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Home rehab is much less intensive than in-patient rehab. I have twice had in-patient rehab after major spinal surgery, and I was actively in rehab for about 6 hours/weekday and 3 hr on Saturday. I also had to dress myself there without assistance for however long it took. If I was not successful, the O.T. would give a few suggestions. but that was it. I also had to figure out how to manage my food, although I was allowed to have assistance opening drinks. No way the situation could be duplicated at home with O.T./P.T. coming there a few days a week for 1-2 hr. (which is what normally happens when you graduate from in-patient rehab.).

Your mother may be very unhappy now, but her chances of a meaningful life will be much increased if she sticks to the in-patient rehab. that's being recommended. That they still want her to have more rehab is very good news, because it means they think she'll still improve more: rehab stops when you aren't improving. BTW, be sure that both of you are learning steps she can take to try to avoid future strokes. Sixty-thee is quite young for a stroke, as I'm sure you both know.
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AndSoItGoes Nov 2023
Wow.. 6 hours every day (except the day with 3hrs)? That rehab sounds quite different from the rehab that happens in most SNFs. I think I recall from my mother's discharge (post head injury) that she was considered too old/weak for the "rehab" where younger/stronger people go. I'm pretty sure her weeks in the SNF were considered / billed as "in-patient rehab," but it was nothing like what you describe. Visit from OT/PT each day, but folks showed up whenever, for brief periods, and often too late in the day for her to have the energy to even stand up. 

It sounds like OP has concerns about her mother's rehab, so she may not be getting the quality/intensity of rehab that you did. 

All the same, it's good to know that experiences such as yours exist.

Does anyone know the right terms for distinguishing between "serious" rehab like what Igloocar describes and the drive-by rehab I remember from my mother's time in a SNF? Do these types of facilities have different names?
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Duff. Personally, I would bring your mom home. If at a later time, if things get too hard, then you can always put her in a facility, after exhausting all options, because there are always a lot of options.

These are our moms, and especially if they want to stay in their home we have to do everything in our power to make that happen. And believe me when I tell you, I could tell you horror stories I know of personally from being a caregiver for the elderly, and also from what my stepfather went through at two separate rehabs where they both almost killed him from extreme negligence. As well as what my mother went through when she was at a rehab for several weeks.

At least with your mom home, you know she's SAFE, she's with you, no one's hurting her, or ignoring her, or doing bad things. She's being *respected and taken care of.
I know one thing, if she has a chance of improving, it will be at home. I know too many stories of people where they're put into homes, especially where they don't want to be, and they get so miserable and depressed, and then the facility starts giving them all these different drugs that ends up ruining their minds.

Just bring your mom home ASAP and eventually over time, if you feel like you just can't do it anymore and you absolutely exhausted every option, then you can consider putting her someplace. But I would at least give her the chance of recovering at home with you, her daughter. And where you will know she's going to be taken care of.

Believe me when I tell you these rehab facilities are not good. They could put on the act all they want, no matter how fancy or expensive they are, I could tell you many stories.

If you are forced to have your loved one in a hospital or rehab or care home, you need to have someone sitting with that person constantly. You, friends, caregivers. You have to watch these places like a hawk.
I wish you good luck and I do hope you bring your mom home. Give it a chance.
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BurntCaregiver Nov 2023
@Lisa

You are mistaken here. There will not always be the option of putting the mother into rehab at a later date. There will be the option of a nursing home.

Do you know how rehabilitation for a stroke, surgery, injury, or accident works? The main part of a person's recovery is in the first six months with a stroke. As with any injury, post-op, or accident, with rehab it is use it or lose it. There is no coming back later.

She will not recover better at home if she's in rehab now. There will be the honeymoon period where she'll be happy to not be in a facility. There won't be physical and occupational therapists making her to do her PT and OT. Family behaves differently with family than they do with healthcare professionals. She will not improve past her current level of recovery now if she is brought home.
Right now will be as good as it gets.

The mother's best chance at maximum recovery is for her to be in a rehab facility for as long as she can be.
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Your mother is young at 63. Her best chance at maximum recovery from the stroke is for her to stay in rehab for as long as possible.

In-home rehab is nowhere near as good as what a rehab facility can offer. If the nursing home/rehab wants to move her see if it's possible for you and her to pick the rehab. Do a little research and find the best one. You say she's still covered by private insurance. Get her moved before that insurance runs out. Once she's on Medicaid there won't be a choice of what rehab she can go to.

Don't bring her home right now. Take full advantage of how ever much in-facility rehab she can get.

I did homecare for 25 years. I have taken care of many people who have had strokes and whose families had taken them home. The families certainly meant well and wanted to take care of their LO, but they were in so far over their heads with what the care needs actually are.

No one nurse, doctor, physical/occupational therapist, or social worker is ever truthful about what the real care needs are going to be at home. They will gloss over the seriousness of a care situation and give it a good sugar coating especially when a person's Medicare days and private insurance coverage is going to be running out. They will also make promises of endless support and resources available to you 24 hours a day. There are no such things. This is the line of BS families get told when a person's private coverage is going to be running out.

Now please don't get me wrong here because I speak from a long experience of working with families in homecare situations. I'm sure your friend is a good person. That they have the best of intentions for your mother and you and really want to help.

Unless they have a backround in homecare or have lived with a person with serious round-the-clock care needs, they will bail.
You can't count on this person even if they're homeless and having a roof over their head is contingent on taking care of your mother.

My friend, I have seen spouses bail on each other because the care needs were too much for them. Once happy marriages ending in bitter divorce because one spouse is a care slave.

The best place for your mother is in rehab for as long as she can be.
She will not be in rehab forever. When insurance stops paying for her rehab stay that is when she moves in with you. That is when you're going to need to take the FMLA to get her situated in your house. You will also need that time to get everything ironed out with what equipment she will need, homecare schedules, and everything else.

All of these things will have to get done and if at some point you go back to work after the three months, all her care plans will have to be set in stone so you can go back.

Don't take your FMLA now. Put her in rehab and do this the right way which is by careful planning, letting her get as long as possible in rehab to maximize her recovery, and to have your home set up and reliable paid homecare in place.
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Dupedwife Nov 2023
Great advice, Burnt. I hope the OP heeds your advice.
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It is, of course, your decision.
However, you do not have the medical equipment nor staff to support her 24/7, even if (as) you want to. And, stroke victims can need ongoing care. Are you prepared for this? not knowing how her health may change / what her needs may be?

Some of us (me) do not know what a PFML is.

I would strongly consider you get into therapy as this is overwhelming for you and I sense you need someone to talk to - to sort it all out. And examine what your needs are and what your mom's needs are. In essence, are you doing or wanting to do this for you or for her? I know this sounds cruel to ask - although you need to put her best interests ahead of your (emotional / psychological) needs / desires.

I don't know what the three months is about - ? vacation time ?
After that, then what?
Even if you have a friend / someone moving in, you will still need more care, and perhaps more qualified care of a nurse, or more.
You cannot depend on a 'friend' - they burn out too.

If you really believe that the two of you are 'enough' care, then you need to re-think your plan here.

While it sounds like $ is not an issue - consider: Be prepared to pay upwards of $20,000 / month for private caregiving and possible/likely ambulance needs (very expensive), and more transportation needs for hospitalizations, MD visits, or PT / rehab visits (if they would be out of the home at a facility),

Remember, you do not know the ramifications of a stroke. And, what follow-up care is needed, aside from being told 'maximum' -

While I realize you want to help your mom and be the primary caregiver, you cannot do all that is needed - as I see it, this is the reality. If she is / was terminal and you wanted her home for her last few months, I could understand.

YOU need to investigate home rehab care.
You need to do your research and find out who provides what ... and when ... and how.

What is your support network?

I am (trying to/) looking at this situation from you/r point of view and that of you mom's. Most people give advice / feedback from their personal experience. I am not. I am giving you an as objective 'overview of the situation' as I can.

If I were you and dissatisfied with the care, I would investigate moving her to another facility.

* Do your DUE DILIGENCE, which perhaps you didn't do the first time (as you are not satisfied with her care there).
* You need to really flush out to ensure she will get the best / level of care that you want her to get.
* Do not make a rash / quick or emotional decision. It will not serve you or your mom in the long run.

You do not, as I read this, tell us why you are back to square one.
So it is impossible really to respond accurately. (What happened?)
These 'things' will come up - perhaps regularly - with bureaucracy ...
organizations, including hospitals who are short staffed. Who'll do all this when you go back to work (?) in three months?

RECOMMENDATION_______________
It might be the 'best of both worlds' to keep you mom in Rehab and hire a personal PT / caregiver for several hours a day while she is there. This is what I would recommend.

I sense it won't be as 'easy' as another said ... 'try it and if it doesn't work out, you can send your mom back to another rehab.'

If she needs maximum rehab - why are you wanting to bring her home?
This is a major red flag to me - that you are not thinking this through.
I don't mean to sound cruel or scare you... I want you to be confident in your decision making and do your due diligence/research.

Gena / Touch Matters
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Igloocar Nov 2023
PFML is Parental and Family Medical Leave, which under many conditions employers are required to grant to employees--normally unpaid. The max you can get at one time (I don't remember whether you can ask for it more than once) is generally 90 days; i.e., 3 months. Hope this helps.
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Duff is Mom still in the 2nd rehab? How is it going now?
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My brother was in the hospital and they wanted to let him die because bystanders ( not the family members who took him to doctor visits) said he was terminal.
When we questioned that, they wanted to send him home on hospice to die.
2 baths a week (lol). A nurse and others as scheduled at least once a week.
I had no choice. Finally got him “rehab” before coming to my home. He was an ambulatory ( except when falling ) confused incontinent mess. And the laundry, bathing, house cleaning etc !
We finally got him stabilized with proper medical care from his regular doctors.
9 years later, he is not terminal, but it was awful while it was going on.
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