Rehab after a stroke? Reader Q&A

Emergency situations can happen to any of us at any time. Such is the case with a Keeping it REAL Caregiving reader.

The situation? Their mother suffered a stroke and was in the hospital. Damage was not 100% debilitating, but enough that rehabilitation would be needed.

Rehabilitation centers are the equivalent of Skilled Nursing Facilities (SNF). This is not the same as Assisted Living Facilities (ALF).

1. Understand your Medicare coverage

If you don’t already have one, make sure to order a Medicare & You Handbook for 2022 and read it.

I call this handbook ‘the bible.’ Don’t just get it and set it in a drawer. Read it so you understand the latest information and guidelines.

For hospital stays such as this case, it is important to know that generally, Medicare benefits kick in once the patient has stayed at the hospital for 3-days (72) hours.

If your mom had a stroke, this length of hospital stay probably won’t be an issue to hit that guideline.

There are some variables in how a hospital categorizes your stay, inpatient or outpatient, so it is important to understand this distinction.

*See Page 28 of the handbook – Medicare covers semi-private rooms, meals, skilled nursing and therapy services, and other medically necessary services and supplies in a skilled nursing facility. Medicare only covers these services after a 3-day minimum (not including the day you leave the hospital), medically necessary, inpatient hospital stay for a related illness or injury.*

Courtesy: Medicare.gov

2. Hospital stays = weaker

Keep in mind, even if doctors were to say your mother could come home and not need rehab, the impacts of stroke plus simply being in the hospital means she will likely be much weaker.

Consider this: she is confined to bed, in unfamiliar surroundings, not up and walking, taking medications, etc. She is likely somewhat disoriented and may need assistance with physical and/or occupational therapy.

This is where the 72-hour stay is crucial. The hospital care coordinator will likely say your mothers needs to discharge and go to a rehabilitation facility.

Even if you believe she is fine to come home (because as caregivers we always want to believe that’s the case) she probably is not.

Say yes to the rehab for the necessary weeks and as many weeks as you can get approved through her current coverage.

Why? Because even if you and your mother believe she is capable of coming home, she will be weak. She will likely need help with:

  • Toileting

  • Meals

  • Bathing

  • Dressing, and more.

If you and/or your home are not already equipped for this reality, your mother can receive the care she needs and physical therapy for improvement at a facility.

3. Size and quality does matter

Within the family caregiver space, it is easy to sound like a broken record. I often feel like ‘the girl who cried wolf’ when it comes to urging people to be prepared and knowledgeable before an emergency. In this case, our reader’s son was tasked with seeking out area rehabilitation centers.

Even before the hospital doctors reach the point when it’s time for your mother to be discharged, your son should begin making physical visits to facilities – now!

Some questions he should ask:

  • How many staff members are on any given shift (especially at night)? What is the ratio of clients to staff and what is the alert system your mother can use to call when she needs assistance?

  • What is the training and depth of knowledge of the physical therapy staff? Are they trained physical therapists with a specialty in geriatrics?

  • Ask to see the therapy room. Is there legitimate equipment and a clean, neat facility?

  • What are the procedures for scheduling and completing therapy tasks? Demand to stay up-to-date on progress reports as your mother builds back her strength.

  • Make sure the staff uses gait belts for any and all stability and/or balance movements/exercises. Safety should always be priority one!

4. Cleanliness matters

When visiting facilities be sure to ask about the policy for offering showers.

Many facilities do not shower clients daily because they simply do not have the staffing.

However, request (demand if needed) that your mother get a shower each day. This is for several reasons.

First, it will get her up and moving each day. Second, if you demand this service it shows that you expect only the best quality care of your mother. And, being kept clean reduces the chance of getting a Urinary Tract Infection (UTI).

This is extremely common in older women (and men). The longer someone is sitting or laying and especially if they are not getting a shower every day, the more likely bacteria from the back side gets to the front side.

When that happens, you have an entirely new problem with infection and sickness and sometimes, another level of decline.

If the facility refuses to provide daily showers, demand to be able to hire an aid to come in (even for one hour) to give her a bath/shower.

5. Together apart

Photo Courtesy: Adobe Stock

In your mother’s room, make sure you write your contact information (and your son’s and anyone else who is nearby) on the message board. Make it clear to everyone on the care team that even though you are not physically there you are close by, watching and engaged in your mother’s care.

Include your full name, phone numbers and email. Let the staff know to contact you at any time (day or night) if anything arises involving your mother. Plus, write down how your mother wishes to be addressed. Mrs. or Ms. xxx goes a long way in establishing grace and dignity.

There are a few other tips and suggestions on this subject and I’ll share those in a future post.

*KIRC’s Julia Yarbough is not a medical or legal professional. This information is from personal experience having served as a family caregiver. Each family situation and facility may be different.*

Bottom line? I believe we have to arm ourselves with as much information as possible and do our homework in advance. Remember – we don’t know what we don’t know. I hope this helps.

Until next time,

Julia

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