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I can't keep doing this alone

Respite, adult day care, and the free local support most families never hear about.

Quick answer

Respite, adult day care, and the free local support most families never hear about.

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Home›By Situation›I can't keep doing this alone

If you are reading this at 2 a.m., that is information. Caregiver exhaustion is not a character flaw, and there is more free support in most metros than families ever find.

Short answer

Respite, adult day care, and the free local support most families never hear about.

What to do, in order

  1. Take the exhaustion seriously as a clinical fact. Caregiver strain predicts poor outcomes for both people.
  2. Use respite before you are desperate. CareScout does not publish a North Carolina adult day health care median, but CAP/DA can help cover it as one of its 18 covered in-home services for eligible enrollees.
  3. Take the free support that exists here. The Triangle J/Central Pines Area Agency on Aging offers Information and Referral and Options Counseling services at no cost; Franklin County residents should contact Kerr-Tar instead.
  4. Get a second opinion on the plan. Your county's Area Agency on Aging will review options at no cost.
  5. Name the thing you are avoiding. Most caregivers know what the next step is months before they take it.

Questions families ask

Can the UNC REX case manager promise my mother a bed at a specific rehab facility?

No — hospital case managers at UNC REX (or any Triangle hospital) can provide a list of nearby skilled nursing facilities with open beds and help submit referrals, but they cannot guarantee placement at any specific facility, since bed availability and admission decisions belong to the receiving facility. They also cannot promise a particular length of stay or that Medicare will approve ongoing coverage once your mother is there. Ask the case manager for several options in writing and independently check each facility's CMS Five-Star rating on Medicare Care Compare before agreeing to a placement made under time pressure.

How do I appeal a discharge I think is happening too soon from a Raleigh-Durham hospital?

Every Medicare inpatient at a Triangle hospital — WakeMed, Duke, UNC REX, or UNC Health Johnston — receives a written 'Important Message from Medicare' notice near admission and again before discharge explaining appeal rights; you can request a fast appeal by contacting the Beneficiary and Family-Centered Care Quality Improvement Organization (QIO) listed on that notice before your family member leaves the hospital. Filing the appeal by the deadline on the notice pauses discharge and financial liability while the QIO reviews the case, typically within a day or two. Ask the hospital's patient advocate or case manager for a copy of the notice if you don't have it, since the appeal number and deadline are printed on that specific document.

How do I choose a rehab facility quickly when Duke Regional says my husband is being discharged tomorrow?

Ask the Duke Regional case manager for a written list of nearby skilled nursing facilities with current bed availability, then cross-check each one's CMS Five-Star Quality Rating on Medicare Care Compare (cms.gov) for staffing levels and recent health inspection results before agreeing. If time allows even a same-day phone call or visit, ask the receiving facility directly about rehab therapy hours per day and physician coverage, since these vary significantly between facilities even within the same star rating. If none of the offered options meet a minimum standard, you can request an appeal to extend the discharge timeline while you evaluate further.

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