Follow
Share

Insurances says she can go home. My Grandmother had a horrible fall the weds before Thanksgiving. Two broken vertebrae in her neck, one in her back and multiple fractures on her spine from T12 to L5. She is in a neck brace (the new halo) and a back brace for when she is doing anything other then laying in bed. She also suffered a minor brain bleed during the fall. Thankfully, she is healing, slowly but surely. Unfortunately, she has been doing as she's been told during her PT and OT therapy everyday in the hospital. She is able to do small things, like dress with assitance, comb her hair, brush teeth. She can stand for up to 5 mins and she can walk a short distance with her walker. She still CANNOT get in and out of bed herself or use the restroom herself. The hospital and insurance says she's fine and are discharging her next Tuesday. We assumed she would be discharged into a skilled home or nursing home...imagine our surprise wheme they said NO. She medically does not qualify to be sent anywhere like that. She has to either go home or go to a Personal CARE home and pay out of pocket! How do I get help to prove she is unsafe at home?! I've tried her social worker, he seems to be no help. I'm reaching out to aging services aND her PCP also. Has anyone had this problem? She does not want to go home and she will only be able to afford a PCH for a short time. I've never even heard of this. We all just thought they would out her in a nursing home and that would be it.

This question has been closed for answers. Ask a New Question.
Find Care & Housing
She is actually on minimum meds considering her health problems. She gets a cancer med infusion 1x every 3 months. She takes 1 pill of low dose synthroid for a mild under active thyroid, she takes 1 lose dose metafomin for diabetes that she controls mainly with diet. She also takes a mild sleep aid in evening and respirentol? (Restless leg syndrome) I dont care if they hook her up to a morphine pump. I want her comfortable as possible. Once her bones heal up more then lets worry about the rest. Its ridiculous. I think my next call will be to admin of hospital...?
Helpful Answer (2)
Report

Seems that the healthcare system is letting your grandma down on so many levels, I wonder what kind of meds she is on that they feel take precedence over pain management? At her age I feel quality of life becomes more important that any life extending therapies, you/she may want to consider finding a gerontologist who feels the same way that can put her real needs for safety and comfort first. Unleash your inner dragon and don't back down!!
Helpful Answer (1)
Report

Thanks everyone. I have actually called Medicare and put a immediate challenge in on her discharge. That will hold for at least 72 hours or more, they said the hospital can not let hee go until they have a decision. Insurance wont let me file an appeal yet since she hasnt been officially denied (next Monday). My Gram is 100% addement that she DOES NOT want to go home right now. She is scared and says she knows she cant take care of herself. Now, this woman is 84 years old. Shes buried a daughter, and a husband. Diagnosed with breast cancer in '98, turned to bone cancer in '99. She has lived on her own, by herself independently with very minimal help at all since 2002. If she says she cant go home, i believe her and back her. She was still driving up until the day of the accident. Also, she is still vomiting off and on (once or twice a day, maybe skip a day, then back at it next day) and shes complaining her pain is not being managed well...ive looked into it. The dr swears they cant give her more...to many drug interactions. I just want her comfortable and as pain free as she can be.
Helpful Answer (2)
Report

Sorry, I was typing as others, including you, were posting. So now I see they feel she's well ahead of the recovery curve for rehab, or so they say. If that were true, she wouldn't need as much help at home.

I think something else is going on but I don't know what. I'd still challenge the decision and get outside advice even from an elder law attorney if you have to. Since you're the point person, try the local hospital contacts and ask your uncle to do the research on ombudsperson agencies. That way he can participate.
Helpful Answer (1)
Report

Lori, you should have received a notice advising that you can challenge the discharge. If you haven't received one, you're entitled to it either by Medicare regs or by law. Make sure you get it, call immediately and file a challenge to the proposed discharge date. This can be done by phone; the notice should include a number to contact to challenge the planned discharge.

I did go through this, last year. A nurse told me my father would probably be discharged, I believe it was the next day. He was unable to walk, was on 6.0 liters of oxygen, couldn't live alone in that condition, and hadn't been in the hospital long enough to qualify( minimum 3 days) for direct placement to a rehab facility.

I gave either a nurse or the discharge planner verbal notice that I was challenging, and also wanted the PCP removed and replaced by a hospitalist. Action was taken before I even had a chance to call. The PCP called 4 times to find out why he was being fired. A hospitalist took over, Dad stayed long enough to get the oxygen level down, and went to a rehab facility.

You can also request a different attending physician, as I did. In your case, I think an orthopedic physician would probably be the most appropriate (b/c of the fractures).

I would push to learn the specific reason why it's been determined that (1) she's medically fit to go home ALONE and (2) why they feel she shouldn't go to insurance paid rehab.

Also, escalate the issue to the Charge Nurse, then up to the Ombudsperson or even the hospital Administrator if you have to. I've involved the hospital Admin person on more than a few occasions.

In addition, contact local Ombudsperson agencies to see if they have any advice or can get involved. It may be that this particular hospital, and the discharge planners, have "arrangements" with specific facilities and steer people toward these places, as opposed to rehab facilities for which Medicare pays.

You're wise and courageous to challenge this decision; your grandmother is lucky that she has such a strong advocate for her welfare.

Good luck, and let us know how this works out if you encounter more resistance from the staff.
Helpful Answer (3)
Report

What does your grandmother want? Would she be happier if, say, caregivers came in twice a day to help her get up and go to bed?
Helpful Answer (0)
Report

They have told me that by next week she should be able to achieve these goals, which i highly doubt. Even if she were to achieve those goals she is still a danger to herself. There are only 3 of us family memebers and we are all United in front. I have been doing all calls ect, keeping my brother and Uncle in loop. My uncle lives oit of state so he doesnt and cant help. My brother also does not have time.
Helpful Answer (0)
Report

She is making too much progress, and it is hurting her in the long run. She meets or exceeds what the benchmarks are for QOL. She can sit and stand unatteded for short leriods of time, she can do basic hygiene care, and get dressed with minimal assitance. Again, she CANNOT GET IN AND OUT OF BED ON HER OWN , NOR THE RESTROOM. Because she did so well, they say she can go home and with 8 HOURS A WEEK of PT or OT (shes getting 24/7 care plus 3 hours a DAY currently) she will be fine. She lives alone, in a 3 story small house that will be difficult to manuver a walker through even if she was able to do so steadily. Nursing homes and Skilled homes will not take her at all bc the drs and insurance are saying its not medically relevant for her to go to one. And, you cannot Private pay for either without a dr saying you deserve to be there either. Her choice is go to a Personal Care home (which will not help her pther then just babysit her...no medical or therapy help) or go home u attended to fall again.
Helpful Answer (0)
Report

When you ask the discharge planner how your grandmother is to get out of bed, what is the reply?

They can't discharge her if it isn't safe. Are you sure there is a united front from the family making it crystal clear that there is no family help available? No one's saying 'we'll look after you, grandma, don't worry' when you're not watching or anything like that?
Helpful Answer (2)
Report

Are the therapists saying she can't improve beyond where she is now? I've seen elders go to therapy when all they could do was sit in a chair a few minutes everyday. As long as they improved and were trying, they were allowed to stay. They had traditional Medicare and a supplemental plan. Not sure if that made any difference in their being offered continued therapy in a rehab. We also always stressed that the intention was to go back home after therapy. I sure hope you can work something out for her.
Helpful Answer (1)
Report

Refuse to take her home, make it clear that she has NO ONE to care for her.
As for having to pay for her care, look for a nursing home that will accept her as medicaid pending, if she has the funds to self pay for a while that will be easier.
Helpful Answer (2)
Report

This question has been closed for answers. Ask a New Question.