My mother has United advantage Medicare and they are not paying for hardly anything,my mom has been on the hospital now for three weeks and I'm trying to figure out where to put her. She wants to go home but the hospital staff hasn't helped me set up home care or help with setting up anything. They are causing difficulties and threatening to put leans on her home for non payment and says she has to pay out of pocket which soon it will total the amount worth of her home,also there is a squatter living in my mother's home which is trying to take ownership and preventing my mother from coming home,she has even had medical equipment returned or turned away and the hospital is telling me that it's on me to make sure the equipment is delivered and since the squatter is causing difficulties and could be dangerous the hospital says it's my responsibility to get home care ready for my mother up on arrival and I would have to move in and be there at all times to provide care and ensure safety, they told me I would be responsible for anything that would happen to my mom if I wasn't there and anything happened but if the squatter is dangerous what do I do for my safety and can legal action be forced on her for being a threat and coming in between my mom's health care at home should the hospital be piling this on just me and then they do not respect my boundaries or anything I ask they call my phone back to back up to the most of 8 times and I have had to record conversations with hospital case manager due to her twisting my words and making situations happen that I have no idea about or going against any plans of care I arrange this is all confusing
- Hospitals do not provide long term care. They will only "treat" an ailment as medically necessary, then the patient has to be discharged.
- The hospital can not make those plans for you, although there is often a social worker who will meet with you (or the patient) to suggest your options.
- It is NOT YOUR responsibility to "be there at all times to provide care and ensure safety" for your mother.
- In fact, I am feeling that you are already too involved, so the hospital is making this your problem. It's because you look like you are accepting the responsibility.
The hospital just needs to get her discharged, and they will look to you to make it happen. Do you have POA or medical POA for your mother? That could complicate things, because then it is your responsibility.
- You, and your mother, are facing so many challenges - with a squatter in the house who won't leave, the bills piling up that she won't be able to pay - and her bills are NOT YOUR responsibility.
- Seek the help of a certified elder attorney, if you can. If you feel you can't manage these insurmountable challenges, call APS and allow the state to take over guardianship of your mother.
- If you feel you can manage this, YOU need to tour skilled nursing facilities, talk with an admissions director who can answer all your questions, and choose one to have your mother transferred to. Pronto! You are paying out of pocket (your mother is paying) for days in the hospital because there is no medical reason for her to be there. They are done treating her, that's why insurance won't pay.
- If you feel you can manage her care at home, bring her to your home.
- If money is a concern, contact the local county Medicaid office and get your mother applied for Medicaid. When her money runs out, they will pay for nursing home or home care.
- Get that squatter out of her home! Call the police and tell them the person is trespassing! Change the locks. Keep them out!
The issue with Advantage is they really work best only for those who are still healthy and capable of only going to and needing care that is only done within the hospitals & clinics that this exact plan has agreements with. Post hospitalization rehab services happen mainly in SNF which are usually out of network so there will be a copay. So getting her placed into easily will be difficult but there will be a NH rehab that will take her. The usual path is hospitalization followed by a short term rehab then a determination made if they are ok to return back home or are best staying at the NH going from a rehab patient to a custodial care resident.
So the hospital is not suggesting that she should be discharged to rehab? That’s unusual. I’d suggest that you try to find out why this isn’t happening and see if it can be. It would give you a few days & maybe couple of weeks to figure out her home with a “squatter” situation, while she is getting rehab.
What’s the backstory on that squatter? Is it a squatter or a tenant? Is a huge difference as to how they can be legally removed. Google how this is determined for your State. Easiest way to get rid of a tenant is “keys 4 cash” as tenants rights can work in their favor for long periods of time. You mentioned the squatter was “trying to take ownership”, if that’s actually true then they would be doing an adverse possession. Adverse possession in reality is hard to accomplish as you usually need 10+ years of continuous presence and doing something continuously of value for the property like paying its taxes or maintaining its yard. Do they have this??? Both need to go thru an eviction process based on type…. tenant or squatter.
Fwiw when there has been a significant change in their status, then they can file to leave the Advantage Plan and back to Original Medicare. That is probably what will need to happen for health insurance. But she or her POA have to do whatever necessary for this. Original Medicare and a gap / supplemental secondary health insurance would probably will work best for her. If she’s low income enough she could get Medicaid for her secondary plan.
My mom chose Advantage plans from the beginning so we did not have the option of going to a supplement later but the cost would have been out of reach so I carefully review Advantage plans each year now.
What city and state is the OP’s mom in because that will make a huge difference. If the OP has POA, I’d start by calling the insurance company to get the story.
Good luck to you.
You need to call her Medicare Advantage and find out what is going on. This is why I don't have one. I may even call an Ombudsman.