My mom is 90 and fell and broker her arm and has been in a Skilled Nursing Facility for about 35 days. Before she fell she was driving fine and is very extremely cognitively "with it" and has lived alone pretty much doing fine although she tires very easily. For the past week to 10 days in the nursing home she has been walking independently with no walker or cane. When the PT and OT evaluate her she is able to do everything with absolutely no assistance. She can go to the bathroom by herself, make a meal in the microwave by herself, dress and undress by herself, do a full set of stairs up and down by herself (holding onto the hand rail). She is slow and careful, but she's been through two evaluations and each time they say she is just a little tentative and therefore they won't clear her to go home.
The problem lies in that at day 31 of her stay, her secondary insurance stopped paying and now she is paying $167 per day co pay. She has a very low income and can't afford this and wants to go home. She has had fantastic PT and OT seven days a week and is actually in better shape than before she fell... but they won't clear her, so she has decided that she is leaving Against Medical Advice to go home. Her primary doctor who knows her quite well has already agreed to coordinate home PT and OT and other social services she might need... she does get tired very easily due to congestive heart failure so she receives Meals on Wheels etc.
My question is... should I be worried about her leaving Against Medical Advice? Someone at the nursing facility mentioned calling Adult Protective Services if she leaves and while my main concern is for my mom, I am also worried if I'll be responsible if she goes home and something does happen... if she falls. Also, I heard that her secondary insurance might not pay if she leaves AMA.
Unfortunately, I live a couple of hours away. I told her tonight that I think she should stay until they clear her, but it seems that she has to be absolutely perfect in the evaluations for her to be cleared. I understand that they don't want to be sued, but it seems ridiculous. She is is in so much better shape than any other patient in that facility by miles. Everyone there is walking with a walker or they are in a wheel chair or bed except my mom. She doesn't even look like she belongs there. Even the PT and OT techs are whispering to her that she should be discharged and they don't understand why they won't clear her.
Is this Medicare fraud... trying to keep her there so they can bill for her stay? Why else would they not clear her?
Any advice is appreciated.
This is what is the real problem. The facilities taking over our loved ones, them deciding what is best and making the decisions. Many times it is money motivated. They will usually decline once the PT is over. I know of someone 91 and living home alone. They try to make a big deal out of normal older aging things. They try to diagnose them with dementia, when it is just normal forgetfulness of old aging.
They love to threaten families. Im sure you would not want her to go home if you felt she was not safe. Help her keep her independence as long as possible. As far as being low income, call your local Office on Aging. They can get you connected with State Assistance Programs that can have meals deliever, aids out to help, and many other servcies.
If you get the doctor and Office on Aging to assist, their threats will mean nothing.
Do what is best for your mom always!
Prayers to you and your mom
A care conference is essential.
I was told my Mom, even with a walker, would need assistance at all times when she returned to the AL. I questioned it because she was only in the hospital, for a UTI, from Tues to Friday. Before that she was walking all over the AL with a walker. When she returned to the AL within 24 hrs she was again walking all over the place.
I really don't see how they can get better when they do PT, OT for maybe a couple of hours a day and then sit them in a wheelchair the rest of the time.
But don’t let her sign out AMA for reasons stated in previous posts.
There is a reason they aren’t discharging her and I don’t think it’s fraud. There are probably other folks needing rehab in the wings.
IMO you should visit ASAP & assess for yourself.
Is her home set up to assure she can manage to care for herself? Does she have a Lifeline device to press if she falls again? Her level of care may have changed and her home may need modifications.
They will reassess her and order in home PT and OT, Medicare pays for these services. If she leaves AMA they will most likely resist paying.
I was told that my dad needed 3 to 4 more weeks of SNF but the next day his insurance said they would not pay anymore and overnight he progressed enough to go home. Amazing!
Please make sure she really is ready and able to go home. Try to get the insurance company to do an exception pay if she's not ready. Cheaper for them in the long haul. Then everyone can be assured that she will continue to do well.
My 87 year old Mom did NOT have to pay for anything when she was in Skilled Rehab because her BCBS Medicare Supplemental Insurance covered what was not paid by Medicare.
You and your Mom need to contact the Secondary Insurance Company and find out WHY they quit paying for her care and why she is having to pay a Co-Pay? What part of her care did the insurance company quit paying for? Sometimes nursing homes make mistakes on the forms that they have to send to Medicare and to the Medicare Supplemental Insurances which can result in nonpayment or a lower payment from Medicare or the insurance company.
Also, have a meeting with the people who make the decision as to whether your Mom can go home or not. Ask for the specific reason(s) why your Mom cannot go home. What do they mean when they say that “she has to be absolutely perfect in the evaluations for her to be cleared”? Is it something as simple as the need for a permanent grab bar in the tub or shower? Does she need rails on the toilet? Do the dishes in the kitchen cupboard need to be rearranged so that she can reach them easier? Is the microwave TOO high for her to use safely? Does she need better handrails on the steps into her house or inside her house? Do the people who make the decision think that there are TOO many steps into your Mom’s house and are afraid that she might fall trying to walk up or down the outside steps? Are there area rugs that need to be removed so that your Mom does not trip over them? Does your Mom have an “Alert button” in her house that she can push in case she falls again or does not feel well? Find out what is keeping “THEM” from releasing your Mom to LIVE BY HERSELF again.
WHO at the nursing facility mentioned calling Adult Protective Services if your Mom leaves AMA? Did they give a reason why they might call APS other than “your Mom left the nursing home and you took her to her home AMA”? What are their concerns?
You need to ask more questions and find out exactly WHY "THEY" will not let your Mom go home. It might be because she is 90 years old and you live 2 hours away. You won't know unless you ask them. Good Luck.
Thankfully across the hall from my office was a sport's doctor so he helped me straighten out my arm. Due to the break I had the physical ability of a 3 year old child since it was my primary arm that broke. My handwriting was that of a 3 year old, so was my eating trying to manage a fork with my left hand, what a mess.
Getting dress was a major challenge, especially putting on a bra, and tying shoes. Had to type one handed, oh well, that's the norm with some people.
Thank goodness for on-line grocery shopping, otherwise all meals would be based on what was on the middle shelf at the grocery store !!
It took me 3 months of going 3 times a week for therapy. Thus, recouping from such an injury can take a lot of time. Plus one's mind is in a tizzy afraid falling will happen again.
For your Mom, the facility said that she is a little tentative, thus that tells me she isn't quite ready to go home. Do check with the social worker at the nursing facility to see what can be done regarding paying for the extra days.
I love Joann's suggestion to tell the facility you have NO money to pay for further services. I'll betcha too that they release your mom pronto.
Best of luck!!!
Go to the finance office and tell them Mom has no money for the extra days. That they need to discharge her or agree not to be paid. Bet she is discharged. Mom can do therapy at home, I think. Check that out with insurance provider. If they do nothing, call her primary. If get nowhere with that, call your state Ombudsman.
I would seek a second opinion from her own doctor, not the doctor at rehab. I am assuming they are different and employed by different employers? If that doesn't work call Medicare to discuss the issue. There is probably a policy in place to address these sorts of issues.