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Thread: mom has new sci t7

  1. #1

    Unhappy mom has new sci t7

    Hi everyone,
    My mom was in an mvc rollover 3/4/08. she fx t9 and down, harrington rods to fuse t-7through t12, internal degloving injury to spinal cord, 9 fx ribs, multiple pelvic fx, right tibia knocked off of the titanium knee from previous injury and left malleolus fx, also right elbow dislocation with ulnar nerve damage and clavicle fx, she was intubated and on life support with 3 chest tubes for 30 days at a level 1 trauma center, tx to ltac for 1 month (where she received almost no care at all, no rehab)she was tx to an inpt spinal rehab 5/9/08 that is closer to my home. my question is they are telling me she will be discharged 5/29/08,yet her tlso brace still hasn't been properly fitted, she cannot grasp anything with the right hand, unable to even sit up on side of bed without 2 nurse assist,has not received her wheelchair, has stage 3 pressure ulcers to bilateral heels, foley, no bowel training, etc. how can she be discharged when she can't even reach her bedside unless they put it close to her?she has only been put in a reclining geri chair once daily for 20-45 minutes.What is the average inpatient therapy time for a par of that level? shouldn't she recieve more therapy before discharge? thanks ahead of time for any answers or suggestions. she is 60 years old and has fibromyalgia, was disabled somewhat before the mvc and already recieves medicare and medicaid all of it.

  2. #2
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    Hopefully SCI nurse will weigh in with some info for you, but I do think they are discharging her way too soon. I looked at your profile but you really didn't fill anything much in, so I have no idea where you are located, but if there is a SCI rehab hospital your mom could go to this would be the ideal. It may well be that the hospital she is currently in has no idea what her potential is, and as much as I hate speculating on this, they may also be marginalizing her because of her pre-existing condition. Since they never saw her pre-injury they may not understand that her functional level needs to come back as closely to that point as possible. If there is no SCI hospital in your area it is worth having her transferred to one even if it is somewhere else, as it will forever have an impact on her future. Also, do not let them marginalize her because of her age. I am 59 and still function independently (mostly), so she is young enough to learn the skills she needs from here on in. If you provide more info people will be able to help you more with specific information. Good luck.

  3. #3
    Unfortunately, the average rehab stay authorized by insurances (including Medicaid and Medicare) has now dropped to 15 days for those with paraplegia. I agree...it is much too short, esp. for someone who already has a pre-existing health problem, or other injuries, or who is older. Unfortunately it is the insurers who drive this, and the rehab centers and health care professionals are much at their mercy as the insurances will simply not pay after that. Private pay may be an option for long stays, but it is very expensive (close to critical care rates).

    While you say she is in SCI rehab, it does not sound like this is a specialty SCI program as she would get in a Model SCI System Center or CARF accredited Spinal Cord System of Care rehab facility. What center is she in?

    She should be receiving a minimum of 3 hours of therapy daily, mostly out of bed. She definitely should have had a bowel program started the day she arrived there, and other options other than an indwelling catheter should have at least been discussed with her. An orthotist should either adjust her TLSO or make a new one now. I assume from your log on name that you are a nurse. You need to get in their faces and demand more. You may need to take family leave and be there all the time to be sure she gets what she needs. Request an appeal of the discharge date now.

    I would also suggest you pursue legal action against the hospital that allowed her to get pressure ulcers on her heels, as this is below the standard of care and entirely preventable.

    Do whatever you have to do to keep her out of a nursing home or so-called "sub-acute" rehab center. They don't know what they are doing with SCI rehab, and she will be extremely unlikely to ever get out of one if she goes to one. Care will be much worse than what she is getting now.

    It would be common for her to not have her own wheelchair by discharge, but arrangements should be made for ordering it, and providing her with a loaner or rental for discharge.

    Where will she live? Has a home evaluation been done? Have modifications completed? Does she have resources for attendant care? Will she be able to continue with a fairly aggressive outpatient therapy program (at least 3X weekly)? Will outpatient rehab nursing consultation (with a CRRN or CRRN-A) be available to her for continuing to do teaching with her and her caregivers, as well as to help with bowel, bladder and skin problem solving?

    Please keep posting questions here. Your mother needs your advocacy until she is able to start advocating for herself.

    (KLD)

  4. #4
    Senior Member WheelieMike's Avatar
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    Quote Originally Posted by SCI-Nurse
    Unfortunately, the average rehab stay authorized by insurances (including Medicaid and Medicare) has now dropped to 15 days for those with paraplegia....
    Ignorance is bliss, I guess that is true. The more I read and learn, the more furious I get. How can insurances expect anyone to survive on 15 days of rehab for a SCI?
    Stupidity ain't illegal, but it sure is inconvenient.


    Help me support the 2010 Bike MS.

  5. #5
    thanks for the input, my mom now has loaner chair,those things are fast lol.
    her decubitus are getting better,she is not in a dedicated spine rehab, but the rehab specializes in cva's, tbi, amd sci. they have made wonderful progress since she has been there, but she still cannot get into a sitting position or put her brace on without 4 person assist,i don't know if she has the option of tx to another rehab at this point, patricia neal sci institute is only 180 miles from home.i am a nurse i work in the ed of a small rural hospital and have never had to deal with this side of the medical system,quite an eye opener.noone has evaluated my home, i don't think the wc will even fit throught the door, i had to reapply for medicaid since i moved her to another state, not sure when that wil go through, i don't have any home health lined up, no hospital bed, etc etc. i will buy a house that is handicap accessible, and not just the front door, but you can't pull a down payment out of your a** in a 2week period. i don't think one person will ever be able to care for her and i have no other family available to help. oh well, i'll do the best i can and leave the rest to god. i am appealing her discharge on tuesday, can't get anything done on a holiday weekend anyway. there is a skilled nursing facility 1 block from my job site that has a good reputation for their therapy programs, the nursing care is a different story,just short staffed, but being so close i have the option of going to her several times a day even during my 12 hour shift, i have a wonderful job with the most amazing co-workers a person could ever ask for.Thanks again for responding, i hope everyone has the best day that they can.

  6. #6
    Patricia Neal is a decent center. I suspect that the place where she is does not "specialize" in SCI but does admit a few a year and really doesn't know what they are doing. It is very different from CVA or amputee or TBI rehab.

    She should ultimately be totally independent in transfers, turning, dressing, bathing and her bowel and bladder care, but ONLY if she gets the right training from a good center. Was Medicare paying for her rehab? Can you get even limited short term home health therapy or nursing care for now through Medicare? Her wound care would justify skilled Medicare coverage, although not much or for long. It may also qualify her for Medicare to pay for a specialty mattress and hospital bed rental. You can also rent a lift if she is unable to do her own transfers yet (and you should not be doing a dependent transfer by yourself). It does not sound like the rehab center has done their job if they have not done a home eval or arranged for the needed equipment like this.

    Unfortunately Medicare is unlikely to pay for more inpatient rehab. Medicaid might, but they are generally considered secondary to the Medicare so they may not pay either. I would definitely complain to CARF about the center where she is now (if it is CARF accredited, which it does not sound like is likely).

    (KLD)

  7. #7
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    Just as a comparison, t7-8 sci, with complications, I was in the hospital 11 weeks. 2 in icu/critical care, then 9 in rehab. This was 3 years ago. They appealed my discharge date 3 times, adding about one month. A large part of the appeal was due to a stage 2 pressure ulcer. I had BlueCross at the time.

    When I went home I could get in the front door, and into the bathroom. My bed was in the living room for another month, while more modifications were finished. So, short term at least, when your Mom comes home, you can manage with a lot less accessibility for a little while, giving you time to either move or remodel.

    SHe will almost definately go home with a loaner chair. Her chair will probably take a couple of months or more ... but she should be measured for it before she is discharged.

    Good luck, it does sound like things are getting a little better.
    T7-8 since Feb 2005

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