If you go against doctor orders, will Medicare refuse to pay in-home care?

Going to try and cover each of you here so bear with me. LOL It was MRSA type of infection and he no longer has the staph but has left scar tissue and weakened his immune system so he would need to be confined if in a NH and we have masks and gloves at home.After talking to my MIL and SIL who has worked in a NH before the doctor did agree to let him come,so the hospital/rehab called the medical supply co.today and had all his equipment delivered.He was to be home around five but when my MIL called the doctor changed his mind about releasing him today and said it would happen in the morning.*sigh* We all know this is probably the last year we will have with my FIL and feel he is not going to progress past this point and either will have another stroke because he has a MAJOR blockage in his neck or some type of illness will get the best of him. All we want is to make sure we have good,quality care at home,less germs,and able to spend time with him because my MIL is disabled. We are hoping the doctor will stay true to his word because the hospital already gave the medical supply co.permission to ship the bed and whatnot today,if he backs out again Hospice might be the next step.Thank you all for your input.

39jakg, The second opinion would be a Hospice evaluation. You can ask for that. Given multiple strokes, pneumonia, staph, G tube and confusion, he is a good candidate for Hospice Evaluation. You don't want staph in your home, and the county health department would agree.

Have any of you answering place him in the unsuitable nursing home actually work in home care? Just curious. Medicare will pay for home care if you 1. are homebound. 2. a doctor will sign orders for the care 3. you do not need care that exceeds 35 hours per week that is nursing and home health aide. I hate to be as negative as some of the comments but know what you are getting yourself into. No agency is going to provide you with 24 hour care. They will barely provide you with home health aide no matter what the doctor orders. The sad truth is your FIL is not a money making case for any agency and they will not admit him. I would contact the ombudsman...there should be someone in your state...who licenses nursing homes. Just so you know there are guidelines for them too...and as soon as they feel they will not be paid or make any more money off your FIL..you will be in the same boat no matter what state of health he is in. This is the sad truth of health care for the elderly who are very ill in this country. Your best bet is to talk to an elder care lawyer so you can make arrangements to do your best to get him on Medicaid(Title 19) and hopefully get him either in to a nursing home that is decent or appropriate home care at home for when Medicare ends. Do what you think is best sometimes an antagonistic relationship with the doctor is what is needed. They really do not know everything. You are a consumer of medical care and just like you choose which store to shop you, you choose which doctor to see.

He has a compromised immune system, recurrent staph & existing cardiac disease & cannot self-feed or do his ADL's, is that about right? Someone with all that needs to be in a facility. You mention staph, has he had C. Diff or MRSA??….if so those often require a special team to deal with fecal so would account for a delay in getting him changed. Also your state may not allow for someone with C Diff or MRSA to leave a facility until they are stabilized. MRSA especially is a big bad staph and you don't want it in your house and your spreading it within your community.

It sounds to me like they are trying to stabilize him to history chart him to do a hospice evaluation that he can pass. Hospice could possibly be done @ home but realize that hospice means palliative or "comfort" care only. If he has C Diff or MRSA, some hospice providers will not service a patient who has these infections as it is just too risky. With hospice, there are no more hospitalizations, or runs to the ER or doctors visits that could be to cure him or make him well. If you do that, Medicare will dis-enroll him from hospice and Medicare will not pay for any of those medical costs. Hospice has very specific rules which have to be complied with. If you don't, you all will be billed and expected to private pay and it will be horrendously expensive. Not meaning to be harsh, but you need a reality check on how ill he really is. It sounds like you have just too antagonistic of a relationship with the MD, so I would suggest you speak with the social worker and the DON - director of nursing - at the facility as to the reality of his situation.

Standingalone:While there once my in laws did file several complaints and when Medicare told us last week he needed to be discharged the NH did not want him back because he complained.Well,sorry to me that is within a person's rights if you are getting unfair treatment.My husband has had to complain as well because they were not changing him nor was his G Tube being taken care of correctly. Now they are okay with my FIL coming back soon.We don't want him in this place but there is a waiting list and Medicare won't wait much longer. My MIL has the POA so whatever suggestions we offer it is completely up to her and him to a certain extent because he's not all there mentally.The doctor at the hospital/NH called Kindred of Louisville is the one suggesting the NH facility who by the way is under the same name and ran by the same owners. We would love a second opinion but it would have to be an outside source and he doesn't have a family doctor on this case.

It's really not the doctors, it's the insurance companies. If you remove a patient AMA (against medical advice) you sign a paper, the release, that absolves the facility from all responsibility for the patient, you agree to take all liability. That means you get to pay all the bills when the insurance company won't. ALSO home care has to be ordered by the MD to be paid by Medicare. Since you have rejected the doctor, you'll have to find another MD. In summary, you can pull out any patient at any time, but you will be on your own when you do. I don't think that is the best way to go.
Instead, I would work out the problems with nursing care with the nurses.
Somehow I think you may be in denial as to how sick he really is. I don't know of any doctor who would keep a patient in a NH without a really good reason.
Your grief may be working against your better judgment.

God, that sounds like a lousy place! Seriously? I'd be livid if my mom had been treated that way. I don't know the answer to your question. Who has POA? Anyone? If you can't get POA you could try getting guardianship over your FIL. Then YOU call the shots.

I've never heard of a doctor being in control like this. If a family wants an elderly person home, especially a family member, then that's how it should be. How can a doctor stop you from taking him unless HE has POA?

Anyone? I don't get this. We need more info. Who decided he was to be placed in the NH? Wouldn't that have been a family decision rather than a doctor's? At the very least, find a new one.