Stroke Recovery: Please Help!

[Anonymous]

My MIL had a major MCA stroke on Saturday. She was helicoptered to Shock Trauma in Baltimore and now she’s getting moved to an acute rehab for two weeks that would only take her if we guaranteed 24/7 care when she gets out. We have no plan in place and need one ASAP but we’re still reeling. We can piece together some care but not enough and need to arrange home care nursing. Can anyone recommend resources in the Rockville/Olney region? I don’t even know where to start. TIA.

[Anonymous]

This really depends on her current cognitive state as well as physical capabilities.
The first thing to do is do NOT let them try to discharge her from skilled nursing rehab until you have a plan in place at home for the level of care she requires.
The key words here: “unsafe discharge”—you just insist that you are setting up what is needed as quickly as possible, but to discharge her before those plans are in place is unsafe. This will buy you a few days.

Once she is in rehab, start contacting places that can offer RESPITE care.
If your loved one’s stroke resulted in memory impairment, contact Olney Assisted Living or Arden Courts (potomac or silver spring) to see if they can offer a respite stay. This can actually be considerably less expensive than having someone come into the home 24/7.
If you want your loved one to stay at home, and you have *some* coverage but you need nighttime hours or daytime hours only, you will want to figure out the shifts needed and then start calling home health services that provide trained in-home certified nursing assistant care at about $32/hour.
Companies like:
Right at Home
Capital City Nurses
Synergy home care

Keep in mind that CNAs are NOT nurses so you will need to do medication management yourself or they will need to have a nurse do that. Most CNAs can give meds once they are in those little daily containers, but they cannot be the ones to sort them into the containers from the prescription bottles. Also these companies will ask you questions about your loved one’s level of care needs that you will need to be prepared to answer—such as do they need meals prepared, help with changing/dressing, help with toileting, showering, etc. This info will help match your MIL with a good “fit” for a caregiver. They will likely schedule an appt for a nurse to come visit your MIL for an assessment.

If she has long term care insurance, now is the time to use it. If not, the costs will be out of pocket and will unfortunately be very expensive.
I’m so sorry,OP. I know this is very stressful.

[Anonymous]

OP here and this is so incredibly helpful! Thanks so much for taking the time to write. I’ve already shared this with my family. Any guess whether Medicare will pay any part of home based long term care?

[Anonymous]

Anonymous wrote:OP here and this is so incredibly helpful! Thanks so much for taking the time to write. I’ve already shared this with my family. Any guess whether Medicare will pay any part of home based long term care?

Medicare will not pay for any home based long term care. They will likely cover a nurse 1-2x a week for about 30 mins at a time for assessment and vitals checks, basic things like that. Maybe some home PT and OT if needed. But for actual care in the home you’ll have to pay out of pocket.

[Anonymous]

Anonymous wrote:OP here and this is so incredibly helpful! Thanks so much for taking the time to write. I’ve already shared this with my family. Any guess whether Medicare will pay any part of home based long term care?

Np, and not based on my research. It could however cover the rehab (depending on minimum hospital stay).

[Anonymous]

I am the first poster under OP...and I'm so glad this information has been helpful. (I happen to work as a client care manager for a company in the DMV that manages "life care" needs for elderly clients and clients with disabilities in the DMV...which was a result of navigating this through a crash-course with my own parents who were states away just prior to covid.) All that is to say...I definitely know what you are going through as the adult children...but also I am more than happy to share the knowledge I have gained through my work experience helping out others.

And OP I concur with what the other posters after me are saying about medicare.
They wlll, however, cover the inpatient rehab stay AND any post-inpatient rehab in-home VISITS from OT/PT services. Upon discharge, they will give you the name of a home health service that will contact you to set up these appointments. (Please note that these are different from the CNA caregiver services I mentioned.)

It is important to accept these OT/PT services (or persuade your MIL to accept the services) offered to her--which will be anywhere from probably 3-6 times a week for about an hour each visit--and emphasize to her that even if she does not feel up to doing the exercises or getting out of bed when they come, she NEEDS to do it anyway because if the patient says "no I don't want to do it today" they will just go away....but they will only allow 2-3 "refusals" before discontinuing this service. And once they terminate that and she wants to re-start, it will be out of pocket.

Feel free to fire off any questions and I'm happy to respond or support other responses. DCUM as a force for GOOD! Hooray!

[Anonymous]

You are awesome PP, thank you!

[Anonymous]

I echo PP. Medicare does not pay for caregiver services. *Sometimes* people discharge from acute rehab and transition to a lower level of care - a skilled nursing facility - instead of going right home. Acute rehab is 3+ hours of intensive rehab a day, and it’s typically more intensive and a shorter length than SNF, which is 1-3 hours of therapy a day. I would ask the acute rehab if they might discharge your MIL to SNF rather than home, if her situation warrants it. The benefit of SNF is that if your MIL plateaus and still needs around the clock care, she can transition to a long-term care bed (and it’s good to select a SNF with LTC beds available).

I would ask and see what the acute care facility says. But what they really want to know is that they won’t be stuck with a patient they cannot appropriately and safely discharge; they need to know that the family will assume care, whether that be provided by hired caregivers or family members.

[Anonymous]

Anonymous wrote:This really depends on her current cognitive state as well as physical capabilities.
The first thing to do is do NOT let them try to discharge her from skilled nursing rehab until you have a plan in place at home for the level of care she requires.
The key words here: “unsafe discharge”—you just insist that you are setting up what is needed as quickly as possible, but to discharge her before those plans are in place is unsafe. This will buy you a few days.

Once she is in rehab, start contacting places that can offer RESPITE care.
If your loved one’s stroke resulted in memory impairment, contact Olney Assisted Living or Arden Courts (potomac or silver spring) to see if they can offer a respite stay. This can actually be considerably less expensive than having someone come into the home 24/7.
If you want your loved one to stay at home, and you have *some* coverage but you need nighttime hours or daytime hours only, you will want to figure out the shifts needed and then start calling home health services that provide trained in-home certified nursing assistant care at about $32/hour.
Companies like:
Right at Home
Capital City Nurses
Synergy home care

Keep in mind that CNAs are NOT nurses so you will need to do medication management yourself or they will need to have a nurse do that. Most CNAs can give meds once they are in those little daily containers, but they cannot be the ones to sort them into the containers from the prescription bottles. Also these companies will ask you questions about your loved one’s level of care needs that you will need to be prepared to answer—such as do they need meals prepared, help with changing/dressing, help with toileting, showering, etc. This info will help match your MIL with a good “fit” for a caregiver. They will likely schedule an appt for a nurse to come visit your MIL for an assessment.

If she has long term care insurance, now is the time to use it. If not, the costs will be out of pocket and will unfortunately be very expensive.
I’m so sorry,OP. I know this is very stressful.

As someone who has gone through this, you are a wonderful person to take the time to answer OP.

[Anonymous]

OP here again with an update and further questions:

MIL was released from Shock Trauma to acute rehab for about a week before returning home. She can eat, get around physically, dress herself, bathe, open doors and cabinets, tidy the house, reheat food, and seems to understand some language, but is still quite impaired cognitively. She had PT, ST, and OT visits as an outpatient and now in the home but her home care has been spotty. She really needs more therapy, particularly ST to address the apraxia and ashasia. Family members are helping out as much as they are able, and she is not alone at night, but needs more. Much more.

Any recommendations for more intensive language recovery treatment? She’s not making much progress in that area and it’s so frustrating and discouraging for her. Thanks.

[Anonymous]

Thanks for the update OP. Hopefully someone can answer your follow up questions.

[Anonymous]

NRH has an intensive Neurorehabilitation day program that is an outpatient service at the main hospital location in DC. It's usually several hours long but I am not sure if it is all covered by insurance. That is the most intense you will find
Other than that getting her regular outpatient services where she would have an appt with a speech therapist at a therapy clinic 2or 3 days a week is your best bet.

[Anonymous]

PP back...just a reminder to you and her, the most recovery after a stroke happens in the first three months. However some people can be recovering up to a year afterwards. So it is a long process and you will need to prepare for the fact that she may not get back to 100% of what she was able to do before the stroke. So this is probably time to start your research on options for her continued care/supervision if she does not progress further.

[Anonymous]

Anonymous wrote:NRH has an intensive Neurorehabilitation day program that is an outpatient service at the main hospital location in DC. It's usually several hours long but I am not sure if it is all covered by insurance. That is the most intense you will find
Other than that getting her regular outpatient services where she would have an appt with a speech therapist at a therapy clinic 2or 3 days a week is your best bet.

Which location in DC? I looked and there are several. She was getting outpatient at Shady Grove but it was hard to get her there for 30-60 minutes. A day program sounds like just what she needs.

[Anonymous]

The main NRH location at Irving Street where they have the inpatient care as well like what she had in Baltimore.
It was a bit hard to find on the website ( their website used to be much easier to navigate!)