Follow
Share

We are having a difficult time trying to admit my mom into a nursing home. She lives at home now with a care giver and all nursing homes are saying it is much easier to admit someone from a hospital rather than from home, but no one is telling me why?

This question has been closed for answers. Ask a New Question.
It's the medical documentation for skilled nursing part that Medicaid requires that is missing when they are living at home. My mom was in IL and I moved her from IL to NH and bypassed the whole AL part. You have to be clever, dogged and work it. My mom's IL was a tiered facilty - from IL, then AL then NH and hospice wing. For her the IL was fine till it wasn't. They weren't helpful in having her placed in their NH either - their position was that she was fine for AL. So my ideal plan of find 1 place for her and she could age along as her money decreased, was shot. IL and AL are private pay and really the AL is the profit center, so......

What I did was have my mom work with her MD's within her gerontolgy group and not the MD at the old facility. Many of the MD's in the group are also medical directors of NH and so know how to write up a chart to show the need for skilled nursing. Just being old, demented or whatever, is not enough. They need a fat file to show skilled medical need.

There are simple things, like change a medication from a pill to being a compound; or have their Exelon pill changed to a patch (which they can't do easily on their own); also they monitored and did labs more often. The day she got a critical H & H and a 10% weight loss and a couple of other issues, was the day she got the orders for "skilled nursing needed". Got her moved within the 30 day window and Medicaid pending. When they are living at home, there isn't the fat file like you have after a surgery &/or hospitalization. You have to work to have it done. Took about 6 months of every 4 to 6 week doctors office visits. Also if they are at home, you need to make sure that within the chart it is documented that they are self-dependent on their medications and ADL's. Good luck.
Helpful Answer (1)
Report

It has to do with the 3 days of acute hospital stay in order to access their Med A benefit for skilled nursing which is short term at best.There is a huge benefit for your parent in doing it this way as it gets them access to a therapy team which can really help with the transition.

The other issue for the nursing home is per-admission screening, physician orders etc,, It's not really that hard to come directly from home it just takes an admissions coordinator that's willing to hustle to get the work done and a willingness to help with the transition.

Good luck!
Helpful Answer (1)
Report

It has to do with payments. Is your Mother on Medicaid or only on Medicare?

Do you want your mother admitted permanently, or would this be temporary for some kind of rehab to get stronger and return home?
Helpful Answer (1)
Report

Well, I know with my Dad, the Dr advised my sister and I to have him admitted to the hospital first. Dad's admitting diagnosis was "failure to thrive". Part of the reason, I think, is to evaluate their physical and mental condition. Also, after my Dad was discharged to the skilled nursing facility, Medicare is paying for his stay as long as his condition improves with physical rehab (for a limited period of time).

So, what I'm guessing is that it's easier for the skilled nursing facility if we have our parent admitted to the hospital first - for evaluation and payment purposes.
Helpful Answer (1)
Report

This question has been closed for answers. Ask a New Question.
Subscribe to
Our Newsletter