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Delay in rehab?

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    Delay in rehab?

    My father was recently injured on 1/3/17 with an incomplete C3. He lives in Florida and is at a hospital in Florida. He has been at the hospital since 1/3. He had decompression surgery on 1/11. He was scheduled to go to the Shepherd Center on 1/25, as that was their first available bed. However I just found out his admission date has been pushed back until 1/30. We have looked into other top facilities too, but they have even later admission dates. His current hospital is telling him he's leaving on 1/25 no matter what Shepherds admission date is. The current hospital has arranged a local "back-up" facility instead of Shepherd for my father. However this backup option is only 3 weeks long for inpatient and doesn't have the specialization for sci. Would you continue to push and wait for Shepherd on 1/30?
    (I should add that I have been informed that starting at one local rehab facility and then transferring to a specialized sci rehab doesn't typically work well with insurance, so we don't think that's a good option)

    we are also getting concered that the delay in beginning his rehab may delay his rehabilitation in the long run...

    Insurance will rarely allow a lateral transfer. I might push back hard.


      Your father's current hospital can no longer justify an acute care stay for insurance purposes and that is why they are moving in a different direction than you want.

      If your father is insured on Medicare, you can/should appeal a pending discharge:

      If this applies to your father, ask to speak with the hospital's "Patient Advocate"- NOT the Social Worker or Nursing Discharge Planner- tomorrow.

      Would you mind sharing the name of the facility in Florida where they want to transfer him this week? We can then look up and compare their services to those offered at Shepherd Center for your appeal.

      Does the "back-up" facility even know that you have a planned transfer to another Rehabilitation Facility in less than a week? Please check this out as well. C473s is correct about lateral transfers.


        Looks like my first reply didn't go through, so I apologize if there are two similar messages.

        My father is currently at Sarasota Memorial Hospital in Sarasota, FL. Sarasota memorial hospital wants to transfer him locally to HealthSouth in Sarasota, FL. HealthSouth is aware we are hoping to move forward with Shepherd Center.

        My my father is in a Medicare replacement plan, however the appeal process would still apply. So that is something we are also looking into.

        Shepherd Center is also aware that Sarasota wants to discharge him before Shepherd center can admit him.


          Absolutely refuse to have him transferred. The hospital tried to do the same thing when my father was injured. Just resist. They absolutely cannot transfer him without your consent. They will threaten that "Medicare will not pay" but they are bluffing. Every day remind them that your father is accepted by Shepard, it is the best place by far for his care and recovery, transfer date is only a few days away, and you will not leave until then.

          Since he is on Medicare, they can only move him if you sign a form agreeing. They also have to give you a form informing you that if you disagree with hospital discharge, you can appeal by calling Medicare and the form has a special direct number for starting is process. Starting this appeal process puts everything on hold for several days at a minimum.

          It will be impossible transfer him from another rehab to Shepard. I promise you.

          So yes, call Medicare if you want and delay delay delay. And delay the call to Medicare until they present you with the form.

          Every day, call Shepard and ask if a bed has opened up yet. Every day. Beds change all the time. Something could open up sooner.

          Every day, remind the hospital of your father's medical problems that the doctors are still monitoring in the hospital. Every tiny fever, blood test abnormality, medical issue will be a reason to continue monitoring in the hospital and wait for the Shepard bed.

          Has a rehab doctor come to see your father (a physiatrist) to do an evaluation? If not, ask for this. They might actually be your ally, as they will realize how important Shepard will be for your father's recovery. But they may also push for discharge sooner, if the hospital is putting pressure on them.

          Don't budge. Even if they threaten you might have to pay for those extra days yourself. That won't happen, and even if it did... It would be worth it.

          Good luck. Be strong. And tell your father to keep fighting, we are rooting for him, and he will improve.


            Definitely don't discharge him to the local rehab. A Medicare replacement plan will generally be less helpful with getting him to Shepard once he is discharged if he doesn't go directly. If the Medicare replacement plan has already agreed to Shepard, that is already outstanding, as some replacement plans would not.



              Thank you all for your knowledge and support. I am also putting my foot down and not transferring him locally to a rehab facility only to then be "stuck" and then not getting him to Shepherd. Shepherd feels confident the admission date of 1/30 will not be pushed back. So my goal is to keep him at his current hospital until he is transferred directly to Shepherd. Thank you all for reconfirming what I too was thinking. I will have the Medicare appeal process as my last resort if needed.


                Be aware that HealthSouth Sarasota's webpage lists "spinal cord injury" as a condition they treat.

                They were awarded some sort of "Gold seal of approval".
                "Committed to a higher level of care, our hip fracture, spinal cord injury and stroke programs have earned Disease-Specific Care Certification from The Joint Commission in addition to Joint Commission accreditation. This Gold Seal of Approval is a direct reflection of our commitment to provide comprehensive treatment programs to help patients reach maximum outcomes."

                It's misleading because they do not have a specialty spinal cord injury rehabilitation program that is accredited by the Committee on Accreditation of Rehabilitation Facilities. I can't find a list of HS staff physicians to check if any of them are PM&R Spinal Cord Injury Fellowship trained.
                Shepherd Center does. To your Dad's Medicare Replacement Plan though, they're providing him with SCI rehab. It's not the same.

                Search online for "florida hospital evictions". It takes a good while for something like that to go before a judge.

                If they hit you with this transfer even earlier than you'd planned, demand that appeal.


                  I can only add that in general, Medicare will pay only for 3 weeks of inpatient acute rehab, regardless of the facility. That count will start the day he goes to either HealthSouth or to Shepherd. So if he goes to HealthSouth first, he will loose out on the days he can have rehab at Shepherd. Stand firm. In addition to speaking to the Patient Advocate at the hospital where he is now, ask for an Ethics Team Consultation. While they only provide consultation, it can be ammo for filing your appeal and the talk you will be requesting with the hospital's Director, if necessary.

                  I forgot to ask if your father is a USA military Veteran? If so, you also may want to explore his medical benefits and ability to get rehab and ongoing care through the VA SCI Centers, the closest to you being in Augusta, Georgia (or alternatively Miami or Tampa, FL).

                  Last edited by SCI-Nurse; 22 Jan 2017, 3:46 PM.
                  The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.


                    Great ideas KLD.


                      My father is not a Vet unfortunately.

                      His current health insurance is a Medicare replacement plan with no max on rehab length. So he doesn't have straight Medicare since it's a replacement plan (not supplement). It's not a common plan he has, but luckily rehab length isn't maxed like Medicare is. It is a replacement plan from United Healthcare.


                        Thank you 2drwhofans for your insight.


                          UPDATE!! Hospital is saying my dad needs to be out ASAP and they can't delay discharge anymore. I have called every contact we have at Shepherd (left all a voicemail), I have called his case manager at current hospital (left voicemail), and spoken to patient care advocate (she's looking into this). Any other suggestions and ideas on delaying discharge? My father needs to stay at current hospital until Shepherd can admit him on 1/30. We plan to do Medicare Discharge appeal too.


                            Just so you have more options, you might want to take a look at Brooks Rehab in Jacksonville. They have an excellent SCI program and the Neuro Recovery Center, which provides continued access to rehab equipment, facilities, and therapists post acute rehab for $100/month.
                            Co-founder & CTO of MYOLYN - FES Technology for People with Paralysis - Empowering People to Move


                              Originally posted by KellyA View Post
                              UPDATE!! Hospital is saying my dad needs to be out ASAP and they can't delay discharge anymore. I have called every contact we have at Shepherd (left all a voicemail), I have called his case manager at current hospital (left voicemail), and spoken to patient care advocate (she's looking into this). Any other suggestions and ideas on delaying discharge? My father needs to stay at current hospital until Shepherd can admit him on 1/30. We plan to do Medicare Discharge appeal too.

                              Nothing has changed. You can still say no. They are just trying to scare you. It's Monday, so they push the most on Mondays.

                              Just be firm, but polite.

                              Look at our prior advice.

                              Call Shephard twice a day. Be nice, but be eager.

                              Keep calling your advocates, as you are.

                              Only call Medicare at the last minute.

                              Does he have any active medical issues right now? Infections. pressure sores, unstable vital signs, blood clots? All reasons the hospital can still bill the insurance company for care in the interim.

                              Threaten to get a lawyer involved, if you want. They are risking the health and long term survival and recovery of your father by pushing for early discharge to a suboptimal facility. But there's no need to hire a lawyer. But you can threaten.