In Patient rehab or going home after Hip replacement?

[Anonymous]

Anonymous wrote:Physical therapist for 20 years here. A hip fracture is very different than an elective hip replacement.
Unless he had severe mobility issues, I would vote home. And like PP mentioned, rehab may not be covered. I would guess less than 10% of patients currently go to rehab after a hip fracture.

I think you mean after hip replacement.

Medicare expert here. A few things:

1. Medicare does cover inpatient rehab in an inpatient rehab facility or skilled nursing facility after replacement if it is medically necessary. That means a doctor needs to sign off on it. The facility also needs to accept the patient. But IRFs are limited in the number/type of hip replacements they can take (because typically a hip replacement doesn't need the higher intensity/ more expensive care offered by an IRF), so getting an IRF to accept your dad is another hurdle. If he does inpatient rehab, it will very likely be at a SNF, which may not be the kind of care you are seeking.

2. It's very important to know if your dad has traditional Medicare or Medicare Advantage. If he has MA, then nothing happens unless the private insurance plan approves it. That will be the biggest hurdle to inpatient rehab in this case.

3. Someone above mentioned "Medicare home health" being of poor quality. Medicare pays for home health care that is furnished by private organizations that are certified as home health agencies. (They also provide care to non- Medicare patients, although the majority of their patients will be over 65.) HHAs hire aides and nurses who visit patients homes. Some HHAs and staff are terrific, others not so much. Traditional Medicare pays either way, so check out Medicare's home health compare website, see if any neighbors/friends have any recs, etc.

https://www.medicare.gov/find-compare-health-care-providers

4. If your dad has Medicare Advantage, he will have to use whatever agency MA plan has contracted with, so little to no choice of provider.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Physical therapist for 20 years here. A hip fracture is very different than an elective hip replacement.
Unless he had severe mobility issues, I would vote home. And like PP mentioned, rehab may not be covered. I would guess less than 10% of patients currently go to rehab after a hip fracture.

I think you mean after hip replacement.

Medicare expert here. A few things:

1. Medicare does cover inpatient rehab in an inpatient rehab facility or skilled nursing facility after replacement if it is medically necessary. That means a doctor needs to sign off on it. The facility also needs to accept the patient. But IRFs are limited in the number/type of hip replacements they can take (because typically a hip replacement doesn't need the higher intensity/ more expensive care offered by an IRF), so getting an IRF to accept your dad is another hurdle. If he does inpatient rehab, it will very likely be at a SNF, which may not be the kind of care you are seeking.

2. It's very important to know if your dad has traditional Medicare or Medicare Advantage. If he has MA, then nothing happens unless the private insurance plan approves it. That will be the biggest hurdle to inpatient rehab in this case.

3. Someone above mentioned "Medicare home health" being of poor quality. Medicare pays for home health care that is furnished by private organizations that are certified as home health agencies. (They also provide care to non- Medicare patients, although the majority of their patients will be over 65.) HHAs hire aides and nurses who visit patients homes. Some HHAs and staff are terrific, others not so much. Traditional Medicare pays either way, so check out Medicare's home health compare website, see if any neighbors/friends have any recs, etc.

https://www.medicare.gov/find-compare-health-care-providers

4. If your dad has Medicare Advantage, he will have to use whatever agency MA plan has contracted with, so little to no choice of provider.

Meant to add: if your dad has MA, there is zero chance they will approve care in an IRF a case like this. A SNF will be the only option.

[Anonymous]

+2 for the "hip replacement is different than a hip fracture." Some hip replacement patients don't even go to outpatient rehab bc they do so well. You can get Part B Medicare treatment in the home thru Luna if you don't want to go out at first to PT and don't qualify for homecare, but sometimes just being ut at the clinic is helpful and encouraging to the patient if they have transportation and help.

[Anonymous]

Rehab 100% if it’s covered. Hospitals will submit for authorization to see if it will be approved.

[Anonymous]

Medicare guidelines have changed recently. Total hip replacement and total knee replacement surgeries (when done on an elective/scheduled basis) are coded as "observation" status or "extended surgical recovery" status. Medicare requires a three night stay in hospital for medical necessity under "inpatient" status before someone can be approved for rehab stay. There are specific things that qualify to be changed to inpatient status and just being a certain age is not one of them.

During COVID the three night requirement was waived in order to move people through the hospital faster, so people could get to rehab easier after surgeries.

In May of this year the waiver was dissolved and the three night requirement came back into effect.

The good news is that recovery from a scheduled hip replacement is generally easier than recovering from a hip replacement/repair surgery after a hip fracture. There have been many advancements in how the surgery is performed and what medication are given before/during/after the surgery that makes going home (sometimes even the ame day of surgery!) very possible.

The hospital social worker/case manager should be able to help you with resources for additional care- some nursing home/rehab facilities offer a set rate for private pay.

[Anonymous]

OP's dad has been immobile for 6 months already and needed care 'before' the hip replacement. He likely does need rehab so he can do his ADL's.

[Anonymous]

100% rehab op. Do not pass go do not collect $200.

[Anonymous]

Rehab, assuming it's covered. So much access to treatment in rehab v fighting to get appointments, get dad in the car and to appointments etc

[Anonymous]

Anonymous wrote:Home. In-patient rehab isn’t needed for hip replacement.

For a 79 yo?

[Anonymous]

Anonymous wrote:

Anonymous wrote:Physical therapist for 20 years here. A hip fracture is very different than an elective hip replacement.
Unless he had severe mobility issues, I would vote home. And like PP mentioned, rehab may not be covered. I would guess less than 10% of patients currently go to rehab after a hip fracture.

I think you mean after hip replacement.

Medicare expert here. A few things:

1. Medicare does cover inpatient rehab in an inpatient rehab facility or skilled nursing facility after replacement if it is medically necessary. That means a doctor needs to sign off on it. The facility also needs to accept the patient. But IRFs are limited in the number/type of hip replacements they can take (because typically a hip replacement doesn't need the higher intensity/ more expensive care offered by an IRF), so getting an IRF to accept your dad is another hurdle. If he does inpatient rehab, it will very likely be at a SNF, which may not be the kind of care you are seeking.

2. It's very important to know if your dad has traditional Medicare or Medicare Advantage. If he has MA, then nothing happens unless the private insurance plan approves it. That will be the biggest hurdle to inpatient rehab in this case.

3. Someone above mentioned "Medicare home health" being of poor quality. Medicare pays for home health care that is furnished by private organizations that are certified as home health agencies. (They also provide care to non- Medicare patients, although the majority of their patients will be over 65.) HHAs hire aides and nurses who visit patients homes. Some HHAs and staff are terrific, others not so much. Traditional Medicare pays either way, so check out Medicare's home health compare website, see if any neighbors/friends have any recs, etc.

https://www.medicare.gov/find-compare-health-care-providers

4. If your dad has Medicare Advantage, he will have to use whatever agency MA plan has contracted with, so little to no choice of provider.

PP, such a helpful guide for you to share.

PP, would you ever considering starting a thread here with "5 (or less or more) things to consider when signing up for Medicare" and maybe a little AMA? If not, do you have suggestions of good resources? I am nearly three years away from it and wondering what I should be considering (e.g., I've heard so much about how bad the Advantage programs are, so will not go that route).

Grateful for any suggestions/tips.

[Anonymous]

My 79 YO father had a scheduled hip replacement earlier this spring. We were worried about this but he came home after one night at the hospital. My parents had arranged for a helper (not sure the term but not a RN nurse or anything) to be there when they got home and for some part of the day for the first week. The aid helped my dad get showered/dressed and some basic things around the house. They were almost more of a help to my Mom than my Dad. My Dad was able to walk (albeit very short distances) prior to the surgery and was also able to walk short distances with a walker immediately after the surgery. He had zero interest in a rehab facility and it worked out fine with physical therapy at home and then quickly in the physical therapy office.

[Anonymous]

Anonymous wrote:My 79 YO father had a scheduled hip replacement earlier this spring. We were worried about this but he came home after one night at the hospital. My parents had arranged for a helper (not sure the term but not a RN nurse or anything) to be there when they got home and for some part of the day for the first week. The aid helped my dad get showered/dressed and some basic things around the house. They were almost more of a help to my Mom than my Dad. My Dad was able to walk (albeit very short distances) prior to the surgery and was also able to walk short distances with a walker immediately after the surgery. He had zero interest in a rehab facility and it worked out fine with physical therapy at home and then quickly in the physical therapy office.

Can I ask how you found the helper - was it paid for through insurance or out of pocket? And was it a different person that did the in home PT? How often did the PT come?

Thanks