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How long in rehab?

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My husband is doing pretty well in rehab - progress is slow, but I see positive changes every day. His "case manager", a sweet young thing who has not been very helpful, says that a typical stay in the acute care facility where he is currently staying is 2-3 weeks, and that I can expect he'll be sent home in that time frame. He was just admitted last Saturday, so that means only about another week.

 

Does anyone have any tips for wheedling, cajoling, threatening or otherwise convincing the rehab facility to keep my dear husband for longer than this? I'm so concerned that when he comes home his progress will slow or stop. His stroke was on 4/22/08, and I'm taking the month of May off to be with him and supervise his treatement, but I'm so afraid that they will force him to come home when he's not ready. What does his condition have to be beore they discharge him? I've been unable to find any specific criteria that spell this out.

 

Meeting with the doctors tomorrow to find out about prognosis and how he is doing. I want to stress to them that Larry needs to be in their facility for as long as possible and that I do not want him booted out after 2 weeks. That can't possibly be enough time, can it?? What's the average stay in these places, I wonder? I'm not the most aggressive person (though I find it is easier to be aggeressive when it's on behalf of someone you love!). Any thoughts on what strategy might work to keep him there? I can turn on tears at will, 24/7, if that helps - and who said I had no talent!!

 

I'm so afraid that they will send him home before he's ready. I'll need to hire a live-in care-giver, which will bankrupt us and probably not even do Larry any good - I am picturing someone who can't speak English who sits and watches the flat screen TV all day while Larry languishes in bed with diapers that need changing. Aaargh! There has to be a better way than this. Quitting my job to care for him is not an option, although I keep trying to think of a way that I could make it work. It might, if our house payent was $5 a month, but as it stands currently I think I need to work.

 

I will welcome any suggestions!

Thanks so very much.

-Janine

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Hello Janine: The length of rehab depends upon the type of stroke and damage done, how rapid he improves and, unfortunately, the insurance company. To make a long story short I had a massive stroke and was basically paralyzed. The therapists worked very hard with me and I worked hard too. I, too, was fearful of going home too soon but they assured me they would send me home before they thought I was ready (I was 63 2 years ago when I stroked and had a private PPO insurance). Fortunately we were retired. I could not be left alone when I first went home and so had friends come a stay when my husband was going to be gone (never more than 2 hrs). I had out-patient therapy for 5-1/2 months after going home and still do a form of exercise (pool therapy & weight training 3x/wk). I have hope and faith. I can drive but my left leg doesn't move well and I get easily fatigued, so nap almost every day. This is a new way of life none of us asked for (dr still can't tell me why it happed to me). Come back to this site often and learn as much as you can. Leah

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Hi and welcome,

 

It seems to be up to his rehab case manager, the type of stroke, damage done, and unfortunately insurance. I'm in Canada where we have universal health care, I spent one week in hospital, twelve weeks in the rehab hospital, and nine months in out patient rehab and OT. Don't let them send him home without a fight, two weeks is fankly a joke. Hang in there, it will get better.

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This is primarily an insurance issue. As I understand it, the facility has to justify keeping him and generally to be retained he has to be: (1) sufficiently medically unstable so that they cannot transfer him to a skilled nursing facility (SNF) - read nursing home; or (2) making domonstrable progress toward identified goals set out in medicare (even regular insurance uses these criteria). The criteria involve being able to care for oneself independantly. If you peek at his treatment notes you will see where they rate him. For example, they describe how much help he needs sitting , standing, walking, transferring (moving from bed to chair). It will say things like max. asst X2 (maximum assistance needed from two people). They have to make an assessment based on these criteria and using their medical judgement. Some places are more generous in their judgement but a lot of US rehab places are pretty strict. If you are not going to get to independant in the next few weeks -- you are out.

 

Wheedling and cajoling is useless. If you want him to stay longer you need to figure out the guidelines they are using, look at his notes to see where he is, and find out how to appeal the decision if you think he meets the guidelines and they disagree. His caseworker will just repeatedly explain why you are wrong. Talk to the doctors and ask for the information you need-- including how to appeal any decision. They cannot make him leave without giving you the right to appeal.

 

In my mothers case, she was slowly improving but they did not think that she was improving sufficiently with respect to their criteria. They wanted her out in less than two weeks. I got a copy of all the therapy and treatment notes which did identify the areas in which she was improving: i.e. she had been a maximum asist of one in sitting ( meaning one person to help her sit) and had moved to a moderate assist of one; She had been a maximum assist of two in transferring-- (meaning two folks to help) and had moved to a maximum assist of one. I argued to the doctors that this was demonstrated improvement. When they said it was insufficient I said that I understood but intended to file a written appeal anyway- with the hospital and medicare and asked for the forms. There were two meetings and six phone calls from various doctors and staff explaining why I was wrong. I was very pleasant and explained that I understood that it was a long shot but that I had read through the criteria and thought she met it and was going to appeal anyway. Eventually the head doctor and I negotiated an extra 10 days and I promised not to appeal that decision. The doctor said that he had NEVER had anyone appeal his decision and he did not want to start. I think he was concerned that it would look bad. He thought I was a total pain in the @#$#$ but when I left he told me that he would have done the same for his Mom. (probably didn't hurt that I mentioned a couple times that I'm a lawyer)

 

By pleasantly pushing and knowing your rights you might get a little extra time. But you need to be realistic, you are only going to get an extra week or so. It is unlikely he will be able to be independant when he comes home, and from what you have said in previous posts you do not have a lot of support at home to help so you have to consider whether or not coming stright home makes sense.

 

If your husband is on medicare (or has decent insurance) and needs 24 hour care he probably qualifies for up to 100 days of paid skilled nursing facility care. I know that this seems horrible but I really, really reccommed considering it - given the reality of your situation. There are some nursing homes that have great speech and other therapy. On medicare he can get up to (I think) two hours paid therapy six days a week while in a nursing home. This does NOT come out of the budget for the outpatient therapy that he can get once he is home-- and which is limted to I think about $3,000 per year.

 

I know he won't like it and neither will you-- but if you can find a good facility-- a nursing home may make sense as a short term option. The first 3-6 months after the stroke is when he will get the most recovery ( although as we all know recovery can continue for years). Being left at home with limited therapy options is not optimal (athough I think your fears about the aide are unjustified-- they have to speak english and they are usually pretty caring- but they are not therapists). Being someplace where he can work with therapists and have a doctor and nurses available 24/7 to you and to him may be very, very helpful during this initial recovery period. It will not be as good as rehab but it could be better than home- at least for a short time.

 

As I explained before, my mom was able to get (eventually) into a very good nursing home -- she still goes there for outpatient therapy. By being in the nursing home she was able to have access to a doctor who got her on a good anti-depressant; to a nutritionist so she stopped losing weight; to a social worker who helped us find an agency to get an aide for when she did come home; to a physical therapist who worked with her 5 days a week on relearning how to use her hand to feed herself; to an occupationsl therapist who worked with her on telling time and reading, and a referred us to someone to get an AFO; to a really great aide who identified the need for a gel cushion for her wheelchair to avoid pressure sores..

 

My sisters and I were able to learn how to shower her, transfer her, get her in and out of a car, roll her over in the bed.... We learned from PT what exercises to do with her... We learned from her what she could do and wanted to do so we could set up the house better (we gor her a laptop, a remote controlled radio/cd player so she could listen to books on tape from bed or the wheelchair). A good nursing home will have speech and phsyical therapy. They may be able to adivse you on adapative equipment. They may be able to help both you and your husband get ready for him to come home.

 

Now it is not all roses-- the first place she was was not good, and even the good place was depressing. The food was not good; many of the patients had alzheimers, you have to be present frequently enough that they know to respond to call bells.... She cried when we left, we cried when we left. It was not great. But I do think for us it was necessary.

 

Finally -- not to be crass- but money is an issue. An aide will likely cost you about $3,000 a month- and insurance will not help a bit. A good nursing home will cost about $10,000 a month-- BUT you may be able to get a few months fully paid for.

 

I know you want him to be home and to feel safe and loved and above all NORMAL-- but to be honest I think you may need a month or so to get prepared to have him home. I don't know how physically limited he is (or will be by the time he comes home) but there are a host of things that may need to be done in addition to switching over the bedroom if he will be in a wheelchair or will use a walker. Will you needs ramps? Can he get in and out of the shower or bath? Can he use a monitor to call you or an aide in another part of the house? Do you have one? Can he swallow pills? Is there an issue of him becoming confused and perhaps physically combative? Could you stop him if he forgot about his disabiltites and tried to get up and leave ( for the first few months my Mom would wake up and forget she couldn't walk-- we needed bed rails).

 

I am not surre you can know the answer to all of these questions in three weeks. I know we did not even know what the questions were in three weeks.

ANYWAY-- everybody and every situation is different but if he has nursing home coverage I would at least look into it. If there is no place decent it is an easy no, but if there is a facility that will offer some real therapy you may want to consider it.

 

 

Good luck!!!

 

 

Mary

 

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janine, mary has given you alot of good info. medicare will pay for a snf stay up to 100 days as long as he requires skilled care with therapy and he can receive all 3 disciplines, pt,ot st if needed. there is a co-pay of $128 a day from day 21-100, that you pay or your secondary ins. pays for. there is also home health that medicare pays for where therapy comes to the home and nurses/aides if need be. unfortunately insurance co's don't care if we get all we need before we are discharged from the hospital. hopefully congress is working on that issue right now. getting family and friends to help you at home when he comes home is very important. there are guidelines that ins.co's use to determine when its time for discharge. fighting them if you can with appeals, may get you more time. i wish you the best. good luck and let us know how its going.

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Janine,

 

Mary did indeed have just the correct advice. Rehab is quite a maze. I have had some success with Bill's outpatient therapists with rewording some goals in order to keep him in rehab longer. However, it hasn't been that way with inpatient rehab. In fact, at this point I have been told directly that based upon their evaluations he will not benefit enough from inpatient rehab to offer that option. I believe he only spent about two weeks in inpatient rehab as well. It was difficult for me to swallow. There was a great deal of cooperation though in readying me for the task of caregiver.

 

I agree with the option of him going to a SNF for continued rehab prior to his coming home. Bill has spent time rehabbing at SNFs three times (I may have already told you that). The rehab was not at intense at the SNF as it was at the medical facility rehab, but it was helpful in helping him regain strength. He has also benefited from home therapy services. The home therapy (PT, OT and ST) really worked at safety and maneuvering around the home, as well as communication. When the home therapists finished they encouraged outpatient rehab. Home therapy is intended for the individual who is not yet getting out. When your husband feels like getting out the home therapists will probably recommend outpatient therapy. Really, these therapies can go on for months (at least in Bill's case they did.)

 

I do remember feeling exactly as you do. I was really frightened about taking care of Bill when he came home. I guess the first year and a half were the most stressful. Bill had lots of health issues during that time and several hospitalizations. It always seemed like he went in for one issue and several more popped up while he was there.

 

I am so glad you will be taking some time to get settled. The time will fly by, so set a little time aside for yourself each day to strategize a more long term plan. Now may even be the time you look into some at-home opportunities that seem to be more available these days. Keep all your options open!!

 

Do take care and I'm glad you are keeping us posted. We really are there with you!

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i was sent to rehab hospital for pt, ot, and st. when i was barely able to keep standing relying on a large quad cane, i was discharged against my wish. I was scary and very much afraid of being without therapists around me. the pt said that most falls of stroke survivors occur not by tripping but by misjudgement. only a few days after my discharge, I had a massive fall which broke my shoulder bone and two ribs. the pt was right. the cause of my fall was my misjudgment. when my wife told me to stay put until she come back, but it was too hard for me standing with cane for more than 5 minutes, so i tried to move forward just a few steps. I thought i was able to do that. it was my misjudgment. when I tried to lift my left foot, it was stuck to carpet and won't move at all but my upper body was already moving forward and instantly fell like a stone statue. the lesson in point is: if you're discharged from rehabilitation facility when you were not fully prepared to walk alone with a cane, never try to walk without a caregiver next to you. joe

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Guest bessy

:Tantrum: sorry to hear bout your hunny janicei waa in out paiteant rehab for just under a yr my daughter taking my every thurs morn the docssaid thryrecommoned thatibeput in a nursing homew butmy greatkids sis no way willour mommbeput in a home she was terefor us when wewerelittle now its ourturn tohelp her out and belive me they have there work cut out for them when my daughter took meto outpaiteant rehab shewatched them vwry close astowhat they were doing and hain corporated that here at home i guess i luck out in many ways im here in my home with my famiy round me i can see whats going on here atall times.i do notwantalivedinnurseherei like my privacy and besides my dogs would nottolorate any one diff here.finding atroke netwaslikea wholenewbegining for mei havemet somany newpeople that under stand what im going threw.

:oohlala: since finding strokenetive cometogettoknowa fewmembers in factive met with 1 and doingthesamethissummer butthis times a tad dif im visiting 2 members from strokenetandi can hardlywait gigglegiggle remember both youandyour hubbyarestilladjusting tohis having a stroke .i use a hemmi canewalkeer here i feel moresturdy usingiti also havea hooverround as wellasa scotterto bebop inright now i can stand as long asi have my footplanted firmly on thefloor hope tomeet you in :chat: some timesoon so you can comemeetthe group . SE YASOONER THAN LATER I HOPE

 

 

BESSY :big_grin:

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Thank you to all who replied, especially to Mary for a whole laundry list of things to do. It is so hard to know what "reality" is here - meaning what you can actually do to work the system versus what is just fantasy and wishful thinking.

 

As it turns out, part of the decision has been made for me already. We had a "family meeting" with Larry's doctor and case manager on Friday, and they let us know that he is not really ready for actue care at this point. He is the most impaired patient in the facility - still unable to speak at all, and totally paralyzed on his right side. The therapy that is provided in acute care is for patients who are further along than Larry, and he's frustrated and not really benefitting from it. It's kind of like someone standing over you and telling you repeatedly to flap your wings...he's just not there yet.

 

The doc explained that at this point they can go to Kaiser (his insurance carrier) and tell them that Larry should never have been transferred to actue care to begin with and that it won't be a problem to move him to a skilled nursing facility - i.e., nursing home. She says that if they wait the whole 3 weeks that's the normal stay time, and then go to Kaiser with that contention, that Kaiser will pretty much say "tough" and cut off the benefit. His insurance does provide for 100 days/year (calendar year or plan year I don't know), so every day is precious.

 

I think the doctor is right. I do see improvement, but it's small and he is not at the level of the other patients. So, much as the words "nursing home" scare me, I think that's what we need to do. I was told that the transfer will probably happen tomorrow, and that I may or may not have a choice of facilities, depending on bed availability of the facilities that contract with Kaiser. I'm so glad that I took some time off work, at least I can be there with him and see what is going on.

 

Larry turned 65 on 4/7/08, and I just went last week to file for Medicare Part A. He's in the CalPERS system, since he is/was a professor and in the Cal State system. That means that he has retiree medical insurance that's paid for by the school system - thank god - but it also makes it more complex because his insurance is different from Medicare. He keeps his Kaiser plan even after retirement, and it does have better benefits than Medicare for a lot of things, but the benefits for what he needs seem to be about on a par with Medicare. I need to research this a lot more - my main project for next week.

 

So, that's the update. I hope the facility is not too horrible, and that Larry's recovery curve picks up a bit. This is all so hard to deal with, and the insurance issues just make it that much worse. What a crazy system we have...I envy Canada and pretty much every other civilized country in the world. I don't think universal health care is necessarily "the answer", but it has to be better than this!!

 

-Janine

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If you can possibly slow them down a day or two --don't let them transfer him to a faciliy you have not seen!!!! Once he is in a facility it can be hard to get another facility to take him so it makes a huge difference to get him someplace good right from rehab.

 

Again, they cannot transfer him against your objection- you can appeal.

 

Try to get them to agree to a day or two more while you check out the facilites that may take him ( a lot of places won't take someone significantly disabled and you need places with an open bed so you may not have a lot of options but....). This is where the tears might help, and the wheeling and the cajoling! not to mention the abject begging. They know some of these places are bad and giving you a tiny amount more time to get him someplace good is not unreasonable.

 

Rehab probably told you that they will have folks come from the area nursing homes to assess whether or not they will take him. This is true but only 1/2 the story. Places that always have open beds ( read- not the best places) will come at Rehab's request to assess him. They are always available and easy for rehab. Not so great for you though. The best places don't come just because rehab calls with an opening. They have waiting lists... Mostly they won't bother to come to a open call like that.

 

BUT- they may take him if you ask. The best places - the places that can be choosy-- are more likely to take somebody who has a determined and caring family. You may be able to convince them that he is short term and not long term care. They may take him because of you. Sell, sell, sell. After all a lot of people just get dumped in these facilities and family visits twice a year. The patients are a lot of work and staff gets stuck with depressed, unhappy, abandoned people. A good facility does not want that (I tend to think that the bad faciltiies do-- they don't want anyone loking over their shoulders). Making clear that you are going to be a BIG part of the recovery team and that you are committed to taking him home makes you (sadly) an appealing minority. USE IT

 

Sorry if it sounds like I keep telling you what to do ( I am bossy aren't I??) but someone should learn from my mistakes!!! If i had to do it again I would not have let them discharge my Mom until we could get into the good facility. They had a bed available in two days and would have taken her directly from rehab without a fight. I gave in and my mom spent a month at a place where she was left alone a lot. It was not terrible (thank god) but it was a waste- and it took a tremendous amount of work to get her accepted at the good place later.

 

Please, please, please- as much as you possibly can ---do not be passive about the choice of a nursing home!

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Thank you so much, Mary. I'm getting ready to go over there this morning and find out what the choices are. Now I know enough to tell them that I demand to see the place before they send him there! I would not have know that I even had the right to do that had you not posted, or that a day or two's grace might mean that a better place would be available.

 

I feel like I'm heading out to the OK Corral...

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Janine,

When my husband was discharged from the hopital after his strokes the rehab hospital felt he needed more time to heal before rehab and suggested a nursing home. I would not put him in a nursing home and instead prepared to take him home. When the rehab heard this they said to go ahead and bring him. It was the best facility that my husband has been in and they were able to teach me how to transfer him and I am glad I had that brief period of time there. However, it was true that he was not ready for that level of rehab. At that time if you tried to sit him up he would roll over like a newborn unless supported. He simply did not progress and rehab sent him home. He simply needed more healing time. He also needed the motivation of being home. We lived in a 40' motor home at the time and the plan was to get enough men to carry him up the steps and in the door. My husband was so happy to home that with the assistance of three of us he "walked" up the steps. At least he tried harder than he had before. He then had therapy at home for a month or so. After about 6 weeks he had improved enough that we made the trip to our home state where I again put him in a rehab hospital. He was there a month but because I was not there all the time his heart was not into even trying to get better. But, I was able to buy a house during that time and prepare to take over his care. He did a brief bit of therapy after coming home but would not cooperate. Finally the next year I got him back into out-patient therapy. He was finally ready physically, mentally and emotionally to make great strides forward. Within a month he was walking around the house and the wheelchair has stayed in the car since then.

 

For those of us who like to fix things right away the waiting is often really hard but sometimes time is the best healer for those we love. If I had known what I know now I would not have put him into rehab so early in his healing process. That does not mean not to do therapy. There is a LOT we did at home just in range of motion etc. I learned a lot from watching what nurses and therapists did and just applied it all at home. Eventually I learned what worked and what didn't work or how to improve on the standard way of doing things. But again, it all took time.

 

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I started a blog with the day-to-day things that are going on with Larry, but in the meantime I don't want to leave this thread as a loose end. Larry is now in the hospital undergoing cardiac testing, because he passed out when they tried to put him into a wheelchair on the day he was to be moved do the SNF.

 

So far they have not found any cardiac problems, or if they have they're not telling me. It is incredibly difficult to get information out of the nurses, doctors and/or staff at the hospital - I think they are all so afraid of liability issues that they don't want to say anything. Larry has has test after test, and for the most part I don't even know what the results are. The only one who can tell me anything is the doctor, who comes around for about 2 minutes every day, and who I always seem to miss. The nurses are very nice, but either can't or won'te tell me anything. I'm worried, because for the 3 days that Larry has been in the cardiac unit he's had no therapy at all, and it seems like he is backsliding. I've been trying to do the therapy myself, but I don't actually know what I'm doing, and he is not very cooperative (wants to sleep all the time).

 

I was told by a nurse in the hospital that the SNF typically does the PT, OT and ST once per day, but that if you pay extra they will do it twice a day. Has anyone heard of this? It sounds like a bribe to corrupt officials in a third world country...can this really be how the system works? How pitiful.

 

We'll see what happens tomorrow - they are supposedly going to transfer him (on Mother's Day? Sunday?), but they've said that before so once again I don't know.

 

Sigh. Sigh.

 

-Janine

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janine, i'm so sorry to hear of larry's setback. hopefully all of the tests will be ok. and he will be placed where he needs to be. i have never heard of paying more for extra therapy unless you are a private pay patient. his insurance should cover his therapy treatments, usually given once a day in 15min units, (an hour is 4 units of therapy) each discipline would see him for an hour so many times a week, if he is able to participate. they might do it twice a day if the insurance company will allow it. keep us posted on how things are going. i know this is all so confusing to you. hang in there, it will all work out.

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Janine,

 

I hope Larry is beginning to get some strength back. I went to a SNF after a month in acute rehab. I received an hour of OT and an hour of PT every day, 5 days a week. I didn't need speech therapy after I left the hospital. I stayed in the SNF for 5 looooong months and then came home. Since I am retired and on Medicare plus supplemental, everything was paid for the first 100 days, including the cost of the SNF.

 

We have a young woman come in every day for a few hours, but my husband is my main caregiver. He expects me to do things for myself and doesn't wait on me hand and foot. I have to use a wheelchair, but I get around.

 

Could you make an appointment with the social worker at the hospital and explain what is bothering you? They are there to help you with problems and he or she might be able to assist you in getting some answers.

 

When I was in ICU, I was kept very sedated because the neurologist didn't want me moving around. The nurses were told to move me every two hours. I learned this afterwards because I don't remember anything about those two weeks. We have a daughter who is a nurse practioner and she kept her Dad and siblings informed because she understood what was happening. Do you know anyone with medical training?

 

My thoughts and prayers are with you. Get some rest.

 

Vi

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Just a quick update - Larry's doing pretty well in the SNF. He has PT twice per day, and OT and ST once per day. That is about as much as he can handle right now anyway; it probably would not be helpful to push him harder. He has made some progress physically, although the aphasia is still about the same. He can't speak and has trouble communicating, but the more he can do for himself the closer we are to bringing him home. I am so looking forward to that day! I know he'll do better as soon as we can get him home; just getting him out of the SNF and back to familiar surroundings will be such a positive step.

 

I'm trying to keep a good outlook and not let myself wallow too much in self-pity. It's tough; I've learned that I'm VERY good at feeling sorry for myself! In a funny way I am grateful for this experience, because I think it has done a lot to toughen me up. It's amazing what you can do when you have to!

 

-Janine

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Hi Janine,

 

I'm glad Larry is doing better!!! The Aphasia is a challenging thing, that's for sure. It takes a long time to get the communication thing down. Have you investigated the communication board? Or has the speech therapist mentioned it? Here is a link you can use to learn a little about it:

 

http://www.righthealth.com/Health/aphasia%...s-sb-9456923278

 

I know how you feel about Larry being better off at home. I do want to caution you not to rush things though. The longer he can get therapy everyday, the better it will be for him in the long run. When he gets home the most he will be able to receive therapy is two or three times a week. For now that frequent reposition is so very important for him.

 

Is he still quite sleepy? he fatigue seems to go on and on - as any of the survivors will tell you, too. Are you able to take him outside? Hopefully there is someplace there that you can go to get some fresh air. It seems like there is usually a courtyard that is inviting.

 

I'm glad for your updates. Please do get all the rest you can. You've been through a lot and you will eventually get sick if you don't get your rest. It will be difficult to get good rest when Larry comes home, mainly because of your concern.

 

Take care now!

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Thank you for checking in on me and Larry. We did get a communication board, but so far it's not helping. Larry can't reliably point at things - if you give him a page with 6 pictures and ask him to point to, say, the fish, he can't do it. On the other hand, if you give him only 2 choices he can get the right one 100% of the time, so my hope is that he'll work his way up from there. He's also working on writing letters, but still gets them pretty jumbled.

 

I want Larry to get as much therapy as he can in the in-patient setting, much as I hate him being there. I figure I will do my best to have him kept as an inpatient, either at the SNF or in acute, until the 100 days' coverage that the insurance provides is exhausted, and then bring him home and hire someone to be here with him. I'll probably have to get a live-in because of my work schedule; I'm typically gone from 7AM to 7PM. Since I don't know at this point what level of care he'll need I can't do much about lining that up, but I've started getting the guest room and Larry's room ready. Life is sure going to change (again!).

 

Larry's not as sleepy as he was at first. He gets tired being in the wheelchair after a couple of hours, but not sleepy the way he was at first. He's pretty alert, and bored. He doesn't want to watch TV, or listen to music, or hear books on tape, so it's a challenge figuring out what to do to fill his days. We do go out onto the patio and sit sometimes, though it has been so hot that we end up coming back indoors fairly quickly. It will be nicer when it cools off (if that ever happens).

 

xxxoo

-Janine

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