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?
It sounds like she will need nursing home placement. What sort of pulmonary rehab? If after 60 days she has not improved enough to care for herself then she may need the 24/7 NH care.
You are family - call them. You’ve been alerted to DC in 6 days. Have you attended care conferences in the last 60 days to discuss your mother’s progress? This should not be a surprise.
As stated, Medicare sets the date - not rehab. If rehab isn’t being beneficial then it’s LTC NH & Medicaid. You will have to assist their SW in getting the forms filled out finance wise.
Medicare does have a Co-pay after 21 days thus her stay now is not 100% covered by Medicare and hopefully her supplemental plan will pay for this.
We had one care plan meeting at the beginning. They called me to schedule a meeting last week. I was there, waited an hour, told 4 people I was there for the meeting and nobody knew a thing. Terrible communication on their part. I drove 45” for this. yes, she does need 24/7 NH placement. She has copd, on O2 for 3 years. Cannot do her treatments or take meds correctly. Im shocked nobody discussed her dc plans with me. Im the only one she has and I have tried for years to help her but I am in no shape any longer. Thank you for your reply!
Patty, I don't know the circumstances of your Mom's placement for skilled care, and whether this involved an initial in-patient hospital stay? Depending, I'm concerned there could be Medicare issues you aren't aware of and probably haven't been told about... I know others have already mentioned progress requirements, etc., but... I'm going to try to give more detail and rationale involved.
Since she's already been there for 60 days, I'm guessing she's not on Medicare Part A, which is involved following an in-patient hospital stay? I know a LOT about Part A, because that's what my Mom was covered by for a period, but your Mom might be under "regular" (Part B?) Medicare, and I don't know as much about the requirements for Part B. However, it's worth your while to find out whether the rehab facility has to follow specific Medicare rules on when and how she can be discharged...
IF it's similar to Part A coverage, then Medicare requires an incremental assessment of improvement in rehab to continue coverage at that level... The facility "guesstimates" when that level is getting close to the Medicare cutoff, and issues a discharge date to the patient. In other words, they base this date on the facility's "prediction" of when Medicare will refuse to continue payment, at which point the facility would be left holding the bag... If this is the way Medicare works in your Mom's case, then the facility must give you a page - from Medicare - setting out your rights per this "planned" discharge. (For Part A, there is UP TO a 20-day initially 100% Medicare-paid period. After that, for UP TO another 80 days, Medicare will cover the stay but require a co-payment from the patient.) The catch is the "up to" clause, because Medicare requires reports from the facility documenting measurable incremental improvement from rehab/therapy. If this improvement stops, or slows down below Medicare's standard, then Medicare will no longer cover the stay. The bottom line is, this official Medicare "exit" notice sets out the option for the person responsible for the patient (with Power of Attorney probably?) to challenge the facility's discharge date/plans. You can contact Medicare directly, from info provided on the form, and file an appeal to the discharge date. Medicare will have doctors completely review the file - the patient's history, and current situation - and then decide whether the discharge is valid under their guidelines, or whether there should be additional care at the facility. If they "uphold your appeal", the facility has no choice and must keep the patient longer... This process can be repeated a number of times - the facility notifies you of a planned discharge date per their "guess", you appeal to Medicare, and await Medicare's decision. (The same appeal is available for a planned discharge from a hospital - you can appeal based on your concerns that the patient can't be safely discharged!) One interesting factor is that the appeal usually adds a day or two to the stay, just because of the time required for Medicare's decision.
So, ask whether the discharge date is mandated by a Medicare provision, and whether you can file an "appeal" to the discharge. If you are given a Medicare form - informing you of your rights - read it! It's certainly worth a try!
Thank you. Im printing this out and will find our more today at 2. Im supposed to have a meeting. I called 4 times yesterday to get this. Im not sure whats going on at this facility. Absolutely no communication.
She is on medicare. The facility called me wed and told me she was to be dc on tuesday. This was the first time I heard anything about a dc. yes, I called 4 times yesterday and finally got the sw on the phone. I have a meeting at 2 today. After reading all the replys Im assuming her time has run out at this facility. She is my stepmom. Im the only one that had helped her but I am in no shape to care for her. She needs 23/7 nh care. She is non compliant with all meds. She calls 911 for every little thing and ends up hospitalized for 3-4 days. This was her first “rehab” stay. Hopefully I will impress upon them today how unsafe she is at home. Doesnt shower, lives in filth and abuses everything she gets her hands on. I have tried for years to help but you can only help someone that wants help. Im exhausted with her
Agree with the previous posters. The NH referral is for skilled nursing and/or rehab but Medicare will pay only as she progresses and or she hits her 100 days (20 days for complete coverage). If the care she currently needs is really more custodial (bathing, dressing, transfers, etc) then Medicare will not pay. You should have a discussion with the discharge planner as suggested about a safe discharge; it may have been assumed that she would be going home with you particularly if she lived with you or you assisted in providing care prior to her hospitalization so make them aware of what, if anything, has changed and why you consider it an unsafe discharge. Most facilities have an initial care conference with resident and family with in the first 10 days of care and then periodically afterward. Since Mom has been there 60 days already you may be a little behind on the schedule of things to have this conversation now but have it at any rate. They may have suggestions for you but be prepared that one of the things they may suggest if she cannot remain at home is long term care (NH). This is the most expensive level of care and few people can afford it out of pocket so a Medicaid application may be needed. I don't know what state you live in but most of the time the application process is rather long (think of it in terms of months) and will require the caregiver (you) to come up with various documents (birth certificates, marriage licenses, mortgage payments/rent receipts) and lots and lots of bank statements. In NJ Medicaid will take a 5 year look back over the applicants shoulder to see if any funds have been transferred or hidden. Gathering this information can almost become a full time job! If this is the case, be aware that Mom may have to go somewhere while her application is being evaluated and that the current NH may not be able to keep her during this process. Get that meeting with the discharge planner as soon as possible.
You have of the option of refusing to take her. While it is correct she cannot stay indefinitely at a rehab, the discharge planner and social worker should work with you to find nursing home placement. Is it possible to private pay the the rehab until you have nursing home placement?
No, shes on medicare and broke. She is at a state run “rehab” after being admitted to the hospital for shortness of breath. They are a medicaid nursing home and I was hoping they would keep her. Im not sure how they can send her home in 6 days without speaking to any family. She is very unsafe to be alone. She falls, forgets when she last took meds, abuses her meds, etc. former alcoholic, now abuses pills. Im just at a loss for words. Its an accident waiting to happen. She has no family and Im in no shape physically to care for her.
Joan is correct...If she is on Medicare, they will not pay if she makes no progress or doesn’t cooperate during physical therapy. You should apply for LTC Nursing Home Medicaid for her as it will be very difficult to care for her at home. You will be doing most of the caregiving. See Social Worker and Medicaid office in rehab. Tell them you don’t want to give up your life to be a full time caregiver.
I agree talk to the doctor in charge of her care. But realize that Medicare determines whether she stays or not. If Mom is making no progress, then Medicare will not pay so she will be discharged. They have done what they could.
She has a Pulmonary doctor, right. Call him and tell him she is being discharged. Drs.in rehab are not Specialists. In the meantime, you should make arrangements for someone to stay with Mom in her home or yours until you can make other arrangements.
The only other option you have, is to file for Medicaid and get her in LTC if she can't afford private care.
Actually, her option(s) actually include distancing herself and simply requiring that the patient services finds an acceptable placement... She doesn't have to assume responsibility for move/placement if she's unable (or unwilling). The authorities simply can't place Mom out on the street, and she isn't responsible for Mom, or her expenses/living arrangements, unless she's willing and able...
You are family - call them. You’ve been alerted to DC in 6 days. Have you attended care conferences in the last 60 days to discuss your mother’s progress? This should not be a surprise.
As stated, Medicare sets the date - not rehab. If rehab isn’t being beneficial then it’s LTC NH & Medicaid. You will have to assist their SW in getting the forms filled out finance wise.
Medicare does have a Co-pay after 21 days thus her stay now is not 100% covered by Medicare and hopefully her supplemental plan will pay for this.
yes, she does need 24/7 NH placement. She has copd, on O2 for 3 years. Cannot do her treatments or take meds correctly. Im shocked nobody discussed her dc plans with me. Im the only one she has and I have tried for years to help her but I am in no shape any longer.
Thank you for your reply!
Since she's already been there for 60 days, I'm guessing she's not on Medicare Part A, which is involved following an in-patient hospital stay? I know a LOT about Part A, because that's what my Mom was covered by for a period, but your Mom might be under "regular" (Part B?) Medicare, and I don't know as much about the requirements for Part B. However, it's worth your while to find out whether the rehab facility has to follow specific Medicare rules on when and how she can be discharged...
IF it's similar to Part A coverage, then Medicare requires an incremental assessment of improvement in rehab to continue coverage at that level... The facility "guesstimates" when that level is getting close to the Medicare cutoff, and issues a discharge date to the patient. In other words, they base this date on the facility's "prediction" of when Medicare will refuse to continue payment, at which point the facility would be left holding the bag... If this is the way Medicare works in your Mom's case, then the facility must give you a page - from Medicare - setting out your rights per this "planned" discharge. (For Part A, there is UP TO a 20-day initially 100% Medicare-paid period. After that, for UP TO another 80 days, Medicare will cover the stay but require a co-payment from the patient.) The catch is the "up to" clause, because Medicare requires reports from the facility documenting measurable incremental improvement from rehab/therapy. If this improvement stops, or slows down below Medicare's standard, then Medicare will no longer cover the stay. The bottom line is, this official Medicare "exit" notice sets out the option for the person responsible for the patient (with Power of Attorney probably?) to challenge the facility's discharge date/plans. You can contact Medicare directly, from info provided on the form, and file an appeal to the discharge date. Medicare will have doctors completely review the file - the patient's history, and current situation - and then decide whether the discharge is valid under their guidelines, or whether there should be additional care at the facility. If they "uphold your appeal", the facility has no choice and must keep the patient longer... This process can be repeated a number of times - the facility notifies you of a planned discharge date per their "guess", you appeal to Medicare, and await Medicare's decision. (The same appeal is available for a planned discharge from a hospital - you can appeal based on your concerns that the patient can't be safely discharged!) One interesting factor is that the appeal usually adds a day or two to the stay, just because of the time required for Medicare's decision.
So, ask whether the discharge date is mandated by a Medicare provision, and whether you can file an "appeal" to the discharge. If you are given a Medicare form - informing you of your rights - read it! It's certainly worth a try!
How did the facility communicate with you that they were discharging?
Are you calling the correct number?
If you can't reach them first thing tomorrow, call the local Area Agency on Aging and tell them what is happening.
Are they going to send her to her own home, or to yours? Is your home her legal residence?
The facility called me wed and told me she was to be dc on tuesday. This was the first time I heard anything about a dc.
yes, I called 4 times yesterday and finally got the sw on the phone. I have a meeting at 2 today.
After reading all the replys Im assuming her time has run out at this facility.
She is my stepmom. Im the only one that had helped her but I am in no shape to care for her. She needs 23/7 nh care.
She is non compliant with all meds. She calls 911 for every little thing and ends up hospitalized for 3-4 days. This was her first “rehab” stay.
Hopefully I will impress upon them today how unsafe she is at home. Doesnt shower, lives in filth and abuses everything she gets her hands on.
I have tried for years to help but you can only help someone that wants help.
Im exhausted with her
If this is the case, be aware that Mom may have to go somewhere while her application is being evaluated and that the current NH may not be able to keep her during this process. Get that meeting with the discharge planner as soon as possible.
She has a Pulmonary doctor, right. Call him and tell him she is being discharged. Drs.in rehab are not Specialists. In the meantime, you should make arrangements for someone to stay with Mom in her home or yours until you can make other arrangements.
The only other option you have, is to file for Medicaid and get her in LTC if she can't afford private care.