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My mom, was admitted to the hospital ER on January 24, 2017 and was released from hospital care on March 16, 2017. She was discharged to a Skilled Nursing Facility. Prior to my mother's hospitalization she was independent and walking. I found my mother in a state of delirium on January 23, 2017, she had an appointment with her regular doctor on the same date, and he did nothing for her. On January 24, 2017, she was still in a state of delirium, we took her to the ER, she was diagnosed with aFib, Congestive Heart Failure, fluid in the lungs, and dehydration. She was in ICU for 1-2 weeks due to low oxygen levels, and aFib. Since she was bed bound for 2 1/2 months she is very weak and unable to walk on her own. The SNF is working with her on walking, and she does participate in all the therapy sessions. However, we cannot bring her back mentally and physically at this point, she is in a wheelchair. Her legs and feet are so swollen from fluids, according to the SNF, a diuretic has been given to her. I have seen her walk with the therapist, however, I am not for sure how she is able to walk with all the swelling of the feet and legs. The SNF states that due to her safety issue (she keeps falling) and impulsiveness; memory care would be better for her. Please note this is the SNF decision, and to the best of my knowledge Medicare has not cut her off. She has Medicare and private insurance. As far as an exact diagnosis of the mental state I do not have one, everything has been given depression, anxiety, delirium, dementia, and delirium may have triggered the dementia or low oxygen levels may have triggered dementia and delirium. The pieces of the puzzle are there, but she cannot gather and put the pieces together. She is 80 years old, and lived at home by herself before this happened. I am just not understanding the rush to get her into memory care. She does not qualify for assisted living, but with all of her health issues that need to be monitored does she even qualify for memory care? The other question that I have with her legs and feet so swollen why has SNF not admitted her back to the hospital? At the SNF I have not met the doctor, just the main nurse. The other question that I have is anyone familiar with the following case: Jimmo v. Sebelius? which basically states, the federal government agreed to update Medicare rules to require that Medicare cover skilled care as long as the beneficiary needs skilled care, even if it would simply maintain the beneficiary's current condition or slow further deterioration. The policy shift affects beneficiaries with conditions like multiple sclerosis, Alzheimer’s disease, Parkinson’s disease, ALS (Lou Gehrig’s disease), diabetes, hypertension, arthritis, heart disease, and stroke. In addition, under the settlement Medicare beneficiaries who received a final denial of Medicare coverage after January 18, 2011 (the date the lawsuit was filed) are entitled to a review of their claim denial." With her heart condition wouldn't she fall into this category, apparently this information is not widely known. Thank you in advance for reading this and any assistance you can render.

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You keep saying Medicare. Medicare does not pay for longterm, which is what ur Mom needs. If she can't private pay you will need Medicaid.
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From what you present your mother is in heart failure which is a chronic condition. And no, leg fluid in the legs does not really require hospitalization. She needs diuretics and she needs to walk for fluid to get out of the legs. It is tough work. She may soon reach the maximum number of days that insurance will cover her stay. It is difficult to answer the case study. Perhaps you should receive legal advice. And then if you pursue this route, it may take months.
I can also recommend that you request a family meeting with the SNF well before you learn that she only has a few days left in her stay.  For her immediate needs, once insurance runs out someone will have to make a decision where to go, home or memory care. I suggest you start visiting some places to see what she can afford. Denial of her immediate problem without being proactive is not prudent. You may find the SNF where she is now will start sending a bill.
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Bumping this up.
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