My Dad, 94 years old, has been diagnosed with CHF, Afib, Advanced Alzheimer's, Dysphagia, Hypertension, and PVD. He is a very stubborn man and, despite family and friend's best efforts, he continued to live at home long after he should have been in some kind of care.
Finally, after several visits to the ER in the last month, once leaving AMA (he is a retired physician), he ended up in the ER again after choking on his food while the caregiver was there. He was admitted and kept in the hospital enough time to qualify him for 100 days in a SNF/Rehab paid for by Medicare.
He had previously been diagnosed with all of the above with the exception of dysphagia. He has been receiving PT for this condition in SNF. He was admitted to the SNF on April 14. On Friday May 7, the nurse/billing person called me to say that his Medicare would be ceasing payment on Tuesday May 11 as, I guess, he has made as much progress as he is going to make -- in their eyes. She told me I could appeal and gave me the number for Livanta. I called and, to my surprise, Livanta left a VM yesterday that the "the Physician Review Board disagrees with the termination of services...he may continue with services without interruption until further notice."
The reason that I appealed for further service and rehab was because within one week of entering the SNF, my father developed aspiration pneumonia, was put on antibiotics and oxygen. He has gotten better, but it seemed to me further rehab for the dysphagia would be best.
This is all difficult as I live 3,000 miles away, so I haven't been able to visit him since this portion of our Eldercare journey started. Also since the facility and the community he lives in is having a Covid outbreak (staff refusing to get vaccinated it seems), I wouldn't have been able to visit and assess his condition anyway.
It's just two weeks after my own Moderna vax, so I feel comfortable going to visit and deal with his house soon.
I am DPOA and Health Care Proxy for him. We want him to remain in Memory Care, possibly in this facility after I evaluate, or we may move him to another.
Can anyone give me information on what to expect when I talk to the facility and what the Livanta decision means in detail?
I did call Livanta today, but they couldn't give me any specifics, which surprised me. But what do I know? The whole process is so confusing. I would like to have more specifics before I talk with the SNF tomorrow.
Thanks so much!!!
Your Dad has a lot of health problems. MC may not be equipped to care for him. He may need to stay where he is. He may again hit a plateau and be discharged from rehab care. Not being able to swallow is serious. He may now be having pneumonia problems regularly.
Thanks so much for your reply and information. My Dad does have United Healthcare AARP/Plan J, so I believe that policy will make up the difference from Day 20 to Day 100 as long as he isn't discharged from rehab care again, which I am expecting, but will appeal again if I have to. He will be full-pay custodial care, so I am sure the facility is anxious to begin having him use his own funds, which I assume will be more than what Medicare is paying. He paid into the system for many many years, so I feel I should try to at least have Medicare pay as much as possible for as long as possible at this point.
Also good to know that Memory Care may not be able to handle his health issues. I was not aware of the differences between Memory Care and Skilled Nursing, but I am guessing that Memory Care is for people with dementias but not as many co-morbidities as my Dad has. It's been a long time since I've been to the facility where he is and am not sure of how they decide to place people in either Memory Care or Skilled Nursing.
I haven't heard from the Nurse/Biller this morning yet, so I am assuming that they have gotten the appeal decision and nothing needs to be done for the time being at least.
Thanks again! Very grateful!