Stroke and Bypass surgery


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My dad had a stroke 12.5 years ago and does not have the use of his left side. he was able to walk with a quad cane. July 1 he had triple bypass surgery and is now is a skilled nursing/rehab center for PT and OT to get back to the level of mobility where he was pre-bypass. His recovery has been really tough. He has only been able to take a few steps which I think is normal since he uses his cane for weight transfer as he walks and the surgeons said that he should put more than 10 pounds of pressure on his chest. Now PT says that since he is not walking they want to stop PT since he has plateaued. how can they say he has plateaued when he has not fully rececovered from his surgery? The center is treating him as a normal cario rehab patient instead of a stroke patient. They have told us we can appeal the decision but now we are not certain if he is in the right place. Can we move him to another facility???? Has anyone else ever lost confidence in the treatment that their family member has recieved,



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Guest lwisman

Plateauing is something everyone does. It does not mean it is a permanent plateau. Rather, the body may be taking some time to heal itself. At a later time it may be ready for more therapy, Ask about what his insurance allows. In many cases, it is possible to return to therapy at a later time. This may actually be a better use of therapy time. And, let's face it, with today's health costs, everyone needs to use it wisely.


Ask questions. Good luck

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If this is medicare covered pt (or insurance covered that uses the same criteria as medicare)-- then pt will only be paid for if your dad is making progress towards specifically identified goals. If he is not currently progressing ( even ifhe will later or even if the lack of prgresion is due to other considerations like overall health), it is called a plateau and medicare will not pay. You can appeal but they will look at the pt notes and determine if proression is actually being made. If it is not, the appeal will fail. Therefore, the place to start is to ask for copies of all of the pt notes and see if you agree or disagree with the conclusion that he is not progressing right now. If you agree, then an appeal would be a waste of time.


If you disagree, then you need to decide if filing an appeal makes sense. There is a low yearly cap on the amount of pt that will be paid-- even if there is constant progression. Going twice a week my mom hit the cap in about four months. I am not sure if in-patient pt counts towards the cap. You should find that out. If it does count- then the question is would you rather have the pt now or save for later when he might get better use out of it. If it does not count towards the cap, you might as well file an appeal- pointing out where in the notes it indicates progression towards walkling.


I would not lose faith in the facility YET. When my Mom was in rehab and later in a snf we had lots of disagreements about the amount of therapy, the type..... Most of the disagreements turned out to be with the medicare coverage-- not with the facility. The faciltiy was more than willing to keep up the therapy if we paid out of pocket and even understood why it might be helpful. The problem is that they are ususally constrained by the regulations and understandably want to be paid. You should try to set up a meeting and ask a lot of questions about the coverage he is entitled under his insurance/ medicare to see if the problem is the facility or the crappy coverage provided by medicare.


We did transfer my Mom from one snf to another--not because of the PT but because of the overall level of care. It can be done but the new place must agree to take your dad and you will have to pay out of pocket for transport. The new facility will work under the same insurance/medicare regulations so it might not make any difference. I think you need to consider the effectiveness of the facility overall-- is it clean, is he clean, are they pleasant, is he happy, is it convenient to visit....? I would not abandon a good convenient facility because they cut him off therapy at this stage.


You might also consider talking to them about what therapy, you can offer your Dad if he has plateued. In a lot of the faciltiies the PT areas are open in the evening or weekends and you might be able to help your dad use them, or PT might might be willing to show you how to work with him in his room. My mom's therapists were always willing to show us exercises and stretches that we coud do with her when therapy was cut off.


Good luck!


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