My mother is in a horrible care facility in NY, she is receiving Medicare and Medicaid. The facility is horrible. Is there a group that would help us with moving her from this facility to another closer to me?
Garden - Stark Law I’m pretty sure can involve anything paid by CMS - so both MediCARE & medicaid. Your dads RXs are getting paid more than likely via Medicare. So if it’s meds Stark can be filed. Stark filings done by the feds are “progress” type of violations, so feds build a case that’s triggered by a consumer who contacts feds on a individual concern or CMS outside contractor finds a pattern of questionable payments.
As an aside on the contractor, HMS has a division that does stuff like this for CMS. Yeah the very same HMS that has another division that’s does MERP for about 1/3 of the states & counting......
Igloo, researching Stark Law now....interesting. I was never aware of this statute.
Given that AL is private pay and Medicaid wouldn't be involved in our situation, I would think the issue would be whether or not a physician treating at an AL facility would have an interest in the specific pharmacy the facility uses.
What just occurred to me is a different issue, that of physicians getting a percentage of involvement in an ACO, referred by a hospital and directly, w/o patient's consent or knowledge. I know physicians get a portion of the Medicare payment because I challenged one and asked specifically how they were funded and to whom income was directed. They ARE for profit corporations.
Garden ...... well since you brought it up..... IF a facility seems to be doing a preference to a vendor - like pharmacy provider- and the facility has any interest / ownership / financial benefit with the vendor, there could be a Stark Law violation if any payments made by Medicare Medicaid.
GardenArtist, Most of the AL in our area require residents to use their pharmacy. If you choose to use your own pharmacy, there is a $200-$300 administrative fee
In AL, does the staff assume the responsibility for ordering meds, with a pharmacy of their choice ( and with which they may have a contract )?
Or does the family have the right to continue its own selection of pharmacy, with scripts from treating physicians?
I ask b/c after trying different pharmacies, I found one which is a REAL pharmacy, with very helpful, knowledge pharmacists who often make suggestions on issues. And they don't gripe if I ask them where the meds were manufactured, as I won't buy meds manufactured in emerging market countries.
One pharmacist I dumped actually lied to me, telling me the meds were manufactured in the US. When I researched the manufacturer, I learned that the pharma was in Asia. And I never went to that pharmacy again.
I moved my on Medicaid mom from her initial NH to her 2nd and eons better NH within her first year. Did it after mom fully eligible for Medicaid (6 mos) and all the multitude of billing issues resolved (another 2 mos), so mom showed zero balance at end of month. To me your timing on the move will be important.... here’s my sequence and it’s gonna be long......
NH1 was getting to be a cascade of issues, so I took mom to see her old gerontology group & asked them which NH they were medical directors at. I visted those and found 2 with likehood of open bed within next 60 days. Clearly spoke with new NH admissions regarding mom switching NH & they both did a search of mom’s Medicaid status online while I was there. So you better have NO outstanding billing issues for your mom. Did a hippa release of moms medical records for them to review & a mini stack of admissions paperwork at both. I’m pretty ocd on paperwork so I brought in copies of mom’s income awards letters and her Medicaid eligibility letter as well. Having mom as old patient of the gerontology group that had one of their MDs as medical director of NH #2 was a plus as easy share of health chart info. Put mom on waiting list at 2 different NHs. One called me back 3 weeks or so later that 2 beds open & did I want one....lol yes! Then the new NH sent out a 2 person nursing team to visit mom at her current NH1 (I already signed a release for this to be done) to evaluate if her level of care could be done at the new NH. Btw old NH was somewhat hostile towards thier visit but they had the release I signed. They called me from mom’s bedside to say all ok and I then called admissions office at NH2 to set move in date. Move in date set for couple of days after moms SS & pension paid - this will be mucho importante for timing, more below. As an aside, my mom was what staff would consider an easy care resident as pretty good on ADLs and no major nursing care chronic diseases; $1900 a mo income so better than average SOC copay and no prior issues with her copay.
I faxed old NH notice of move with 2 weeks+ notice. NH cannot require a 30 day notice IF they are on Medicaid for my moms state. Medicaid pays in real time so if they need to move to a hospital or different facility overnight it’s allowed by Medicaid rules. NH by accepting Medicaid accepts these terms.
However mom needed to pay for every day she was in each NH. So you must figure out your mom’s daily copay for the month of the move and make sure it gets paid to the correct penny to each. AND within the window of being paid on time with no late fees. I did my moms move right after the 3rd as mom got her SS, etc paid on the 3rd. Did FedEx overnight with cashiers check to old NH as thier billing office was a real clusterF of chaos.
Now my mom did NOT make the NH her payee for income. Mom still had her checking account which got her SS & pension and built each month by the $60 a month Medicaid personal needs allowance. I as dpoa wrote a ck each mo from this account to NH for her SOC. Mom’s personal needs trust fund at NH#1 was zeroed out before the move. IF THE CURRENT NH IS YOUR MOMS PAYEE FOR HER MONTHLY INCOME, you will need to get that changed back to her & deposited into her checking account BEFOREHAND. This could be easy or get quite involved as Bank needs time to do switch and if you need a sign off from NH well the NH billing office can do foot dragging OR billing done out of corporate HQ wherever that is. AGAIN: old & new NH must be paid their exact amount copay due days for the transition month or Medicaid can be contacted for resident non-compliance.
IMPORTANT: you must remember to get any funds in mom’s at the NH Trust account before the move. Getting it afterwards could be simple or require a flurry of letters.
IMPORTANT: you must get your mom’s medications!!! This is something that never ever would have occurred to me IF new NH didn’t stress was needed. Prescriptions once in a Facility are done in 90 day orders, often in blister packs that are on hanging files placed in secure closet at nurses station. Medicaid/ Medicare will NOT pay for duplicates. You MUST get all of moms meds. So take ziplocks and a sharpie marker to label her meds just in case. Take your dpoa or mpoa to show your right to this just in case. Nursing staff at old NH was some kinda hostile on this for my mom....
New NH let me move mom’s stuff in the day before. So TV done, photos up, clean wardrobe up, new toiletries lined up. Made her transition easier. If your mom is in a NH, she likely doesn’t have a ton of stuff.... mostly soft goods like clothes, linens, a lamp or two, photos, maybe a chair. Really should fit in a SUV. To me you just got to take time off to do this unless you have close family that mom copacetic with.
Also for Medicaid there’s a daily “butts in seats” count done (like what public schools do). I had to get mom in by around 10:30 AM so the new NH could get the Medicaid room&board for that day. I got it all done solo but had broken stuff down in advance.... like moved all extra clothes, better linens & geegaws out once I decided a move was happening. Clearly ask the new NH what the timeframe specifics are. You don’t want to find there’s a private pay surprise day to pay if you can help it.
Another good thing was I did set up mom to go to on site beauty shoppe at NH for next available appointment for the works. The weekly beautyshoppe “hens” chatted mom up and presto she had a lunch bunch.
Moving them can be done but my experience is that there is just no way around whomever is the dpoa being boots on ground throughout the process. If you cannot then you might be able to hire a geriatric care social worker with private practice to do this for you. Or you get someone you trust from your mom’s past to basically be you in absentia, maybe one of her / your old neighbors or extended family. Good luck.
aja2130, how did your Mom wind up in that facility to begin with? Was it a case where she went to the hospital, then to rehab, and then to that facility? Usually a patient goes to where ever there is an open bed that accepts Medicaid.
As recommended in other posts, you would need to visit those other facilities that accept Medicaid, not every nursing home accepts. And to see if there is an empty bed available. Don't be surprised if there are waiting lists, hope not.
As for the current facility, can you tell us why the place is horrible? Have you witness this, or is it something your Mom is telling you?
I think you're looking for an actual mover, someone to either pack or move boxes, furniture, that sort of thing?
I did hear about such a group several months ago, but I don't recall much about it now. I believe it was in Michigan, so I don't know if it could be of any help to you.
You might want to contact the Alzheimer's Assn. or Area Agency on Aging in your area. They both have lists of various sorts of help for seniors, and might have some suggestions.
You could also try 211, a hotline (I believe for United Way), which also might have some suggestions.
I assume that (a) the family can't (or won't help with the move), or that (b) the funds aren't available to hire a moving company?
If where she is now is so horrible, perhaps you would want something a step up from her present facility. It’s best that you go to visit these places in person and then choose one. A random agency doesn’t know you or your mom and to be able to choose a facility for your mom would be guesswork for them at best. You need to have “eyes on” these places and not take someone else’s word for it. Visit websites and then narrow your search down to the ones you want to visit.
As an aside on the contractor, HMS has a division that does stuff like this for CMS. Yeah the very same HMS that has another division that’s does MERP for about 1/3 of the states & counting......
Given that AL is private pay and Medicaid wouldn't be involved in our situation, I would think the issue would be whether or not a physician treating at an AL facility would have an interest in the specific pharmacy the facility uses.
What just occurred to me is a different issue, that of physicians getting a percentage of involvement in an ACO, referred by a hospital and directly, w/o patient's consent or knowledge. I know physicians get a portion of the Medicare payment because I challenged one and asked specifically how they were funded and to whom income was directed. They ARE for profit corporations.
Thanks for sharing and "opening my eyes" to this issue.
Most of the AL in our area require residents to use their pharmacy. If you choose to use your own pharmacy, there is a $200-$300 administrative fee
In AL, does the staff assume the responsibility for ordering meds, with a pharmacy of their choice ( and with which they may have a contract )?
Or does the family have the right to continue its own selection of pharmacy, with scripts from treating physicians?
I ask b/c after trying different pharmacies, I found one which is a REAL pharmacy, with very helpful, knowledge pharmacists who often make suggestions on issues. And they don't gripe if I ask them where the meds were manufactured, as I won't buy meds manufactured in emerging market countries.
One pharmacist I dumped actually lied to me, telling me the meds were manufactured in the US. When I researched the manufacturer, I learned that the pharma was in Asia. And I never went to that pharmacy again.
NH1 was getting to be a cascade of issues, so I took mom to see her old gerontology group & asked them which NH they were medical directors at. I visted those and found 2 with likehood of open bed within next 60 days. Clearly spoke with new NH admissions regarding mom switching NH & they both did a search of mom’s Medicaid status online while I was there. So you better have NO outstanding billing issues for your mom. Did a hippa release of moms medical records for them to review & a mini stack of admissions paperwork at both. I’m pretty ocd on paperwork so I brought in copies of mom’s income awards letters and her Medicaid eligibility letter as well. Having mom as old patient of the gerontology group that had one of their MDs as medical director of NH #2 was a plus as easy share of health chart info. Put mom on waiting list at 2 different NHs. One called me back 3 weeks or so later that 2 beds open & did I want one....lol yes! Then the new NH sent out a 2 person nursing team to visit mom at her current NH1 (I already signed a release for this to be done) to evaluate if her level of care could be done at the new NH. Btw old NH was somewhat hostile towards thier visit but they had the release I signed. They called me from mom’s bedside to say all ok and I then called admissions office at NH2 to set move in date. Move in date set for couple of days after moms SS & pension paid - this will be mucho importante for timing, more below. As an aside, my mom was what staff would consider an easy care resident as pretty good on ADLs and no major nursing care chronic diseases; $1900 a mo income so better than average SOC copay and no prior issues with her copay.
I faxed old NH notice of move with 2 weeks+ notice. NH cannot require a 30 day notice IF they are on Medicaid for my moms state. Medicaid pays in real time so if they need to move to a hospital or different facility overnight it’s allowed by Medicaid rules. NH by accepting Medicaid accepts these terms.
However mom needed to pay for every day she was in each NH. So you must figure out your mom’s daily copay for the month of the move and make sure it gets paid to the correct penny to each. AND within the window of being paid on time with no late fees. I did my moms move right after the 3rd as mom got her SS, etc paid on the 3rd. Did FedEx overnight with cashiers check to old NH as thier billing office was a real clusterF of chaos.
Now my mom did NOT make the NH her payee for income. Mom still had her checking account which got her SS & pension and built each month by the $60 a month Medicaid personal needs allowance. I as dpoa wrote a ck each mo from this account to NH for her SOC. Mom’s personal needs trust fund at NH#1 was zeroed out before the move. IF THE CURRENT NH IS YOUR MOMS PAYEE FOR HER MONTHLY INCOME, you will need to get that changed back to her & deposited into her checking account BEFOREHAND. This could be easy or get quite involved as Bank needs time to do switch and if you need a sign off from NH well the NH billing office can do foot dragging OR billing done out of corporate HQ wherever that is. AGAIN: old & new NH must be paid their exact amount copay due days for the transition month or Medicaid can be contacted for resident non-compliance.
IMPORTANT: you must remember to get any funds in mom’s at the NH Trust account before the move. Getting it afterwards could be simple or require a flurry of letters.
IMPORTANT: you must get your mom’s medications!!! This is something that never ever would have occurred to me IF new NH didn’t stress was needed. Prescriptions once in a Facility are done in 90 day orders, often in blister packs that are on hanging files placed in secure closet at nurses station. Medicaid/ Medicare will NOT pay for duplicates. You MUST get all of moms meds. So take ziplocks and a sharpie marker to label her meds just in case. Take your dpoa or mpoa to show your right to this just in case. Nursing staff at old NH was some kinda hostile on this for my mom....
New NH let me move mom’s stuff in the day before. So TV done, photos up, clean wardrobe up, new toiletries lined up. Made her transition easier. If your mom is in a NH, she likely doesn’t have a ton of stuff.... mostly soft goods like clothes, linens, a lamp or two, photos, maybe a chair. Really should fit in a SUV. To me you just got to take time off to do this unless you have close family that mom copacetic with.
Also for Medicaid there’s a daily “butts in seats” count done (like what public schools do). I had to get mom in by around 10:30 AM so the new NH could get the Medicaid room&board for that day. I got it all done solo but had broken stuff down in advance.... like moved all extra clothes, better linens & geegaws out once I decided a move was happening. Clearly ask the new NH what the timeframe specifics are. You don’t want to find there’s a private pay surprise day to pay if you can help it.
Another good thing was I did set up mom to go to on site beauty shoppe at NH for next available appointment for the works. The weekly beautyshoppe “hens” chatted mom up and presto she had a lunch bunch.
Moving them can be done but my experience is that there is just no way around whomever is the dpoa being boots on ground throughout the process. If you cannot then you might be able to hire a geriatric care social worker with private practice to do this for you. Or you get someone you trust from your mom’s past to basically be you in absentia, maybe one of her / your old neighbors or extended family. Good luck.
As recommended in other posts, you would need to visit those other facilities that accept Medicaid, not every nursing home accepts. And to see if there is an empty bed available. Don't be surprised if there are waiting lists, hope not.
As for the current facility, can you tell us why the place is horrible? Have you witness this, or is it something your Mom is telling you?
I did hear about such a group several months ago, but I don't recall much about it now. I believe it was in Michigan, so I don't know if it could be of any help to you.
You might want to contact the Alzheimer's Assn. or Area Agency on Aging in your area. They both have lists of various sorts of help for seniors, and might have some suggestions.
You could also try 211, a hotline (I believe for United Way), which also might have some suggestions.
I assume that (a) the family can't (or won't help with the move), or that (b) the funds aren't available to hire a moving company?