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stepbill 06-10-2012 05:41 PM

Home care or rehab facility?
I will be having a TKR and my doctor is giving me the choice of either doing physical therapy at the house with a home care person or staying at a rehab facility after being discharged from the hospital. Which would you do?

janewhite1 06-10-2012 10:05 PM

Re: Home care or rehab facility?
Rehab facility, hands down. You'll be staying in a handicap accessible room, you'll have access to better equipment, you'll be fed and won't have to worry about chores at home, and you'll have nurses on hand to make sure you get adequate pain medication. (After TKR, pain meds are very important. It's especially important to take them before you do your therapy.)

The rehab home is a much better choice, as long as your insurance covers enough of the cost.

Silver Swan 06-11-2012 09:45 AM

Re: Home care or rehab facility?
[QUOTE=stepbill;4996543]I will be having a TKR and my doctor is giving me the choice of either doing physical therapy at the house with a home care person or staying at a rehab facility after being discharged from the hospital. Which would you do?[/QUOTE]

Hi stepbill:
I completely agree with Jane White. Go to a rehab facility if your insurance plan allows it and will fund it. I went to a rehab facility for both hip replacements and would not do it any differently. I even asked to be sent to the same place the second time. They were great. You can't get that kind of PT at home. At the facility we had it twice a day and they reelly did a great job. Progress was noticeable.It also helps to be around others who are going through the same thing.

Shirley H.

stepbill 06-11-2012 11:50 AM

Re: Home care or rehab facility?
Thanks for the feedback! Now to check with my insurance. I'm kind of lucky there. I have three, mine, my wife's and tricare.

stepbill 06-11-2012 02:30 PM

Re: Home care or rehab facility?
checked with my primary insurance and they said they would only cover it if I had both knees done at once. On to step two....

ldy12 06-12-2012 02:08 PM

Re: Home care or rehab facility?
Hi stepbill,

In April of 2011, I had a right TKR and arthroscope of my left knee in the same surgery. (I had a meniscal tear and torn ACL in my left knee, but did not want to do both TKRs during the same hospital admission.) Because I live alone, I HAD to go to a rehab facility for them to teach me how to walk the stairs in my apartment safely.

This March, I had the left TKR (the osteoarthritis in my left knee unfortunately undid my surgeon's excellent scope repair faster than either of us expected!)

So this time, because I only had ONE knee operated on, I had 3 days of PT IN THE HOSPITAL (They started a new group therapy program in the Ortho Unit for joint replacement patients.) and then was allowed to go home and have home physical therapy through the local Visiting Nurse Service. (I even had my regular outpatient therapist do my home therapy, because she's affiliated with my local visiting nurse service. She actually did my home therapy last year too after I came home from the rehab facility. Because I had my right TKR first last year, I was not allowed to drive for SIX WEEKS post surgery.))

If you don't live alone and/or are having only ONE TKR, I would opt for home PT through your local visiting nurse service. Most of the rehab places are usually within a nursing home which can be VERY DEPRESSING even if you're only there for a few days! If you opt for home therapy, I think you feel more comfortable.

Hope this advice helps!

CPW2012 (Carol)

ldy12 06-12-2012 02:31 PM

Re: Home care or rehab facility?
Hi again stepbill,

I disagree with the other two people who advised you to go to a rehab facility. As noted in my first post to you, most rehab is done in a nursing home which can be AS DEPRESSING AS H**L and getting anyone to answer my call bell within five minutes was non-existent!! Plus, the Friday I got there, I had very bad post anesthesia nausea/vomiting and they were only giving me these stupid FOUR MG. PILLS FOR IT!! Finally at 3 AM that Saturday morning, I asked the nurse what the dose of the pill was. When she said 4 mg., I blew a gasket and asked, "Are you for real?" NO WONDER I'M STILL NAUSEOUS! THIS ISN'T GOING TO BEGIN TO COMBAT THE NAUSEA!! I need either an anti-nausea pill of at least 300 mg, or PREFERABLY an injection of anti-nausea med of at least 400 mg.!!" I finally got the nursing supervisor to call the idiot covering doctor and he ordered the injections. I had to have them every four hours throughout the entire weekend and couldn't eat anything except saltine crackers!

So, because of that bad experience, when it came time this past January to schedule my left knee TKR, I told my surgeon that I wanted to go straight home. He definitely okayed that since I now had one stable TKR knee to rely on.

My recovery at home went MUCH FASTER and within a month I was walking up and down my stairs normally, one foot after the other! It was just more soothing and comfortable recovering at home. Plus I had plenty of friends checking up on me the first couple of weeks.

The other point, which you made yourself, is the insurance issue. Since I only had one knee operated on this year, my Blue Cross HMO WOULD NOT HAVE PAID FOR A REHAB FACILITY. Last year was different - they okayed that since I had surgery on both knees.

Since you are only having ONE TKR, don't bother fighting your insurance company. Just go straight home and have your hospital discharge planner arrange for the physical therapist to come to your home. This way, you will be back in the atmosphere of the creature comforts of your own home, and I believe you'll find yourself really motivated to do everything your surgeon and PT ask of you to get better faster!

Hope this advice helps you.

CPW2012 (Carol)

SweetPeainSF 06-13-2012 01:33 AM

Re: Home care or rehab facility?
This is sort of a hybrid answer: I would research rehab facilities nearby and get the pre-approval from your insurance. That way, if you feel like you need to go to a rehab facility, you have everything in place to do so.

In addition, if the hospital discharges you because you are medically stable but won't allow you to go home, you can research a facility ahead of time. My roommate in the hospital had her hip replaced. She was medically stable, but could not ambulate on her own. Thus, the hospital could not keep her for a fourth night, but she could not go home either. She and her husband were stressed and scrambling to pick a rehab facility. Not sure what she did about insurance.

(I'm a planner, so having options available makes me feel more secure.)

janewhite1 06-13-2012 01:41 AM

Re: Home care or rehab facility?
On the "depressing" issue, after one of my father's hip replacements, he was lucky enough to get into a rehab facility that specialized in actual REHAB, people recovering from injury or surgery, most staying a matter of weeks or months, rather than mostly handling long-term care patients.

He liked that place much more than the nursing home he went to after the other hip replacement!

ldy12 06-14-2012 03:55 PM

Re: Home care or rehab facility?
Hi stepbill, I can tell you that if your primary insurance said no to only ONE TKR for a rehab facility, your other two insurances will probably say the same thing. Plus, you don't live alone like I do, so you will have family support plus Visiting Nurse service that provides a home physical therapist for as long as you need it, right in the comfort of your own home.

My surgeon who is Chief of Orthopedics at the hospital where I had each of my TKRs a year apart, asked the hospital to please start an "In House" group physical therapy program with the goal of being able to send patients straight home and get any supplemental physical therapy they might need in the comfort of their own homes. He found that his patients healed faster and were more motivated going into surgery if they knew they could go straight home to complete the rehab process.

That turned out to be true for me this year with my second TKR (left knee). As noted in my original post to you, the only reason I had to go to a rehab/skilled nursing facility last year was because I had the right TKR AND an arthroscopic repair of my left knee. That is the ONLY reason my insurance approved a rehab facility. This year, with just the left TKR being done, even if I HAD wanted to go to a facility post hospital, my insurance co. would definitely have said no.

You can check with your other two insurance plans, but I am willing to bet they will turn you down on the rehab facility just as your primary insurance did.

Let me know what happens.

CPW2012 (Carol)

Silver Swan 06-14-2012 05:53 PM

Re: Home care or rehab facility?
Hi stepbill:

This has been a very interesting discussion regarding whether to go to a rehab facility or have Physical Therapy sessions in your own home.

I suspect that the main reason I was sent to a rehab facility after each of my hip replacements (both hips total) is that I lived alone and there was no one to help me when I got home from the hospital. No doubt it was cheaper in the long run for my insurance plan to do things that way in order to prevent a fall or other accident with me trying to do things alone at home.

Shirley H.

ldy12 06-15-2012 10:32 PM

Re: Home care or rehab facility?
Hi Shirley,

In your case, I would DEFINITELY HAVE TO AGREE WITH YOU! As you probably noted in my previous posts in this thread, the ONLY reason I had to go to a rehab/skilled nursing facility for my first TKR (right knee 4/5/11), was that my surgeon ALSO had to do an arthroscopy on my left knee during the same surgery because, a month before that surgery, I had developed a compensating meniscal tear AND (discovered during the scope) a TORN ACL! Since I live alone too, and had a total of 17 steps to navigate in my upstairs garden apartment (3 porch and 14 inside my apt.), my insurance company AND my surgeon felt it was safer for me to go to a facility first to learn to navigate the stairs AND get occupational therapy for dealing with "Activities of daily living". Though I hated the place I had to go to because it was in a nursing home and they didn't separate out the temporary rehab patients on the unit from the permanent, elderly and unfortunately dementia addled residents, it got pretty depressing even for the week that I was there! But the PT and OT staffs were great! My physical therapist there had me walking with a cane and navigating stairs the FIRST DAY OF PT!! (I used a walker during the weekend that I was there since I got transferred late on a Friday afternoon and there was no PT on the one weekend I was there. - Didn't matter anyhow since I was sick with post anesthesia nausea the entire weekend - it took till that Sunday night for me to need my last injection of anti-nausea med!)

For my second TKR this past March (3/23/12) on my left knee, I told my surgeon that I wanted to go straight home this time with visiting nurse services and my own physical therapist coming to my apartment. Turns out, the Ortho Unit at the hospital where I had both TKRs, had started an "in house" group physical therapy program at the beginning of March (just in time for MY surgery!) with the goal of sending MOST of my surgeon's patients straight home. (He's Chief of Orthopedic Surgery/Joint Replacement at my hospital.) The only patients who had to go to a rehab place were those two or three who were having both knees done during the same hospital admission, a few days apart. And since I was only having ONE TKR this time, my insurance would NOT have allowed me to go to a rehab place even if I HAD wanted to, since I already had ONE stable replaced knee (right one) from the year before.

Also, as I may have noted in my other posts in this thread, I was SO MOTIVATED to get this left TKR over and done with, that I told my surgeon that if I got to my Ortho Unit room early enough in the afternoon after surgery and Recovery Room, that I was going to get up and walk on the walker the same day of surgery! AND I DID - 200 FEET ON THE WALKER THE SAME DAY OF SURGERY!!!! My surgeon was in the O.R. with other cases the rest of the day after mine which was the first case, so that no one had the chance to tell him how far I had walked that day. When he came on rounds that Sunday, two days later (my surgery was on a Friday), he was so thrilled and astounded that I walked that much the day of surgery, that he nicknamed me "Rascal" for always being on the go during my hospital stay!! That's his new nickname for me now when I see him in his office for checkups on the left knee!! - He also calls me his "A#1 FAVORITE PATIENT" at pretty much every office visit. I guess my doctor/patient relationship with him is a "mutual admiration" deal, since he has had great respect for my being a real trouper and almost never complaining throughout the past two years since I came back under his care in October of 2010! In turn, I consider HIM my MEDICAL HERO for what he has given back to me with his surgical skills - return to FULL MOBILITY WITHOUT PAIN!! He is not only one of the most skilled Ortho surgeons in the country, but probably the kindest, most caring surgeon I have EVER HAD IN MY ENTIRE LIFE! And I've had quite a number of surgeries over my life to date.

Hope things are going well for you since your hip replacements and that they are serving you well WITHOUT PAIN!!! I know I am thrilled to have had excellent outcomes on both my knee replacement surgeries and I pretty much am completely healed with the left TKR after just TWO MONTHS OF THERAPY!!!

All the best,

Carol W. (CPW2012)

Silver Swan 06-16-2012 07:49 AM

Re: Home care or rehab facility?
Hi Carol:
I am doing fine with both of my hip replacements, and thanks for asking. No pain and both hips feel like my very own joints. Had a wonderful hip surgeon and he also had a great bedside manner.

You are a brave girl getting up right away and walking after your knee surgery. I can see why your surgeon admires and respects you for this.

I am sure many are/will be inspired and encouraged by your example.

Shirley H.

ldy12 06-16-2012 04:06 PM

Re: Home care or rehab facility?
Hi Shirley,

Glad you are doing well and that you too had a good experience dealing with your surgeon when you needed him to be so compassionate at a time when you were in such pain, like I was and had my wonderful, kindhearted and highly skilled knee surgeon.

And you are, I hope, quite right that others are/will be inspired by my motivation to get through both surgeries as well as I did. I had spoken to one lady at my last job who had had both her knees done a year apart, and she told just to make sure that I DO EVERYTHING THAT'S ASKED OF ME pre and post surgery if I wanted the great outcomes that I've gotten. So I made sure that I followed my surgeon's and his physician assistant's instructions to a T! One of my aunts (who's in her late 70s) and thought she knew better than her surgeon, had both knees done last May (2011) during the same hospital admission. She did NOT ONE THING AS TO PHYSICAL THERAPY THEY TOLD HER TO, AND NOW, JUST OVER A YEAR LATER, SHE'S STILL HAVING PROBLEMS WITH POST SURGERY INFLAMMATION AND OTHER ISSUES!!! She also tells me that she is STILL AWARE A YEAR LATER, that she even HAS prosthetic knees!!! I, on the other hand, like you, am at a point where, most of the time, I FORGET that I have artificial knees. Like you with your hip replacements, my knee replacements have become a part of me. So it's my aunt's OWN DARN FAULT for thinking she knew better than her surgeon and that's why she's having all these problems. (And probably always will for the rest of her life!) Now, when she calls me to find out how I'm doing, and I tell her I'm doing great, she'll quickly launch into all her knee problems. I usually just listen for about five minutes and then make an excuse that I have to cut the call short! I have NO SYMPATHY FOR SOMEONE LIKE HER who did this to themselves!!!

By the way, thanks for the compliment for calling me a brave girl!!! I'm actually older than you apparently thought I was. (I'm 56, so I'm probably not much younger than you or maybe we're about the same age!!!) I was blessed with good genes from BOTH my parents so I look WAY younger than my true age. Most new people I meet, when the subject of age comes up, and they ask how old I am, I dare them to guess. Most usually guess that I'm no more than in my early 40's, at which point, I tell them that they're my friend for life! (I usually have to show them my driver's license to prove that I really AM in my late 50s!!! They never believe me otherwise!)

And as for my relationship with my surgeon, he not only has the wonderful bedside manner I described in my last post, but a great sense of humor too. He and I are always exchanging these great and fun wisecracks at each visit! That also helped me with my recovery from both TKR surgeries - having him tease me in a fun way to make me laugh, helped take my mind off my post-op pain!!

Example from last year's right TKR/left knee arthroscope surgery:

My surgeon knew that I used to go to karaoke for a number of years. (I quit just around the time I switched back to him in October of 2010 because people there made it "unfun" for me because they took it way too seriously and I knew they were making fun of my singing behind my back.) Anyhow, the evening after last year's surgery, he came to my room on evening rounds with the nursing care manager for the Ortho Unit. (I had a spinal with sedation for anesthesia so I kept going in and out of consciousness during the surgery and I DO remember asking one of the assistant doctors to please scratch my nose because it itched and since my arms were strapped to the O.R. table with IVs, I couldn't do so myself.) My surgeon said to me that evening, "Carol, you were really rockin' in the O.R." I said, "My God, what did I say under sedation?" His response? "Well, when you asked for some music, you said just make sure it wasn't karaoke!" I said, "I didn't say that, did I?" He said he was just teasing, but it got everyone who was in my room at the time, including me, to really crack up laughing!!!

And for this year's TKR, both in Pre-op and the recovery room, he had a few more of these gems up his sleeves!!

Shirley, normally, morally, I would be against human cloning, but in my surgeon's case, they could make an exception!! The world could use a few more surgeons like mine!!!! LOL!


Silver Swan 06-16-2012 04:28 PM

Re: Home care or rehab facility?
Hi Carol:
Well - you are a girl compared to me. I had my two hips replaced in my late 70s and will be 83 in August. How about that! I am truly blessed in having reached this age. I have a sister who is 10 years older than I and still living. We had a paternal grandmother who lived to almost 100. Our own parents died early - my mother at 60 and father at 42. He had been gassed in WW I and smoked like a chimney. So it is not just a matter of genetics - how we conduct our lives is important too. Our mother's second husband smoked too. She didn't have a chance.

Shirley H.

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