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From rehabilitation center to ‘skilled’ nursing facility; what next?


My wife is disabled one arm paralyzed and wheelchair bound; needing the care that I cannot give her at home! She may also be having dental problems with pain that I cannot tell except strong breath.


Will it be assisted living or nursing home ?

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Prior to discharge from the skilled nursing facility, I would request a meeting with her care team to discuss current level of functioning, home care coverage, current medications, medical equipment needed, and anything else related to her care. I would also have a conversation with her physician regarding diagnosis and prognosis. Whether assisted living or nursing home depends on the answers to the questions above AND her financial status. Most if not all assisted living do not have Medicaid coverage. Nursing homes do but any resources must be spent down first while completing a Medicaid application for financial assistance.
In regards to the dental issues prior to her discharge from the facility, I would ask for a dental consult to assess any dental issues.
Lastly, I would start this process by talking to the social worker of the facility.
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disgustedtoo Jan 2020
Pretty much what I would have suggested. One needs to be assessed and require skilled nursing care in order to require a NH. The rehab place should be doing assessments and discussing the results with OP and his wife. Her doctor(s) should also make recommendations.

Note that "resources must be spent down first" should be qualified with the PATIENT's resources need to be spent down (Medicaid will determine how much that might be) AND don't just spend willy-nilly on anything, use it to cover any costs in the care of the patient (aides or AL cost.) Giving away anything and/or frivolous spending could result in a penalty (delay in getting access to funds.)

Also, curious why no SS - others have questioned this as well. Gov't job? That should have a pension associated with it, although the various costs in her care already could be dipping into savings. So long as one has worked the required # of years in a non-gov't job, one should have SS. (Gov't jobs can be federal, state or local, in which generally you pay into a pension system and not SS.)
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Can I encourage you to go to www.nelf.org and find a certified elder law attorney to help you navigate the financial end of getting your wife the care she needs.

As far as what that care looks like, ask the facility to do a needs assessment. Then ask them to help you find a facility that can provide the level of care that she requires.

I know that you feel completely overwhelmed and alone, but there are people available to help you navigate through all of this. Just ask.

One thing that I would recommend, when they start making noises about discharge do not let them just send her home. I found that they will say anything to get you to agree to take the patient home. This is an unsafe discharge because you can not take care of her at home, memorize that term "unsafe discharge" and repeat it until you get help finding your wife the care she needs.

I am sorry that your family is dealing with such a traumatic incident. You will find a way to live with your new normal.
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I know you are hearing this from others on here but I'm throwing it in too because I did it and that is to get a consultation with an ELDER Law attorney. It was the best thing I ever did in dealing with that for my mother. It may cost you approximately $300.00 for one hour. Yes, that sounds high but it was worth every single penny. He saved me from getting myself into a mess with the spend down to Medicaid and issues dealing with my mother's financial affairs (her money). There will eventually be two government agencies you will answer to at some point. Medicare/Medicaid, and Social Security. They both will audit for any shifting of monies and Social Security will audit to be sure her check is used for her care and if she's getting the use out of her money and that a family member is not spending it. So make a list of questions, and get an appointment. I ended up in the lawyer's office 4 times over 4 years my Mom was in the nursing home. Don't go on hearsay from anybody including some suggestions on here. Get professional legal advice. Protect yourself from the start.
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You need to get yourself to a certified Eldercare Attorney who can aid you in applying for Medicaid for your wife. You are the Community Spouse.

You will not be impoverished.
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Gnu262 Jan 2020
Will definitely look into it ASAP - thanks
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Of course nursing home as limited assistance at the assisted living
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Usually if a person requires a two person assist, it’s a skilled care facility. Assisted living for the most part is a one person assist. Hope this helps.
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Talk to the Social Worker at the facility your wife is currently at. They know the laws and the local resources. They can help you with creating a plan of care for "after".
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So sorry to hear about your wife’s stroke. That’s tough. I am thinking she will be in a nursing home rather than assisted living but I really don’t know. Can you speak with a social worker to help you sort this out? Best wishes to you and your wife.

My daddy had a stroke. It’s interesting how different strokes can be depending on the circumstances.

Daddy had his after his heart surgery. He was actually in the hospital recovering from his bypass when it happened. He was in ICU.

After he was released from the hospital he did rehab. No paralysis. His stroke effected his speech so I took him to speech therapy three times a week.

He would mix up words. Once he told me to pick up a gallon of paint for mom. I called mom and she had told him to bring home a gallon of milk.
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I would plan for a NH. I’m curious - when was her stroke? If she has been hospitalized then sent to rehab I am thinking 2 months ago?
The reason I ask is trying to establish what is baseline for her....can she swallow without aspirating for instance? Usually with time she will reach her maximum potential if she has not already.
When you have time, give her good oral hygiene. That strong smell may be pocketed food.
For your wife’s care, a NH will provide more support than an AL.
Good luck to you both.
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When did the stroke happen?

Ask the SNF staff to show you how to help your wife clean her teeth. If there are any dental problems, rather than just hygiene having been overlooked lately, they should come to light then.

Is your wife's speech/communication badly affected by the stroke?
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Gnu262 Jan 2020
Called aphasia ; she struggled for the wanted words to express her thought.
( I gather that patients can hear everything, intellect is retained and need a long time to come out of this )
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