patient is discharged. Instead of demanding a patient’s ‘rights’, focus on their ‘expectations’. What can patients and their families expect, and how should they go about being sure those expectations are met?”

 

“That’s easy for you to say – but I have clients that need answers – so here goes...”

 

1.  Who determines the length of stay? Isn’t it just based on available beds?

 Incoming patients are assigned a Rehab Team that includes nurses, physiotherapists, occupational therapists, speech pathologists, psychologists, dieticians, recreation therapists, and a Discharge Planner, who is usually a social worker.

It’s important to recognize that decisions about patient treatment and discharge are a Team effort, with the Program Director confirming the ultimate decision.

 

Here are some of the elements that determine length of stay:

1. Setting Goals

Team members interview new patients to identify goals, which are then assigned a tentative achievement date. These goals may seems deceptively simple – ‘sit alone on edge of bed for one minute’ – but they are challenging and meaningful to the patient. The team meets weekly to discuss progress, share information and make any adjustments.

2. Determining Discharge for a Patient

A Rehab Unit will only discharge a patient when the Team agrees that the goals have been realistically met.

The team is also responsible for discharging the patient to ‘an appropriate level of care’. This is when things become controversial!

 

What if the family doesn’t like any of the options for discharge?

That’s quite likely. The options will certainly be very limited – and either expensive, such as going home with a mix of subsidized home care supplemented by agency care, or a respite stay in the heavy-care unit of a retirement home – or problematical, such as being pressured to find, then wait out the wait list for, a nursing home that no one really feels good about.

 

How Can a Family Make Things Better?

1. Recognize the knowledge and experience of the team.

In our example, the adult son didn’t pause to consider the knowledge base of the Team. He focused instead on his own agenda of ‘getting Mom what she needs’. Just out of interest, I added up the years of education and experience of the team—36 years of education alone!

2. Seek to understand.

Families should take a longer view – what’s the goal here? How can I work most effectively with these people?

3. Mind your manners

As in any work situation, you can’t just bully your way to a solution. In our family, the adult son showed no respect toward the team. He made the assumption that it was a ‘we-vs-them’ scenario.

 

Did the son ‘win’ – and did he do so at his mother’s expense? This story is not over by any means – wait for next month’s blog for the eventual outcome.

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Related articles:

Caring for elderly parents (overview of the subject)

Caring for elderly parents: How siblings can work as a team

What are the real costs of aging at home?

How to find a retirement community for your parents

Caring for your elderly parents and yourself too

Have you gone through a similar issue with your mom or dad? How did you handle it? Share your insight with others by posting a comment below.