Because of a question someone else asked about Medicare rehab, and people referencing the Jimmo settlement in their answers, that was the first I'd ever heard of that! And, I think, the first that the nursing home my mom is in had heard of it, too!
My mom is 81, has Parkinsons (no tremors, but had gait and balance problems), mild Dementia (affecting short-term memory) and kidney issues. She has been able to stay living at home independently thanks to the Medicaid Waiver which provides home health aides every day for 8 hours (split between a.m. and p.m.), weekly nurse visits who fills her electronic pill box, and a Life Alert pendant. She's been doing pretty good until recently. In mid-May she caught a cold which then turned into pneumonia. Her cognitive skills have declined and so far have not improved even though the pneumonia was gone by 5/24. She fell a couple of times or slid out of her chair (leather recliner) and wasn't able to get up on her own so EMS had to be called for lift assist. On June 7 the aide arrived at her house for her 9:00a.m. shift and found my mom on the floor in the kitchen. She had fallen at some point. She was conscious, but for some reason had never pressed her Life Alert button, so we don't know how long she was down. EMS took her to the hospital and due to the unknown time, dehydration and rhabdomyolysis they admitted as an in-patient for 4 days. So that qualified her to go to a nursing home for rehab under Medicare (instead of Medicaid). On June 11 she was discharged to the nursing home. Last Monday was her first care conference (which I attend via phone as I live 2 hours away). Today was the second one. They are not optimistic about her being able to go home as they are not seeing much improvement. She has been walking more (with a walker), but she still is quite confused and needs help with pretty much everything - dressing, bathing, toileting, figuring out how to position her body to move around people/things when walking.
But I'm thinking "she's only been here 2 weeks!". She was there 2 years ago after pneumonia (under all-Medicaid that time as she did not have the in-patient hospital stay then) for rehab and she was there for 5 weeks at that time, and she WAS able to go home then. I know 2 years is a long time, and maybe her conditions have changed to the point where it's not safe for her to live alone now, but it was like a light switch was flipped. Before she got the cold/pneumonia last month, she was FINE. And then boom - major confusion issues that haven't yet seemed to start to go away. But I feel like she could improve given more time before pressing the "Easy Button" and saying she needs to stay at the nursing home forever now.
So at today's care conference they gave me the 2-days notice required to let us know that Friday would be her last Medicare-covered day, and as of next Monday she'll be there on 100% Medicaid. I think she'll still get therapy, but not at the same level as what she's had the past 2 weeks.
I brought up the Jimmo settlement and read right to them about maintenance nursing and therapy, and preventing or slowing further deterioration, and how she can't be denied based on the absence of potential for improvement, etc., and no one sitting around that table seemed to know what the heck I was talking about. I told them I was going to appeal the decision and they said they'd fax me the papers.
So my question is....how involved is the appeal? Do I need doctor's notes, etc.? Do I just cite the Jimmo settlement and explain how it should apply to my mom? I need to get my ducks in a row to do this appeal process and try to keep her under the Medicare coverage for SNF/rehab, as least another month or so, until I am more convinced that she's not going to recover to the point where she'll be able to go home.