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Mark K. wrote: >...the care manager ...is pushing us to seek a nursing home placement. (T)hat >would be disasterous for both his mental health and countinued physical >improvement. Her attitude is "he's now been on this unit for 7 days, >he's stable, he needs lots of assistance, where else can he go, I only >go by what I see ..." He's in the subacute unit now, which is less >expensive than a 'regular' hospital unit, but it is obvious that the >focus is on length of stay rather than quality of care and desired >outcome. > Mark, I certainly understand and appreciate your frustration. I'm glad to hear your dad has made progress; unfortunately, in this managed care world we live in, making progress often means reduction/termination of services. My father has been in and out of that same boat several times in the past few years. An exacerbation or complication would send him to the hospital; after a few days inpatient, he be "stable" enough to d-c to the "rehabilitation (sub-acute) unit" ...For the next 2 - 3 weeks, he'd make remarkable progress -- mostly, I'd guess, because he felt comfortable and secure knowing that skilled professional care was instantly available to him, 24/7 -- so, the next thing we'd know, why, he'd be all "rehabilitate-ed", and there'd be "nothing more (they) could do for him, that he couldn't do at home"! They'd cut him loose to return home, with assistance from Home Health Care services. Until the next time. It was usually about 3-1/2 months before he'd have another exacerbation, which would end him up in the hospital again, which would start the whole process over again.... It's extremely frustrating. And disheartening. (Especially for the patient!) Sadly but realistically, however, the improvements PWP make (as a result of a new medication, or med. change, as in your father's case) are relatively short-lived -- and the patient's care needs will slowly and steadily continue to increase. In my dad's case, it finally became *necessary* to consider alternative care placement last spring. As a social worker I have had a lot of contact and involvment with Adult Foster Care Homes, and suggested this as an alternative to the LTC (nursing home) option. There are many very good AFCH's available, with differing levels of care and services provided to their residents. This option may be appropriate even with the idea dad will still be headed home, but right now still needs of more care than can be provided at home -- but considered "stable enough" to warrent discharge from the subacute unit (i.e., as a temporary arrangement) Rather than nursing home placement, has your family considered Adult Foster Care? Have you discussed this option with dad? There are other options of course -- Home Nursing Services, Live-in Aide(s), Independent Living Apartments (Senior Housing)-- but it sounds as though your dad might be approaching the point where these options might not be practical. It is very frustrating. And gut-wrenching. Good Luck to you.