Hi Everyone
My 95 yo Mom ended up in the Emergency Department last evening after a fall resulting in a very swollen ankle and quite a goose egg on the back of her head. She could not walk or bear weight due to the ankle pain.
They admitted her as I was quite adamant that it would not be a safe discharge back to her home when she cannot ambulate.
I spend a lot of time at her house but do not live there. She has an Aide 3x per week for ADL assistance, meal prep and housekeeping. She does sleep alot and has experienced a significant loss of her short term memory in the last yr. She does not drive or cook...I have removed the stove knobs as well as installed hand railings and other safety features and a bedside commode. She ambulates with a walker or cane when she remembers otherwise she can furniture surf as we have strategically placed heavy furniture to assist her in navigating the first floor of her home. I also have 2 cameras in place to keep an eye on her when I am not there.
Five years ago she spent 3 mo in rehab recovering from a major stroke. She worked hard to regain mobility and strength to baseline. It was nothing short of a miracle. So she has the drive and desire to do what ever it takes to heal. That and the fact that she is sweet as pie keeps me in her corner fighting for her to age in place.
My hope is that she can return home after a rehab stay bringing her back to ambulation. So....am sure most of you know where this is going at this point!
It is an ankle sprain not a fracture...negative for UTI...CT of head and neck is negative as well. Consequently no medical reasons for the required 3 day hospital stay to qualify for a Medicare paid rehab stint.
We have started the spend down for Medicaid but she is not there yet. At this point Social/Discharge says she is in Observation status & they will continue to search for an in patient qualifier but it doesn't look promising. They can't even tell me if her CDPHP Plan F will cover this maybe up to 3 day hospital stay if she doesn't convert.
Please advise as I search through previous threads on this subject. I know its a nightmare many of you have experienced.
Thanks in advance for any advice to help me through this!
Living in a home is not the end of the world, most adjust nicely, my mother for instance is happy, glad to not be alone 24/7. She has also made many new friends, her age, very helpful as she can communicate back & forth on her own level.
Mom spent a week in the only LTC facility in our area last November for Respite and really liked the people and the food especially the ice cream. Other residents loved her and she loved the attention as they were always looking after her. It was heart warming.
When I picked her up she was laying in her own excrement and hadn't had the 1 shower I requested! And this after saying hello to 1 RN and 2 Aides just chatting away. They even stole the oversize plastic Boscovs shopping bag I brought her clothes in with! Appalling!
I won't bore you with the stopped up toilet and angry red peri anal rash she came home with. And yes this will be the rehab she will go to if approved.
That is kinda laughable to me now as I was advised 5 yrs ago post stroke to spend down just in case. I did some home improvements all to her benefit and now she is almost spent down leaving no cash for a private pay starter LTC or even a Rehab stint.
So I think what you are saying is: Refuse the discharge....insist on Rehab & go from there? It makes sense.
Bottom line tho she is willing to put in the work to heal from an ankle sprain which seems like a walk in the park compared to the work she put in post stroke and I want her to have that chance to be with her kitties and birds.
Thanks Bill and all who came to my rescue. Please read the update above...I may get my wish afterall!
OR
It sounds like she needs to have caregivers there more than 3 times a week.
either option would be a way to spend down so that she is eligible for Medicaid.
4 people basically pick/haul her up from the lounge chair w dangling legs and sit her down on the bed then place her legs together up onto the bed. Does anybody know what kind of transfer this is called? Is it a transfer? It is scary and extremely painful for her .
And away she goes to Radiology as we have now xrayed her spine due a history of back fractures as well as her hip....all negative and the pain persists.
PT did a more intensive exam isolating the pain to possibly her knee and will try again tomorrow to weight bear/walk and see want happens. Poor Mom is so tired of answering the same old question a 1000 times of "where does it hurt" that she doesn't even know anymore. She knows it s not her ankle so much anymore and says she hurts all over.
The xrays and PT eval were requested by me based on my assessment and exam when I get there after she has been moved to the recliner.
If I were not there none of this additional testing would have been performed despite the fact that they transfer her from the bed to the recliner and are aware of this pain.
Still in the same boat...no medical reason to convert to in patient status.
Because Medicare is the primary Insurance they govern the 3 day rule with required DX to convert. Her CDPHP is supplementary and therfore secondary insurance.
My moms broken hip didnt show up on the first set of xrays. There was a nice poster, DeManBro, whose mom ended up with fractured verterbrae; the hospital thought she was "faking" the pain.
Keep advocating!!
No they have not xrayed her pelvis. Will consult De Man's post.
It could be her knee as the swelling there has increased.So what xrays and further testing should I ask for today???? Radiology is not my field...need all the help I can get.
A GF says an MRI is in order. Dr did say no to that yesterday with regards to her hip.
I feel like I am the DR! Based on my daily assessment of Mom I ask the nurses to have the Hospitalist to come see me and I show him where her pain is and without much of an exam by him at all he follows my instructions!
Whats wrong with this picture? As long Doc keeps listening and I get advice from everyone here maybe its all good.
Thanks Barb...am even more distraught now with no answers and Mom now inactive for 4 days...they heard crackles yesterday. :((
I feel like Rehab is the best opportunity now to PT her ankle back to baseline.
Am not at all confident in the Nursing Care at the only LTC facility in my area but the Rehab Department is excellent.
And maybe what u all are trying to politely tell me is that a 95 yo has a slim chance of recovering. I hope you are wrong but I do know you could be right in which case I will concede.
Al tho I have not contributed much to Aging Care lately I am here taking it all in from you wise and generous folks. The gift of the time you all took to reply is melting my heart.
Here is the update since my post: The Hospitalist decided to treat her empirically for a UTI with IV antibiotics hopefully necessitating a 3 day in patient stay and thus triggering the Medicare Rehab stint.
I explained to him that the ED obtained a stinky stinky stinky dark yellow cloudy urine specimen only to be rejected by Lab Staff for a labeling issue. The subsequent specimen obtained after hydration in the middle of the night was negative but the optimum specimen is first AM void. He palpated her tender tummy and HEARD me! Yay!
At least she is not being sent home today unable to ambulate as the Case Worker threatened this morning.
I applied for Medicaid for my Mom. I had 90 days to give the caseworker all the paperwork required. Cash in her insurance policy and prepay her funeral with it. And place her in a NH. I stared the process in April. Placed her in a NH on May 1st paying privately for May and June. ($18,600) This took Mom under the $2k cap needed. I confirmed with the caseworker that he had all the paperwork needed and Medicaid started July 1st.
Just one more chance :))
They mis-read the initial xray? And they won't admit her? I think you need to talk to the Patient Advocate office at the hospital. Now.
Ortho casted it on Wed with instructions of no weight bearing for weeks.
Can you imagine being forced to ambulate on a fractured ankle by aides and your very own daughter?
I met with the Director of Nursing, the Resource RN and the Hospitalist without much satisfaction. My every complaint was met with an "OK" by the Hospitalist. I stared him down and said "Not OK" to which he replied "all right." I then said "not all right either." I thought any minute someone was going to yell "Candid Camera!"
I had actually met with the DON day 2 as Mom was with out a drop of water in site one morning and she was left in the same position in a chair for over 8 hrs the day they put the cast on. Just found out today about the Medication error. Everyday I walked into a "WTH?"
The DON encouraged me to speak with the Patient Representative but at that point I was exhausted and Mom was being discharged never having achieved In Pt status. Figured I had nothing to loose when I said neglect was mandatory report able as was malpractice and that I'd rather have the next conversation with NYS and Joint Commission.
Mom is pushing thru the pain and has ambulated 6 times over the wk end achieving a distance on one occasion of 20 ft. With the walker she sorta hops on her sprained ankle.
Am still campaigning for that Medicare funded Rehab Stint. Will ask for the Failure to Thrive DX today. Am praying it works.
Her wk end RN said they were looking for LTC for her? What would that look like as I dont want to sign her in for LTC? Or will I have to and after successful ambulation with PT which is on site sign her out?
This facility houses both LTC and Rehab.
See All Answers