Mom broke hip and rehab will not keep her because she will not walk again. How do i get help? - AgingCare.com

Mom broke hip and rehab will not keep her because she will not walk again. How do i get help?

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I cannot handle her recovery at home! They told me at her 2 days after they filled their bed at rehab that because her orthopedist sed she should never bear wieght on that leg again they cannot show medicare any progress therefore cannot justify her stay there. If I put her in a home for recovery we cannot pay our mortage and bills...i dont know what to do but am furious that money will dictate her quality of care.

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I'm sorry to hear this. It truly is sad that money does dictate so much. You will probably have to see if your mom qualifies for Medicaid. Then her nursing home bills will be paid. You'd have to apply through your local social services.
A broken hip is one of the worst injuries an elderly person can sustain. I hope she can at least be kept comfortable.
Take care,
Carol
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Medicaid is supposed to leave a person their home and one car if their intent is to return to the community, and they may have a waiver program that provides daytime help at least too. I eventually ended up selling my mom's home, but not until it was very very clear she could never go back, and we never did end up getting Medicaid for her. This was even though she was able to stay at home for a time while my Dad was on Medicaid and covered much of his nursing home care. Don't get me wrong, they are not generous, and they are not in the business of preserving inheritances for children of needy parents (look up "estate recovery program"), but they do not necessarily make it impossible for people either. And you should not have to try to do something you know you can't do. You might be able to find a caregiver training program for some of the physical skills, or get the hospital PTs and nurses to teach you but don't even go there if you know you cannot do it with whatever help and equipment can be lined up.
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Have you spoken to the doctor yourself but why would the doctor send her to a rehab if he did not think she would benefit. I don't know your mother's particular condition but my mother was in rehab twice for broken hips and they can't bear weight initially since it is healing. From what i remember the doctor does x rays every week or certain number of weeks after a hip fracture to see how it is healing. You can appeal the rehab's decision to discharge. If the dr thinks she can improve she would do better staying at rehab, if they are making an effort. Perhaps you could go to the therapy sessions and observe (which is what I did). when they know a family member is watching they have to make an effort. If she does go home you can get physical therapy at home on medicare but as i said, it is better if they start off in the rehab.

do an internet search for the words "how to appeal a rehab nursing home decision to discharge medicare" and you will find an article which includes this info.

They must give your parent a written Notice of Medicare Provider Non-Coverage (NOMPNC) form at least two days before the anticipated discharge date. On that form there will be information about how to contact the relevant "Quality Improvement Organization" (QIO). The QIO is the group that reviews these cases and makes determinations about whether care should continue.

If you haven't received a NOMPNC at least 2 days before the discharge date, the facility has to keep your parent until at least two days after you do receive
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It does not seem right that they sent her home without arranging for any at home care, nursing physical therapy. did you attempt to appeal the decision? If your dr thought she would benefit from therapy you could submit a letter from him. Meanwhile, can you ask the dr to order in home therapy and help with bed baths. Medicare does pay for that usually when initially released from a rehab. do you have a hospital bed? Ask your dr if she would qualify for that and ask him to write a prescription. Would she qualify for medicaid or any state program that is designed to keep those who otherwise would qualify for permanent nursing home placement to stay in the home. they provide a certain number of aide hours and meals and other things. In my state it is called the waiver program - the long term care nursing home diversion waiver program.
i see you live in Oregon. I thought Oregon was known for providing some of the best resouces and funding for elder care. have you called
have you check this oregon site for contact. her dr can be your best help b/c if he orders something, ususally it will be covered.
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if you get in home therapist, they can teach you how to move your mother without hurting her or yourself . I wouldn't take the rehab facility as the last word, unless they assisted you with an appeal with the insurance or agency denying you assistance you you lost.
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I assume you have consulted an elder law attorney re the issue of the home and medicaid and any possible options? Also, aren't there other programs that allow higher income /assets than medicaid but still provide some in home care to avoid nursing home placement? i would think if your mother does not get proper care at home to prevent bed sores etc and ends up hospitalized, then govt via medicare has to pay more so it should be in govt's interest to provide less costly in home support.
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Juju - 2much & Kiwanis has given you some good advise.

I'd like to add my experience in dealing with the elder having a home, it's expenses and MERP (estate recovery after death). Yes, their home and a (1) car is an exempt asset for Medicaid. However, the $ the elder has after they get into a NH is usually limited to whatever your state has set as their "personal needs allowance". The $ varies by state - just as the Medicaid rules vary by state.
My mom is in TX in a NH on Medicaid and still owns her home. Her PNA is $ 60 a month and is totally spend on stuff she needs to live at the NH like cosmetics, clothing replacement, hair salon. The reality is that the PNA is designed for doing just that and no more. Some states have a PNA as low as $ 35.00 a month. All expenses for her home (taxes, insurance, utilities, yard stuff, etc) is paid for by myself & another family member, there is no mortgage and the property is modest and we are fortunate to be able to do this. BUT if there had been a mortgage (traditional or reverse), then the house probably would have been sold as the monthly mortgage costs would have probably become an issue eventually. Now when she dies, we will let MERP know within 30 days that we will file a claim against her estate for all our expenses related to the empty house. This has to be done in our state within 30 - 45 days in order for the MERP expense exemption to be done.

As you live in the house and have been a caregiver for more than 2 years, you qualify for the caregiver exemption, but you will need to properly file for the exemption with your state's MERP program so there is not a problem with a MERP claim or lein against the house later on. My mom's state (TX) has all this stuff on-line so it's easy to find. You need to remember to do whatever your state's MERP program wants after mom dies and within the timeframe set by the state.

Now once they are in a NH on Medicaid, all their monthly income less PNA must be paid to the NH. If they get $ 1200 a month, then the NH get's paid $ 1,040.00
if they live in TX. So if you want to keep the house or live in the NH, the state expects you to pay on your own whatever to do that. If the house has a current Realtor listing, then you can apply for a waiver to divert some of the monthly money to pay for whatever needed to have it market ready. This usually is limited to a couple of hundred $$ to pay for yard, utilities and seems to be limited to a few months as it is expected that the house will be sold. But if it's the situation, that you are living in the home, the state expects you to pay for all without ever coming back for a claim for expenses. The expense claim seems to only be able to be used if the home is considered empty.

The cost of the mortgage is the big issue here. Can you on your own continue to pay the mortgage? Or do you really truly need mom's income to do this? How much is owed and is there anyway to pay it off completely? Go through the mortgage paperwork to see how to do an early payoff and what it might cost you.I'm assuming this is a traditional mortgage or a HELOC and she has owned the house for quite a while and there is alot of equity in the house and most of it has been paid off. If the amount owed is just for a few years more and you can possible pay more on the mortgage each month, look into doing that. Even if it is just like an extra $ 75.00 a month added to pay down the mortgage. You need to do whatever you can so that you don't find yourself homeless. Good luck.
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A therapy plateau no longer ends Medicare (yes, I mean Medicare, not Medicaid) coverage. You can read about the new rules in this New York Times article from February 4, 2013
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There was a recent finding in a US District Court in Vermont entitled Jimmo vs Sebelias. I would google this finding and then fiind an elder care attorney. Based on this ruling Medicare cannot discontinue just because the patient is not responding. Also call your state Ombudsman and see if he/she can help, but I think the Jimmo case is really important.
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Yes Medicaid is next however, they will tap into most of her income so i cannot make her mortage payment! She is doing remarkably well but requires two to move her as her shoulder is broken as well. I live alone with her and have no family or support system i dont know how I can manage changing diapers and moving her alone here! I am only being offered few hours a week in home PT. and she does have a nonskilled bather/caretaker 4 hrs week but they cannot be on call for help as needed throughout the day/eve
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