She's on home oxygen, noncompliant with meds and can't take more than 2 steps. Shes been there for 60 days and needs more skilled care. She's on Medicare. How can I convince them she needs to stay longer?
Your mother is noncompliant. She needs both a geriatric psych consult along with palliative care. Someone needs to help you and her manage your expectations of what is and is not possible to improve her condition. A rehab facility is not a nursing home although they are often the same facility. If she needs a nursing home placement, now seems like a good time to get that done.
Patty, thanks so much for coming back. I would call or write to the state ombudsman and file a complaint. Talk to the SW at the hospital about how to prevent this from happening again.
These facilities are protecting themselves first and foremost, as well as trying to prevent having to bill Medicare/Medicaid for care. Facility did not want any issues to happen while she was there, hence the rush to get her discharged and out of their hair.
Having worked in LTC, I find this quite bizarre. Once it becomes apparent that the resident is nearing the end of their stay, P.T does a home eval. If the resident is safe to go home then measures are taken to ensure DME equipment, etc., is ordered and set up. If the resident is not safe to go home, and appears to need long term care, then a care plan meeting is set up to help the family with the arrangements, and the resident stays in the rehab wing until a bed becomes available. Furthermore, if they cannot stay at the current facility, then they and the family make arrangements for another LTC facility transfer. A resident CANNOT be discharged to an unsafe environment. I would contact whomever governs LTC facilities in your state....
When my dad was in rehab with medicaid LTC pending, they kept him in the rehab wing until a LTC bed became available. This woman doesn't have the wherewithall to pay for 24/7 care. Someone must help advocate for her.
Pattyreddp: So you're saying that they don't have a bed for her in the Long Term Care unit of this same NH? Not so genius idea to send her home. I know Nursing Homes all too well and the way they operate. The one my late mother was in told her that she was too well to stay there. Come again??! Less than 48 hours later she suffered a stroke there and died days later at the hospital.
Did she come from being admitted to a hospital first?
Depending on her admission diagnosis, medicare usually pays by “groups”. In other words, people who have had similar health issues and how long they were in rehab. They do not go by your stepmom’s personal situation.
For instance, if the majority of people get better and discharged in 45 days, this is what they go by.
The good news is, since she has been in rehab more than 30 days and cannot be discharged under her own care, she can apply for Medicaid and she can stay at the NH facility under medicaid pending. Contact the NH case worker to help you apply. Keep in mind that Medicare stops paying on the day they “discharge” her.
I wish I had known about the Medicaid when my mom went through a similar experience.
She should be transferred to the Long Term Care unit of said NH. Also, the number of allowed Medicare days may have run out. I don't know if she has a Medicare Supplement Plan and if so, which "Letter" and whether the NH accepts it.
Im a lifelong asthmatic getting worse as I age. And now complicated by the fact I have heart disease since 53. I'm now 55.
Best I can say if I were advocating for myself, and not nicely is, "you are sending me home to die alone of preventable disease in the wealthiest country on Earth and you don't care."
Go to the business office and get an application for Medicaid Long Term Care today. If she owns her home, check off the box that says that she plans to return home. Apply for Medicaid if you think she has low enough income and assets to qualify. It is my understanding that once she applies for long term care, they can't discharge her unless they feel she demonstrates all the daily living skills necessary for living independently. If there is a move to discharge, appeal it. If they deny the appeal, appeal that. Also, at your meeting, request a home assessment. This is done while she is still a patient at the rehab facility. She is driven by you or a handicap van to her home, and the physical therapist follows in his/her own car. They observe mom enter the home and maneuver about the house. This observation will inform the professional what the patient will need to return home (ie. grab bars, bed rail, room for walkers, hospital bed, ramps, etc) They can assess how competent she is while ambulating. This process proved very helpful for my dad on two different occasions. A good physical therapist will recognize great interventions and also inherent risks. I suggest you record this on your phone for your reference. If at some point she is discharged, apply her immediately for whatever Community In-Home Medicaid program your state has. Massachusetts has something called Frail Elder Waiver. Programs like this can provide up to 18-20 hours a week of in-home help. Once she is on Medicaid and a Frail Elder Waiver type program; it can take quite some time for them to process the application. My mom was able to benefit from frail elder waiver which allowed her an automated locked med dispenser, life-line, and help 5 days a week divided between mornings and supper times and qualified her for adult day care although she never partook of that. This allowed her to live "independently" for over two more years. Yes, I did help her too, but it was doable. When she landed in rehab after breaking her hip and wasn't participating enough for Medicare to say she could stay, the Frail Elder Waiver assessment nurse clearly recognized that mom would need too much care to return home and okayed her for up to three more months in the facility. (As an aside, I would like to see a Medicare appeals person break their hip and only address the pain with Tylenol and perform the level of physical therapy they expect. It would be very difficult at even half the age of my mom!) For some individuals the extended stay can allow for them to improve enough at a kinder pace in order to go home. If not, a long-term care application is completed. Your mom might require hospice. This can be provided in the nursing home. An in-take nurse will determine if she qualifies for hospice. I was in your shoes back in 2014. I knew nothing about anything. Hopefully, you will find a kind business office person, or social worker who will show the way. My guardian angel for applying mom and dad to Medicaid was a hospital administrator where my dad had been a patient in the recent past. The business office at the rehab/nursing home helped with the Long-Term Care applications for first my dad and then my mom when the need arose. The community elder outreach person also was helpful. Keep asking questions, advocate, and persist. Good luck with everything.
Check with the insurance company. An appeal can be filed which will buy you a little bit of time. You will have to consider putting her into a nursing home facility or assisted living. You could bring her home and hire caretakers but if she isnt walking I wouldnt recommend doing that. The insurance company can tell you what rehab facilities are available near you. You are the advocate so fight for the care that she needs. Another person to help guide you is the social worker...discuss options with the social worker. Good luck!
I don't know about an insurance company helping with placement... (I think she stated step-Mom is totally on Medicare?) But - in any event - if you choose to become integrally involved, don't just rely on ANYONE'S referral/recommendation! Check things out for yourself - read online reviews (and pay attention to who is leaving those reviews! Facility staff aren't exactly reliable?!) When my Mom was hurt, had surgery/discharged to hospital in 4 days, I was totally at a loss as far as placement options... She needed rehab/skilled nursing, and I personally checked a couple of places out (which is only minimally helpful when touring with the "marketing manager"?), and then relied on the recommendations and opinions of the hospital social services staff and "A Place for Mom". Mom ended up in a beautiful, new, horrible, abusive, and neglectful facility, which damaged her beyond recovery - literally - in less than a week. I didn't find out until afterwards (per reviews and personal contact from prior patients, families, and other community sources) that this place is well known for neglect and abuse... I learned that "pretty and new" doesn't necessarily equate with "competent and caring". I ended up moving Mom to another facility (managed by Benedictine Nuns!) which was frankly run-down and pretty sad per physical inspection, but abundant with good care and caring staff (and a good community reputation). Knowing what I know now, I would even go so far as to inquire with a local Social Media site (yes, even local community FB groups) per peoples' first-hand knowledge, experiences, and recommendations. Then put all this info in a "pot" and make your own decision! (This process really doesn't have to take that long when you don't physically run around to all the local "options", but winnow it down to a few most-likely to work!) Sadly, I wish I'd learned all this when it mattered to my Mom...
They are not supposed to release her to an unsafe environment. If she cannot walk, then it is not safe for her to be home alone. It seems they should work to set up home health care for her. Ask if they have a social worker who could work on that. If not, contact a home health agency to see if they will try to get her approved for their care. Another possibility is one of the care assistant agencies like Visiting Angels, Right at Home, or a similar group. They could place someone in her home to assist her. But, getting Medicare to pay is an obstacle. Good Luck!
When someone is going to be discharged from rehab in a long-term care facility the home must give you a "Notice of Medicare Provider Non-Coverage" form to sign. This is a Federal requirement and must be given 48 hours prior to discharge from Medicare.This form simply says that the resident is being discharged from therapy. If you feel that your loved one is being discharged to soon you can appeal this notice. The form will have the number where you call to appeal. The appeal is done by a third party, not the facility staff.
The appeal will be completed within 48 hours so you don't have to worry about additional cost.
If the reason for your loved one being discharged is that they are refusing therapy you will not win an appeal.
The social worker at the home should be working with you to establish a discharge plan. They cannot discharge her to an unsafe environment.
Yup - just what I described/explained earlier in a more long-winded, detailed manner! Don't let the bureauocrats bully you around! Know and excercize your rights!
From my experience with a similar situation, if you feel that you are unable to keep your mother-in-law (SAFE) in her present condition this should be a very valid reason. Make sure you emphasize SAFE. No facility will release a patient if caregiver cannot keep them safe. Hope this helps. Good luck. 🙏🏻🌹🙏🏻
Medicare only pays for so many days (I believe it is 100 days maximum). it's rehab--not permanent placement. Further, they have to chart some kind of improvement in order to stay in rehab. If she does not cooperate with physical therapists they will chart "refused" and it's back home. It sounds like she needs permanent nursing home placement. Contact a social worker to get her on Medicaid; however, another option is hospice. Medicare pays for hospice.
I previously explained this process in detail... Yes, Medicare (Part A, probably) will cover up to 100 days in rehab/skilled nursing following a hospital stay. (UP TO 20 days all-paid and UP TO and additional 80 days, with a co-payment) The facility, though, decides at which point Medicare will deem the patient isn't making sufficient rehab progress (and not pay after that), and the facility schedules the discharge date. (They "guesstimate" this date to be before Medicare stops paying, but that's what it is - a calculation on their part.) They should HAVE to provide a Medicare-rights sheet at the time of discharge notification. This will have the process, and phone number, for appealing the nursing home's discharge decision and date. You (your step-Mom or responsible - POW - person) has the right to appeal the discharge with Medicare. They will have medical and rehab records reviewed by medical personnel, and decide - within 48 hours - whether YOUR appeal will be upheld, and the patient allowed to stay for an additional period, or whether the discharge is proper as scheduled. This process can (and probably will) be repeated a number of times, and the same options are available each time. (I appealed my Mom's discharge 3 times, was upheld, and she ended up staying for 96 out of the 100 days! - apparently almost a record, because the facility was really shocked!) When she is to be discharged, you do not have to take her in - cover her costs - even make arrangements for placement. You can "warn" them that if they place her in an unsafe situation (for instance send her home if that isn't safe and appropriate) you will scream bloody murder to Senior Protective Services. Keep a journal/record of everyone you talk to, what was said or decided, dates/times/etc. - and keep a record of any valid requests you make that are ignored, and any care meetings, arrangements, promises, etc. they make that they don't follow through on! Keep a record of everything!
Something like this happened with my mom. I actually got help from the Senior Linkage Line. They have been a godsend for me. They put me in contact with home health, help with getting medication refilled, etc. My mom has had 2 heart attacks and a devestating stroke. She is unable to live by herself, cannot do ADLs without help. The Linkage line also calls monthly for updates, any help I may need and just to make sure we are ok. Is worth a try!
Someone there should have Discussed this with you before Talking about Discharging her. You need to speak to Someone, Hun, And Soon about Caring for Her in her Own Home or in a Facility such as Skilled Nursing.
Patty, does she live alone? Are they saying that she is okay to go home alone with home health? Do NOT pick her up. Do not sign that you agree to discharge. Let her sign for herself.
When they send her home, call Adult Protective Services and ask that they conduct a wellness check.
No, I cant pick her up. They will provide transportation for her and charge her $50. Im still at a loss for words but time will tell. She will be calling 911 within a week or 2, then back to the hospital. Im really done with this horrific system. Very sad!
When my 85 year old aunt was to be discharged when we all thought she should not, i refused to return to the ER to pick her up. They sent her home at 11:3o pm IN A CAB, in her hospital gown and a light coat on a November night. And this was a good hospital! And when I wrote to the state health dept. they said this was all within hospital protocol. So I agree, Don't pick her up, but they might try to send her home on her own. Compassionate care is not the priority these days in hospitals. It's making sure the insurance bodies won't be upset with them.
Thanks for all the advice and answers. I went to a meeting friday and they told me in no uncertain terms shes going home tuesday. They dont have a bed for her. I met with 6 people that met her once and had no answers. A nurse will come in and assess her to see what help is available for her. Im really done with this stress. Amazes me
You have a right to appeal this decision. Please talk to her social worker and at least insist on an appeal. The problem, unfortunately, is bigger than one insurance company or one hospital. It's our whole US healthcare (I use that term advisedly) system. Best of luck.
PS: Be sure they checked with other nursing homes in the area. They are supposed to do this.
Medicaid takes months before it's approved...it took 8 months because they found all kinds of things, and wouldn't approve it.. I think they do that on purpose so they get more money.....2 months later my mom passed away. It's all a racket and most elder lawyers are useless.
Everyone keeps saying about it being your mom but since you did say it is a step relationship this may or may not have been a close one . Regardless you are not responsible for her unless you have taken this on willingly - and be aware that you def should not accept financial responsibility unless you clearly have those means which I assume you don’t . You actually have no right to even access her records and documents unless you have received that legally so of course you don’t need to fill out applications the sw does . As a kind person your only responsibility is to make them awAre that she is on her own at home and that she can’t manage - through her present facility and the area agency on aging . Then you can go visit her on occasion as a friend . You have been kind to help her but you don’t need to go above and beyond especially since if she does actually have living relatives this could come back and bite you in the future if they claim some issue with how you mishandled anything
She needs a neuropsych evaluation or may just a geriatric psych evaluation to confirm that she is unsafe at home. They need a diagnosis of something like alcoholic encephalopathy or dementia to work with to confirm she is unable to care for herself due to cognitive dysfunction. She needs to have competency determined and have a POA or guardian established to make decisions for her. otherwise, she could just be allowed to make her own decision, call 911 again and end up in hospital again. If rehab won't help coordinate this, they they are stuck with a plan for her and may just decide she is compenent.
Note to all, when you have a LO in hospital or rehab, enjoy the break but start working on discharge plan immediately. Your house does not and should not be the discharge goal, but don't expect the hospital to do the heavy lifting for you. If you don't think LO is competent, ask for an evaluation while in the hospital so they can confirm that. Otherwise, if person is felt by hospital/rehab staff to be able to make their own decisions, they can just send them back to their prior living arrangements. While it is usually obvious to family that person cannot life alone safely, it may not be obvious to caregivers. If family member is still at home, and doing fine, then read Being Mortal and then have the hard discussion with them, get the POA done and don't be an ostrich or allow them to be.
Speak to the administrator of the facility. That no one is contacting you or returning calls needs to be addressed. Sometimes they don't know people aren't doing their jobs unless someone tells them.
If they won't talk to you could it be that they don't have a copy of your MPOA? HIPPA laws are applied to every person unless they verify you have the authority to get info. If you aren't authorized they won't speak to you.
Call the ombudsman and have them help you, they might direct you to resources or intervene to get a safe discharge in place. I had to stand my ground because the rehab was pushing for discharge and my dad had no safe place to go. It was awful but stay strong and keep repeating that she doesn't have care and needs a safe discharge plan. My dad was telling everyone that he had a place, my house, and I was screaming no he doesn't, could this be what is happening in your situation? You could have your doctor write an excuse letter stating you are unable to care for her.
I hope you recover quickly and well from your surgery. Sheesh, this situation is the last thing you need. Be strong and don't let them bully you or just dump her out.
Depending on her admission diagnosis, medicare usually pays by “groups”. In other words, people who have had similar health issues and how long they were in rehab. They do not go by your stepmom’s personal situation.
For instance, if the majority of people get better and discharged in 45 days, this is what they go by.
The good news is, since she has been in rehab more than 30 days and cannot be discharged under her own care, she can apply for Medicaid and she can stay at the NH facility under medicaid pending. Contact the NH case worker to help you apply. Keep in mind that Medicare stops paying on the day they “discharge” her.
I wish I had known about the Medicaid when my mom went through a similar experience.
Best I can say if I were advocating for myself, and not nicely is, "you are sending me home to die alone of preventable disease in the wealthiest country on Earth and you don't care."
The appeal will be completed within 48 hours so you don't have to worry about additional cost.
If the reason for your loved one being discharged is that they are refusing therapy you will not win an appeal.
The social worker at the home should be working with you to establish a discharge plan. They cannot discharge her to an unsafe environment.
I hope this helps, good luck!
Make sure you emphasize SAFE. No facility will release a patient if caregiver cannot keep them safe.
Hope this helps. Good luck. 🙏🏻🌹🙏🏻
My mom has had 2 heart attacks and a devestating stroke. She is unable to live by herself, cannot do ADLs without help. The Linkage line also calls monthly for updates, any help I may need and just to make sure we are ok.
Is worth a try!
Are they saying that she is okay to go home alone with home health?
Do NOT pick her up. Do not sign that you agree to discharge. Let her sign for herself.
When they send her home, call Adult Protective Services and ask that they conduct a wellness check.
PS: Be sure they checked with other nursing homes in the area. They are supposed to do this.
You have been kind to help her but you don’t need to go above and beyond especially since if she does actually have living relatives this could come back and bite you in the future if they claim some issue with how you mishandled anything
Note to all, when you have a LO in hospital or rehab, enjoy the break but start working on discharge plan immediately. Your house does not and should not be the discharge goal, but don't expect the hospital to do the heavy lifting for you. If you don't think LO is competent, ask for an evaluation while in the hospital so they can confirm that. Otherwise, if person is felt by hospital/rehab staff to be able to make their own decisions, they can just send them back to their prior living arrangements. While it is usually obvious to family that person cannot life alone safely, it may not be obvious to caregivers.
If family member is still at home, and doing fine, then read Being Mortal and then have the hard discussion with them, get the POA done and don't be an ostrich or allow them to be.
You can't help someone who doesnt want to be helped.
If they won't talk to you could it be that they don't have a copy of your MPOA? HIPPA laws are applied to every person unless they verify you have the authority to get info. If you aren't authorized they won't speak to you.
Call the ombudsman and have them help you, they might direct you to resources or intervene to get a safe discharge in place. I had to stand my ground because the rehab was pushing for discharge and my dad had no safe place to go. It was awful but stay strong and keep repeating that she doesn't have care and needs a safe discharge plan. My dad was telling everyone that he had a place, my house, and I was screaming no he doesn't, could this be what is happening in your situation? You could have your doctor write an excuse letter stating you are unable to care for her.
I hope you recover quickly and well from your surgery. Sheesh, this situation is the last thing you need. Be strong and don't let them bully you or just dump her out.