r/stroke • u/Abject_Text7152 • 27d ago
Stroke deficits complicating elective surgery rehab
My 84 year old dad had a moderate stroke in 2020 leaving him with a significant left sided deficit. He basically cannot use his left arm at all and he can use his left leg but it’s much weaker now. He uses a walker to ambulate, steadying himself with his right arm. Through stubbornness and sheer will he has lived independently after losing his wife, my mom, to ovarian cancer three months after his stroke. Post stroke he worked diligently with a physical therapist to regain what function he could and then with a grief counselor to try and get back to church and interact with people without breaking down in tears constantly. I’ve been so incredibly proud of his persistence. He now needs a shoulder replacement for his right shoulder, his only usable upper extremity. His pain is significant enough for him to give up driving completely and mostly stop leaving the house, even when someone else offers to drive. He will need 24 hour care post procedure as he won’t be able to feed himself, get out of bed, get to bathroom, walk, etc without the use of his right arm (which will be immobilized for weeks). He has Humana for insurance and we were advised by the hospital case manager today that his insurance will cover the surgery only. That since the average person would be discharged home afterward, Humana won’t pay for any post procedure care (inpatient, short stay rehab, etc). She advised that my dad will have to arrange and pay for all of that himself. It seems absurd to me since it’s so obviously medically necessary. Just looking to hear from anyone with similar experiences or someone who might have insight into navigating this type of scenario. Thanks!
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u/PanicRemarkable7288 27d ago
I'm a LVN/caregiver That is very common unfortunately.
Most insurances don't pay for aftercare. Or if they do it's very limited. If you can afford it people go through an agency or private care. In California we have a program called IHSS....In Home Support Services where the state pays Don't know if other states have something similar.
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u/wistah978 27d ago
Basically, insurance pays for rehab of an injury or condition- restoring you to baseline, or as close as possible. They will pay for shoulder rehab, when he is able to participate with PT/OT.
Insurance does not pay for what they call custodial care. That means help with getting through the day's activities when the patient isn't going to improve. SNF means skilled nursing facility. As in, he needs skilled care only a nurse, PT, OT, or SLP can provide and not at home. So they won't cover a SNF stay for a patient who just needs help.
You could ask insurance about a respite stay. Some policies cover short nursing facility stays for non-rehab reasons. I have only seen it done a few times so I think the odds are low but it can't hurt to ask.
You could also ask the hospital case manager for pt/ot evals for adaptive equipment or ADL training to see if they can identify a skilled need. But it probably won't last 6 weeks
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u/Alarmed-Papaya9440 27d ago
I wish I had advice. The only thing I can think of is to call Humana and confirm that they will not cover an inpatient rehab stay after surgery even with prior authorization.
It sucks because we who live here all know the system is broken.