My first post! I've tried to see if someone has already covered this, but couldn't find an answer. I have already learned so much reading through the forums. You all make it a wonderful resource.
My father is ready to be discharged to sub-acute rehab after a fall left him with a brain injury and fractured bones. He was denied by all facilities except one, which has a good (but not great) rating. I've seen other facilities ask for financial disclosure for assisted living, long term care, etc., but none for sub-acute rehab. I asked the facility abut their need to know all his assets as I could show his checking balance would easily cover the cost of the full 100 rehab days. They said they anticipated he would need long term care as he has a feeding tube and had lived alone previously. I've shown no interest in their long term care. If they are the decision makers about my dad's progress (and can also profit from the decision) it seems like a conflict on interest. My dad is fairly wealthy, so I don't want them to see his assets and see him as a $$$ opportunity. Thanks for any perspective!
When my mom, post stroke, post broken hip repair was in the hospital, we POA brother, MBA sIL and I) met with the discharge planning nurse.
"How much does mom have?" was her first question.
My brother and I, brought up never to discuss money sat there in shocked silence. My sil asked why she needed to know.
The nurse explained that she would be sending mom's information out to a variety of places, some of which would accept her as a Medicaid resident after a period of Medicare-paid rehab. She needed to know how long after rehab (which is rarely paid for by Medicare for more than the 20 days it covers in full; it covers days 21-100 at 50%-there is $150 co-pay for those days) mom's money would last before an application for Medicaid would need to be filed. My mom was also seen as being likely to remain as a long term resident.
We gave the nurse the general picture of mom's assets and she was satisfied with that.
If you guys hold POA. YOU, not the NH, are the decision makers of where dad resides. The therapists will note progress or lack thereof in therapy and Medicare's decision to pay for continued rehab is based on that, and is appearance.
See if they will be satisfied with a general picture of his finances; the rehab is most likely wanting to know how soon dad might become an unprofitable Medicaid resident.
The fact that they are the only facility offering acceptance makes it trickier.
If they are concerned about the bill getting paid if his stay is extended, you may be able to reassure them by providing proof of ability to pay for a longer period, e.g., 12 months and offering to provide more information if he is still a resident long after you anticipate his stay will end, e.g., 6 months.
Proof of ability to pay would include his guaranteed income (SS, pension, annuity) for the time period plus checking and maybe one other account. Some financial advisors will provide letters documenting that one’s assets will provide a level of income greater than or equal to a specific amount for a period of time without disclosing the details on the underlying assets. (I think Ric Edelman said on his podcast that his firm did this for retirees acquiring mortgages.)
Should he need LTC, I would pray that an opening at a better facility might become available or that we could get in-home care. Given this facility is our only rehab option now, I may have to string them along.
My Aunt recently fell, was hospitalized for a few days and then transferred to a rehab facility. She has advanced dementia and broke her hip that requires surgery to treat, but we said no to that. Turns out this facility does not have permanent placement for LTC. I've been dealing with their Social Services person, and their Business Office Manage. I'm still waiting for UHC (UnitedHealthcare) to call me to discuss who is paying for what and for how long. The facility asked for a DNR signed by her current doctor, even though she had one created with her other legal docs.
If your Dad has no desire or need to stay at this facility I'd say to call up the Bus Off to talk to them about the trajectory of his care after he completes rehab (if he is able).
If you are not his DPoA I would be very careful about what documents and contracts you are asked to sign going forward. Even as PoA you should sign them as "Your Name as PoA for Your Father's Name". I hope everything works out as you find care for your Father.
i hope you're ok, i hope she's ok.
new year hugggggg to you both.
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If dad can self pay, what he has is none of their business.
I would ask them if they accept Medicaid when dad runs out of money. If the answer is no, you will need to determine, if he needs LTC, where he will go, how long he can pay and make sure they accept Medicaid to ensure he can stay.
Just because they ask doesn't mean you need to comply. I have seen where people with money are charged more for the same services as someone that doesn't have much.
I pray your dad gets better and can go home or at least to an AL.
I have found that what the business office is doing does not affect the rehab. They only know if he isn't meeting Medicare requirements and that they need to plan discharge from rehab. Because dad will have to meet certain requirements for Medicare to pay for rehab. Self pay for 100% wouldn't be affected.
And THOSE places WILL require full disclosure of his assets.
So the truth is that they ARE thinking ahead and were so honest as to tell you that. You do not need to provide this to them, but do understand that you may actually benefit by their knowing, and if there ARE assets they will call in those places able to provide (for a price) the best care his money can buy.
You do not have to give them this info now, but unless YOU YOURSELF are going to do all the hoof work of getting out there now and seeking care for him (at which time you will need to have an eyeball view of his assets) they should know. Social services and discharge planning will need the numbers, an eyeball figure, at hand when they seek placement options.
The truth is that yes, this is invasion of privacy and you don't HAVE to give them this info. But there may come the day they tell you that there is no more coverage, or no more progress and you have 5 days to find placement.
Will you be able to do that? If so, start looking NOW. You are forewarned that this likely will be needed.
I got used to, when my brother was diagnosed with early Lewy's after a severe car accident (while he was in rehab after this accident) telling people he was "basically a million on the hoof "(think cattle auction, where the term is used.) They liked that number. They wanted that million. Remember, they are in business.
It feels invasive, and you are dealing with an ILL loved one, and it strikes a hot iron of anger into your heart, but the truth is that yes, it has come down to this. His care now depends on how much he has. For all the glorious things we are, welcome to the USA. Where everything depends on how much money we have, and what we want, and how much we can pay for it. Might as well accept the truth of all that and make it work for you the best way you can. I know how it hurts. I know how invasive it feels. My heart goes out to you and I wish you the best.
Is Dad on Medicare? If so, all they need to know is his Medicare and supplimental info. From that info, they know what Medicare will cover and then its calling his supplimental to see what they cover. At Moms Rehab, I was given paperwork. It showed what Moms responsibility for payment would be after speaking to her supplemental. It was $150 a day at that time. I was her POA so I signed that Mom would be responsible for that payment as her representative. Did not make me responsibility for the payment. Always put POA after my name.
IMO I would say No they are not entitled to Dads financial info. Tell them at this time you are not considering Longterm care for Dad. If and when you are, you will be glad to give them that info. You may want to allow them to think it will be them when and if this happens. If Dad eventually needs a facility, you can choose any Longterm facility you want. It does not need to be the one he has therapy in. All you need to do is tell them Dad is capable of paying the 80days that Medicare only pays 50% or what the supplemental won't cover. If they want an affidavit from his bank saying that you will be happy to get that from them. But for now, they are putting the cart before the horse.
Again, I think they are assuming alot at this point that Dad will transition to LTC or that it would be their facility. You should have a care meeting within the week. See how that goes.
here’s what I would do, I would keep my Dad at home. I would hire a full time caregiver that has RN nursing skills. I found that to be way cheaper. Plus, you won’t be feeling like this facility is going to suck him dry of his money. He’s got the comfort of home, all medical supplies and you have a peace of mind. I noticed that this works for many people. This has been working wonderfully for my sister taking care of our Dad. I’m not going to give any more details. It will take time, but it’s worth it. I noticed that too many people are gullible when some drs are full of …… just to make money. I don’t personally trust any rehabilitative facilities. I have a friend, older gentleman, had Covid and went to a rehab facility. They took away and refused to give him his required medication, insulin!!! When, he left the place his blood sugar was over 500. We gave him his insulin. The same thing happened to another patient too. They tried to take his phone. I have this question, why do these facilities have locked doors and security guards? I have a gentleman friend said that a nurse came in and cleaned his genitalia, and made him have a orgasm. He was angered by how she “cleaned” him. I got her fired for sexual assault, I made sure she got charged for it also. She is currently in jail for 3 years. If your free to leave on your own, then why are they refusing to let patients leave with family members waiting to pick them up? Why the locked doors with security guards?? This sounds like a American concentration camp. I had to call the police and say this rehab place is holding a person against their will. Kidnapping?!! Locked doors all day? Why? How come family cannot visit? To me, sounds like this rehab place needs to be shut down. Who can speak for these people that want to leave, but are held there against their will?? My gentlemen friend said he was leaving and to let him out. Where can I file a complaint against this facility?? The abuse, that’s covered up? Medicine is not given to some patients?? If your family member is telling you that they are being mistreated, get them out of there immediately!! Your insurance will pay for anything you need. Please, understand, you have rights and to choose to go to another place and or home, until decisions can be made about proper care. This experience was a nightmare, and just reminds me of that movie, I care a lot. On Netflix. Any advice is welcome. Thanks.