My mom is being held hostage in a rehab facility. Her insurance has cut her off, and Dr. and therapists say she is not ready to be released.

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This is a true Catch 22, and I am wondering if rehab is just trying to keep her to get more money?

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Et, being held hostage means that they are demanding money for her release. That isn't what's happening, is it.?

Deep breath. I'm going to guess that mom is in rehab after a hospitalization. The therapists are saying that she's made all the progress that she's going to, and thus Medicare will no longer pay for rehab.

But she's not safe to go home, according to the doctors. Meaning that she needs a higher level of care than living alone. She may need a long term care facility, or she may need in home care.

It's time to figure out what mom's resources are AND to talk to the discharge planners about what her level of need is.

If she has no resources for long term care, you appt for Medicaid.
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Reply to BarbBrooklyn
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Okay; So, again, deep breath.

When you appealed, did you do so with the support of the therapy and medical staff? Did they document that she was still making progress? If THEY think she's plateaued, neither Medcare nor her supplement will pay for continuted therapy. She then needs to become a long term care patient.

Ask the head of the therapy department to go over with you what they've submitted. Appeal again if they are saying she's still making progress.

Ask rehab what they need in place at home for discharge. They need to send an OT out to evaluate her home.
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Reply to BarbBrooklyn
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I am not trying to overstep my bounds but when I was told my mother could not leave the nursing home in order to go home with me my mother went as they put it AMA. That stands for against medical advice. She can get treatment at home and the rehab facility cannot stop her from leaving. She still has rights in America.
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Reply to wouldustayorgo
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Quite, Shad - unless you are very confident that your mother will never need to see a doctor again, given the importance of the insurance cover, it's a bad idea to discharge against medical advice.

So the issue is literally these four steps in the home? That's the lot? Then you have two options:

pay for the continued rehab and encourage your mother to work it! work it! on those steps (which would be good for her strength, balance and confidence) - in which case, too, instead of arguing with rehab you want to argue with Medicare;

or

get quotations for a ramp, stair lift or double hand rail for those stairs; and/or ask the OT what adaptations would satisfy their discharge criteria.

But if Medicare have you chipping in in the background about how you're sure mother would be fine at home now then it's hardly surprising they've turned down the extended rehab, is it? Personally, I'd go for the "argue the claim and cheerlead the PT" option.
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Reply to Countrymouse
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Etowahrivergirl, can you tell us why your Mom is in a rehab facility? If she has been there for 20-21 days and has not improved, then it is up to her health insurance as to whether they will pay for extra days.

If Mom is improving, then her insurance should allow her to stay more days, but Medicare would only pay for part of those days, and hopefully Mom's secondary insurance will pick up the rest.

Sounds like miscommunication between the rehab facility and Mom's health insurance.
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Reply to freqflyer
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Do you have two people on hand who can consistently get her up those steps?

Have you spoke directly to the supplemental insurance co to ascertain that they received all of the documentation?

Is she walking consistently within the facility, not necessarily in the therapy room? Just with an aide, say with a gait belt? Or is she resistant to getting out of bed?

Has she had a stroke? Are there underlying mental health issues?

Just trying to get a fuller picture.

You can call the ombudsman if you truly feel that she's ready for dishcarge and they are not letting her go unfairly. You can appeal the appeal to your state insurance commission, I think.
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Reply to BarbBrooklyn
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My mom lived another 2 and 1/2 years where if I had left her in the nursing home I am sure she would have died in just a couple of weeks if that long.
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Reply to wouldustayorgo
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By Audie Liametz MD, JD--Relias.com
"Simply because a patient elects to leave AMA does not mean that he or she is always entitled to do so. In fact, there are situations in which the practitioner is mandated to override the patient's refusal to stay (i.e., not permit a patient to leave AMA), such as when the patient is: expressing suicidal ideation, lacks decisional capacity, is a danger to others, or poses a public health risk (e.g., active tuberculosis and refusing treatment).

Most patients believe that the insurance company will not pay for their visit if they leave AMA. This is a myth; however, insurance may not pay for a repeat visit for the same symptoms.

It is not too difficult to document the basic elements of an appropriate AMA discharge, including:
1. Decisional capacity;
2. The physician's opinion regarding why the patient should stay;
3. The physician's ongoing concern about the patient leaving;
4. The informed refusal, including possible outcomes and alternatives;
5. Family who are present and aware of the condition;
6. Any other efforts: i.e., family, social work, nursing supervisor involvement, etc.
7. Signatures from the patient and witness(es)."
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This information mostly applies to patients that leave the ER or hospital.
In your mom's case, she is stable and not in need of medical treatment to save her life.

In my opinion, I would arrange a meeting with the director of nurses, the physical therapist, the occupational therapist, the doctor, the facilities' ombudsman and the social worker. I would have a list of questions ready.
How much longer is her therapy needed?
How will this stay be paid for? (especially if you can't pay for it.)
What is needed for home modification to make her return possible?
Can one caregiver handle her care?

The appointment for the meeting should be made within the next week (to reduce any further costs to you.)

According to what the above information is saying, she would be able to leave Against Medical Advice BUT she may NOT be able to re-enter rehab again with Medicare or other health insurance paying the bill.

Might be a good idea to also talk with an elder attorney. (You can find retired elder attorneys listed in the senior center of your town who work on the ability of the patient to pay.)

You need to get to the bottom of this as the bill keeps increasing day by day.

Good luck.
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Reply to SueC1957
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If there are only a few steps up into the house please check out "Raase Lift". Wheelchair lifts can be expensive but this powered wheelchair ramp isn't much more expensive than a winding wooden ramp in front of the house (which some subdivisions won't allow). The best thing is that the ramp is only 8 feet long and can usually be installed inside an enclosed garage (away from rain/snow/ice).
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Reply to FriendlyBedGuy
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You know you can take her home = Against Medical Advice. They will probably ask you to sign papers == which is reasonable. But they can't keep your mom if she wants to leave or the person who has medical guardianship wants her to leave.  The fact is you can just walk her out as long as she wants to go  and/or you have proper authority. 
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Reply to MsRandall
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