Advocacy_HomepaQ. My husband is 70 and paraplegic, due to an automobile accident at age 21. He coached at the local high school until retiring last year, but that all changed when he had a stroke last month. He is now in a skilled nursing facility for rehab from the stroke, but is being released before he has had an opportunity to fully recover from that episode.

The nursing home administrator has told me that they will be releasing my husband within the next week, because he is “not making sufficient progress toward recovery,” so Medicare will not continue to pay for his stay. I feel that part of the reason for the perceived lack of progress is because they have not been taking sufficient time to teach him new things, such as how to do independent transfers while using a slider board. He has only had about five opportunities to try transferring, which is not enough time to recover the strength and learn the skills needed for more independent transfers.


I have also asked them to teach him how to drive a power wheelchair, as one side of his body is weak, so he will not be able to push a manual chair. They won’t do that because his vision is also affected on that side, so they don’t think it would be safe. He used to drive a ramped minivan, and I plan to get it modified so I can drive with him as a passenger.


Do I have any recourse in order to extend my husband’s stay in “rehabilitation” long enough so that he can return home with some level of independence? Our house is already partially wheelchair accessible. Is there anyone I can contact for assistance in getting it upgraded for his new level of disability? Are there any additional steps I should be taking?

— Frustrated and Worried

A. During the past few years, the length of hospitalization after disabling injuries or other serious problems like a stroke has been getting steadily shorter. The Centers for Medicare and Medicaid Services has been requiring hospitals to send people home immediately after they have become medically stable. Private insurers also follow that pattern and, if they are not getting paid, no hospital or doctor is going to continue treatments outside that guideline.

Catherine Britell, M.D., a physiatrist with extensive experience in the treatment of spinal cord injuries and other paralyzing disabilities, recommended several actions that you should consider once he is released from the nursing facility. The first would be to consult with a recognized rehabilitation facility or the nearest Regional Spinal Cord Injury Center to get a second opinion regarding your husband’s condition. That could be very helpful even if you need to pay for it yourself.

Britell also confirmed that, especially with a stroke, starting outpatient therapy soon after your husband gets home could make a real difference in the long run. That will require arranging for transportation to get him to the medical facility, or finding therapists who would be willing to travel to your home. To provide you with more flexibility, he can also apply to use the paratransit system until he can independently maneuver a mobility device onto a fixed route bus.

One issue that is often overlooked is the extra work that might be necessary on the part of a spouse or other family members. Don’t be shy about hiring some part-time attendant care, at least periodically, to minimize stress or avoid getting overworked. A good way to find that help is by referral from the rehab facility or from friends.

Recognizing that greater accessibility will be required in the bathroom and shower until transfers become independent again, you might see if a friend would spearhead a fund-raising campaign through the athletic teams that your husband coached, or some local service organization like Rotary International, to help pay for modifications. There are also volunteer groups like Rebuilding Together that build wheelchair ramps and modify homes and apartments for accessibility at minimal or no cost.

Besides taking all of the above steps, you may still be able to appeal to Medicare for additional support based on the second opinions received from rehabilitation specialists like physiatrists or therapists. Be forewarned that Medicare appeals can take an extensive amount of time, and you should not delay beginning therapies on an outpatient basis while you wait for a response.

Resources
• Regional Spinal Cord Injury Centers: www.nscisc.uab.edu/sci-model-systems.aspx
• Rebuilding Together: www.rebuildingtogether.org
• Centers for Medicare and Medicaid Services: www.CMS.gov
• Sample Medicare appeal letters can be found by entering “Medicare appeal letters” into search engines such as ask.com and google.com.