My mom is 90 and fell and broker her arm and has been in a Skilled Nursing Facility for about 35 days. Before she fell she was driving fine and is very extremely cognitively "with it" and has lived alone pretty much doing fine although she tires very easily. For the past week to 10 days in the nursing home she has been walking independently with no walker or cane. When the PT and OT evaluate her she is able to do everything with absolutely no assistance. She can go to the bathroom by herself, make a meal in the microwave by herself, dress and undress by herself, do a full set of stairs up and down by herself (holding onto the hand rail). She is slow and careful, but she's been through two evaluations and each time they say she is just a little tentative and therefore they won't clear her to go home.
The problem lies in that at day 31 of her stay, her secondary insurance stopped paying and now she is paying $167 per day co pay. She has a very low income and can't afford this and wants to go home. She has had fantastic PT and OT seven days a week and is actually in better shape than before she fell... but they won't clear her, so she has decided that she is leaving Against Medical Advice to go home. Her primary doctor who knows her quite well has already agreed to coordinate home PT and OT and other social services she might need... she does get tired very easily due to congestive heart failure so she receives Meals on Wheels etc.
My question is... should I be worried about her leaving Against Medical Advice? Someone at the nursing facility mentioned calling Adult Protective Services if she leaves and while my main concern is for my mom, I am also worried if I'll be responsible if she goes home and something does happen... if she falls. Also, I heard that her secondary insurance might not pay if she leaves AMA.
Unfortunately, I live a couple of hours away. I told her tonight that I think she should stay until they clear her, but it seems that she has to be absolutely perfect in the evaluations for her to be cleared. I understand that they don't want to be sued, but it seems ridiculous. She is is in so much better shape than any other patient in that facility by miles. Everyone there is walking with a walker or they are in a wheel chair or bed except my mom. She doesn't even look like she belongs there. Even the PT and OT techs are whispering to her that she should be discharged and they don't understand why they won't clear her.
Is this Medicare fraud... trying to keep her there so they can bill for her stay? Why else would they not clear her?
Any advice is appreciated.
Go to the finance office and tell them Mom has no money for the extra days. That they need to discharge her or agree not to be paid. Bet she is discharged. Mom can do therapy at home, I think. Check that out with insurance provider. If they do nothing, call her primary. If get nowhere with that, call your state Ombudsman.
If you are afraid Medicare will not pay for her nursing home bill if she leaves AMA, I have previously researched this with Centers for Medicare and Medicaid Services (CMS) and that is not true. It is another falsehood nursing homes tell families and residents.
Your mom may fall at home. She may fall in the nursing home. But, she will likely get stronger at home with therapy where she has to do more for herself---but more importantly she will be happier at home.
I love Joann's suggestion to tell the facility you have NO money to pay for further services. I'll betcha too that they release your mom pronto.
Best of luck!!!
I was told my Mom, even with a walker, would need assistance at all times when she returned to the AL. I questioned it because she was only in the hospital, for a UTI, from Tues to Friday. Before that she was walking all over the AL with a walker. When she returned to the AL within 24 hrs she was again walking all over the place.
I really don't see how they can get better when they do PT, OT for maybe a couple of hours a day and then sit them in a wheelchair the rest of the time.
My 87 year old Mom did NOT have to pay for anything when she was in Skilled Rehab because her BCBS Medicare Supplemental Insurance covered what was not paid by Medicare.
You and your Mom need to contact the Secondary Insurance Company and find out WHY they quit paying for her care and why she is having to pay a Co-Pay? What part of her care did the insurance company quit paying for? Sometimes nursing homes make mistakes on the forms that they have to send to Medicare and to the Medicare Supplemental Insurances which can result in nonpayment or a lower payment from Medicare or the insurance company.
Also, have a meeting with the people who make the decision as to whether your Mom can go home or not. Ask for the specific reason(s) why your Mom cannot go home. What do they mean when they say that “she has to be absolutely perfect in the evaluations for her to be cleared”? Is it something as simple as the need for a permanent grab bar in the tub or shower? Does she need rails on the toilet? Do the dishes in the kitchen cupboard need to be rearranged so that she can reach them easier? Is the microwave TOO high for her to use safely? Does she need better handrails on the steps into her house or inside her house? Do the people who make the decision think that there are TOO many steps into your Mom’s house and are afraid that she might fall trying to walk up or down the outside steps? Are there area rugs that need to be removed so that your Mom does not trip over them? Does your Mom have an “Alert button” in her house that she can push in case she falls again or does not feel well? Find out what is keeping “THEM” from releasing your Mom to LIVE BY HERSELF again.
WHO at the nursing facility mentioned calling Adult Protective Services if your Mom leaves AMA? Did they give a reason why they might call APS other than “your Mom left the nursing home and you took her to her home AMA”? What are their concerns?
You need to ask more questions and find out exactly WHY "THEY" will not let your Mom go home. It might be because she is 90 years old and you live 2 hours away. You won't know unless you ask them. Good Luck.
I did this because several years ago the hospital was going to put my husband in a skilled nursing facility to teach him to walk. To make a long story short, he had been walking fine when they admitted him for a heart problem. They had kept this 83 year man in one position for a week. No turning, no moving around. The last day they had a Physical Therapist get him up and he had a hard time walking. I told them it wasn't going to happen. All he needed was to get up. They were getting the AMA paperwork ready when (Wow) the regular release papers showed up. In an hour he was walking just fine. All he needed was to move around a little bit. Of course I am leaving out my "talks" with the Doctor and a lot of other garbage.
See All Answers