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My husband is in a state owned VA facility. They are requesting that I pay for a one to one companion for him due to frequent falls due to his diagnosis of orthostatic hypotension. He is in a memory care unit due to dementia.He has been there for almost 3 months and has had 3 falls since his admission. The near falls are much more since they have been providing one to one for him. I was recently informed that they can no longer provide this service due to staffing. I was told that I need to provide this service for him through my own funding. He has a VA connected disability rating of 90%.This would be difficult for me. Do I have other options? He also has a Medicare Advantage Plan through Independence Blue Cross.

I’m sorry—repeated falls and orthostatic hypotension make this a safety and care-plan issue, not simply a private-pay decision. Ask the facility in writing for: (1) the assessment supporting 1:1 observation, (2) what level of supervision the care plan requires, (3) why facility staff cannot provide it, and (4) the grievance or appeal process and deadline.

Request an interdisciplinary care-plan meeting with nursing, social work, the administrator and the patient advocate. Ask whether safer alternatives—fall precautions, room placement, scheduled checks, therapy, or a medication review—could meet the need, or whether a different setting is required. Because this is a state veterans facility, ask its social worker or patient advocate what VA-funded options may exist. A Medicare Advantage plan generally does not pay for a private companion simply because a facility lacks staffing; coverage depends on the medically covered service and plan authorization. Before signing a private-pay or coverage-change agreement, ask for the terms and alternatives in writing.
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Reply to medicaretools
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He needs a wheelchair to solve this problem
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Reply to MACinCT
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You tell them that you don't have the resources to pay for someone to be with him. That would cost you thousands a month.
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Reply to JoAnn29
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[ Moderators please relocate this post to the Questions section, thx ]
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