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.