Something is Wrong With This Scenario
Yesterday I heard something that's still bothering me. I was evaluating a woman. Her husband told me the following. He couldn't tell me when the problem started, just that for the past few weeks she couldn't sit up without leaning on something. He had been taking care of her at home and calling a grandson to help move her. Finally he couldn't do it anymore so he took her to the hospital, where she stayed three days before coming to us.
It turns out the hospital did nothing for her. They didn't run any tests or scan anything. She was seen for therapy one time. According to the husband, the purpose of the hospitalization was so she could go the SNF under Medicare part A. Her status at admission was exactly the same as prior to her hospitalization. This is wrong is so many ways. I don't deny she belongs where she is. It's how she got there.
The hospital admitted her solely for the purpose of qualifying her for a SNF stay. That is bad. While there, they didn't seem to work up any of her problems. They accepted her poor functional status as baseline and sent her to therapy at the husband's request. Turns out the woman became unresponsive while getting into a car maybe three weeks before hospitalization and then became total assist for care. That is just as bad.
It seems to me they could have at least run some tests and done a CT scan to see if maybe something had changed. After all, she was in a hospital. Granted the onset was weeks before admission, so the primary problem might not be treatable but the secondary issues could have been addressed. Sadly, no one I've mentioned it to seems surprised.
Ironically, that same day I evaluated another person. According to the family this person fell at home, was admitted and discharged 30 minutes prior to qualifying for a SNF stay. The SNF admission was a week later as self-pay. At time of discharge, assist for mobility and ADLs was needed. At the time of assessment, I found no deficits. There probably was a need at discharge.
Obviously in the first case, the husband should have taken her to the hospital immediately. In the second, I don't think a SNF stay was really needed since the person improved so much in just a week. By now, I'd be struggling for reasons to continue care. Nonetheless, both of these examples demonstrate the wrong way of doing things.