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My father in law had a stroke with left sided paralysis. He’s been in rehab for a week and the case manager thinks one more week then to either SNF or home. I’m an RN and familiar with the requirements of Medicare. He’s active in rehab, but I’m curious if he meets criteria if he would benefit from more days. He needs total care and it seems a little early in the process. Any tips?

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You will be aware that they must have care conferences. You will be attending those, I hope, and as an RN you will know what to ask. You also can make honest evaluations of your FIL's ability to benefit, truly, from the care.
If he is total care and you expect him to be so I would, myself, as an old retired RN, be concentrating on the discharge plan, and would be asking discharge to help me find the best SNF care for your Dad, one where he may be able to continue PT and OT.

It sounds as though not a tremendous amount of progress is happening (as you say he remains total care, and I know you are familiar that "most" improvement takes place in the first two weeks after a CVA). I am glad that they are trying another week. I would throw myself upon their mercy in telling them this is your Dad's one chance at some improvement, and attend all care conferences. A caring family, esp with someone in medical practice, can make such a difference. In my brother's case I was even allowed to do this by phone, which wasn't easy, but did help tremendously.
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Reply to AlvaDeer
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I am with Midwest. Medicare contracts out to these Medicare Advantages. The insurance company must abide by Parts A&B but they don't. My daughter, RN, ran a woundcare clinic and fought with these Advantage plans all the time about what they cover. Ivwill not have one. If Dad had traditional Medicare, he could be in longer than the initial 20 days that Medicare pays 100%. 80 to100 they Medicare pays 50%. Dad would be responsible to pay for thatvor hopefully his supplimental would pay all or partbof it.

I suggest you make an appt with your Office of Aging to review Dads coverage. Open enrollment is coming up.
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Reply to JoAnn29
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Based on my experiences, Medicare advantage wants to save money by discharging him as soon as possible. If he had traditional Medicare, the rehab would be keeping him longer if he was progressing, as those additional days would be covered. If he needs total care, I would be looking for the best SNF that his insurance will provide. Unfortunately, your choices might be limited. You can always appeal a discharge, but I would put my energy elsewhere.
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Reply to MidwestOT
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Since you're an RN you probably know that PT is scheduled as medically necessary and the patient needs to be cooperative and progressing. If he meets criteria then he'll probably be fine, as long as he faithfully continues the PT at home as prescribed. After my knee replacement, I didn't need to continue seeing the therapist -- I could do it all at home and progressed fast and well. I realize a stroke is completely different but the principals should be the same.

If your FIL has a supplemental gap plan for Medicare, it might cover more PT.
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Reply to Geaton777
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Klwear24 Aug 3, 2024
He has Medicare advantage and no long term care coverage. But yes that’s what I’m thinking too is there’s not a huge advantage to staying inpatient in the eyes of Medicare.
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