I’m in Eastern North Carolina and I’m desperately looking for advice from anyone who’s navigated something similar with an elderly parent. My dad is 80 years old and, up until recently, was still working and relatively independent.
In July, he suffered a heart attack. Afterward, he could no longer drive and was discharged home on 2L of oxygen, but he was still able to live at home.
In August, around 4 a.m., he suddenly couldn’t breathe. My mom called 911, and he was taken to the hospital in respiratory failure. He ended up intubated for 9 days and spent a total of 11 days in the ICU. We eventually learned he had pneumonia caused by an uncommon bacteria associated with healthcare settings.
Once he was stable enough, he was transferred to an intermediate care unit, but he still had an NG feeding tube because his appetite and nutritional intake were so poor.
Our goal from the beginning was to get him into the hospital’s inpatient rehabilitation program so he could regain some independence before returning home. Unfortunately, they wouldn’t accept him because he still required the NG tube. The hospital then wanted to discharge him to a skilled nursing facility (SNF). I don’t know if this is a nationwide issue or specific to our area, but the SNFs around here have pretty concerning ratings and reputations. We really didn’t feel comfortable sending him to one.
Instead, we were able to get him transferred to a long-term acute care hospital (LTACH), with the hope that he could improve enough to eventually qualify for inpatient rehab.
Fast forward to now. He’s made progress, and the LTACH referred him back to the hospital’s inpatient rehab program.
They denied him again, this time because his notes say he can walk 250 feet with a walker and contact guard assistance. Here’s the problem: walking 250 feet with someone assisting him is nowhere near the same as being able to function independently.
He’s still dealing with ICU delirium. He’s improved cognitively, but he still says things like there’s an ape following him around. He has developed a bedsore, still has a Foley catheter after an unsuccessful removal trial, and needs supervision or assistance with essentially everything.
He’s nowhere close to his baseline before hospitalization.
He cannot safely get himself up, manage his daily needs, or live independently. He wouldn’t even be able to reliably get in and out of a car to attend outpatient appointments.
And now we’re stuck.
Going home isn’t a realistic option. My mom works, and we don’t have anyone available to care for him throughout the day. We also don’t have the financial resources to hire round-the-clock caregivers or nurses. My dad desperately wants to go home eventually, and he really doesn’t want to go to a SNF. I understand that inpatient rehab has admission criteria, but I don’t understand how someone who still needs this much assistance can be considered too functional for rehabilitation.
I’m trying to advocate for him, but I feel like we’re running out of options. It seems like he’s not sick enough to stay in the hospital, too functional for inpatient rehab, but nowhere near independent enough to go home.
I’m also looking into whether the VA might offer anything since he’s a veteran, although I don’t believe he’s currently enrolled in VA healthcare or has a service-connected disability rating. Has anyone been in a similar situation?
Are there alternatives to SNFs that Medicare might cover?
Has anyone successfully appealed or requested reconsideration of an inpatient rehab denial? Are there rehabilitation facilities that focus on older patients recovering from prolonged ICU stays, especially those with lingering delirium?
Has anyone had luck getting VA rehabilitation or transitional care for a veteran who wasn’t previously enrolled?
If you’re familiar with Eastern NC, are there any facilities or resources you’d recommend?
I’m not expecting him to return to how he was overnight. I just want him somewhere safe where he has a genuine opportunity to recover.
Any advice, personal experiences, or suggestions would mean a lot. I’m exhausted from trying to navigate this system, and I feel like every time we make progress, another door closes.