My mother fell at home and broke her hip. She had surgery, and will be admitted tomorrow to the nursing home for rehabilitation. She is 80 yo, and late stage dementia. She does not have a POA, dad makes all the decisions. We've asked him to assign one just in case, but he has yet to do so. The facility said that her insurance would pay for 20 days, and then we would have a co-pay of $400. We plan on signing her out after the 20 days. Dad can't get out of the house to sign her in, and has given permission over the phone for me to do so. They are asking for my dads banking information, and he doesn't feel comfortable sharing that. Do we have a right to refuse giving that information? What wording should I watch for to ensure I don't put the responsibility of payment onto myself, or my father? I'm also a bit concerned that if she doesn't progress in therapy, they will try to keep her against our will. Is that possible?
She gets in tomorrow/Wed. PT/OT does evaluation that day or Thurs AM. She has Day 1 PT Thur. Day 2 Fri she goes to AM & PM sessions but unable to actively follow directions. Her chart sent to Medicare for EOW report. Nothing on the weekend. Mon Day 5 she’s unable to follow directions for AM session & PM session & complaints that she’s tired or hurts. Once Medicare gets this, her chart is red flagged. Same thing Tues Day 6. Same Wed Day 7. Realistically 8-10 days.
By following week Tues, she’s 3 sequential days of being non-compliant for care. Next Wed Day 8 or Thurs Day 9, Medicare issues discharge from rehab Notice to the SNF and her. Rehab stopped due to her being non-compliant for care. She can do an appeal but at best that’s 1 or maybe 2 days she can remain there. Appeals heard really fast and her non-compliance for care is all documented in real time in her health chart. Basically she has 24 hours from the Notice for a decision to be made as to where she is to be discharged to.
Went thru this with MIL. She refused to go down to in-hospital PT & OT after hip replacement surgery. They came to work with her bedside and she said it was too much pain and she was all about asking for blankets, better food, TC stations, yada yada. Did it as minimal as possible. She got discharged to SNF where she did the same thing. When they would come to fetch her to go to down to Therapy room, she did it 50% of the time. We were not in the least surprised to get the early discharge from rehab Notice. Mil went Medicaid Pending that day. Beyond fortunate that this SNF had open available LTC Medicaid beds.
Right now as she is hospitalized, her health insurance is paying. & her health insurance can pay for rehab. If she stayed on Original Medicare, it pays rehab 100% for up to 20/21 days if - IF - she is progressing. Medicare can pay up to 100 days in rehab if warranted but there will be a rehab in a SNF copay of $210 a day after day 20/21. The $210 copay usually covered by a better secondary / supplemental/ gap health insurance. If your folks stayed on Original Medicare but do not have a gap policy, SNF will want info from them to deal with required (by Medicare) copay billing. Routine for rehab/SNFs to request.
BUT if they switched from Original to Medicare Advantage Plan, how it pays varies wildly. I bet they did this as you wrote “Part C”. Advantage designed to pay for care entirely in network. NH & SNF out of network & copay will be significant. If they are MAP, the NH will absolutely want info for their copay billing as that Advantage will be paying as little as possible.
What do your folks have for health insurance?
As an aside, imo It would be beyond unusual MAP to go beyond 20/21 days. I would not be surprised, if they pulled the plug even sooner using criteria that she is unable to do follow required for therapy while a rehab patient. If mom is asked “MrsFuzzy do you want to go down to PT” and if mom answers “no I’m tired, I hurt, etc” and mom does this couple of days in a row, she will be written up as non-compliant for care. If she goes down to PT & cannot try to do the exercises with the PT & OT, again written up non compliant. Health insurance gets these reports quickly. Being noncompliant means within 24/48 hrs, she will get rehab discharge notice. If her dementia is more end stage & on an Advantage Plan, I bet she gets 8-10 days rehab as cannot do what therapists ask of her. LSS 20/21 days NOT guaranteed!
You wrote “we plan on signing her out after 20 days”. A couple of things: 1. If y’all do this, SNF can attach to health chart that she left AMA / Against Medical Advice. Can pose problems for future care and placement. You want to avoid this being in her chart.
2. If she cannot walk independently, or transfer from bed2chair, do toileting & bathing, pull up panties, just who is going to be the team doing all these things for/with her at home? If she’s bedfast, it will be a constant challenge. Your bro has his hands full dealing w/ESRD Dad. Bro cannot be expected to care for them both. Who is moving in FT to be there? Or will in-home-health be paid by parents to come in several days a week and then y’all for free do night and weekends?
Vast majority in a NH as custodial care residents, entered NH as post hospitalization rehab patient. Segueway from rehab patient on health insurance to a custodial care resident. Custodial is private pay, LTCI or LTC Medicaid if low income/anssets enough. By being there for rehab, she will have the medical “at need” documentation needed by LTC Medicaid program. LTC Medicaid will require pretty deep financial information to be “at need” financially eligible. If folks want any type of governmental support - LTC Medicaid, Home & Community Services, SNAP - financials required. If Dad refuses to provide info facilities or programs need to do eligibility, either they will private pay for care or you kids pay this for them or yall do it for free. fwiw Facility will still bill and if unpaid will turn it over to collections.
Really have a family meeting to decide on what path asap.
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Where is Dad getting dialysis ? If DaVita or Fresinus, my understanding is they require their clients to have POA and MPOA on file.
Medicare does not pay for long term care, but Medicaid does, if your mother has limited assets. I would start looking at long term nursing homes now, so you can choose one when she is discharged from rehab.
The alternative would be to send mom back home again, with hired caregivers, and hospice care, if she qualifies.
If your mother and father are both so weak they can not take care of themselves, perhaps consider selling their home and moving them into an assisted living facility together, or separate accommodations, if that is what they need.
Their money and assets will need to be used to pay for their long term care, and if/when their money runs out, they should be eligible for Medicaid.
As for signing anything, just make sure you are carefully reading anything that you sign, and that you are not signing to be liable for payment. I would NOT share your parent's banking information! As her husband, your dad might be responsible for any payments incurred. It would be good to speak with an Elder Law Attorney about separation of assets.
There is a possibility that your mother will not be a safe discharge. If doctors fill our forms saying so, prepare for Medicaid application. Your parents financial info will need to laid out. Spend down will be inevitable which might mean your family needs legal assistance. You can also choose to do nothing, which leaves the nursing home to petition probate court to appoint a guardian and conservatorship. The choice here is who in the family wants to take on this burden or not.
Is he there voluntarily? Is he doing this caregiving voluntarily? Does he have a job? If not, is he financially secure for his own future once your parents are gone? Is he relying on inheriting the house or other assets, which may instead need to be used to pay for your parents' care? Do you need to come up with a plan to hire additional care (out of your parents' funds) to assist at home, or to discharge your mother to a facility when rehab is up, and possibly move your father to one as well?
This may be all planned for and under control. But I raise the questions in case any of them need to be addressed.
I would have Mom evaluated for 24/7 LTC. It will not be easy caring for her now and Dad won't have the strength to do it. Not fair to brother to take care of two people one his Mom.
I and my other siblings are rotating staying in the hospital with mom.
Dad is on dialysis 4 days a week, and overall very weak. He only leaves for needed appointments.
If you are planning on her not staying longer than the 21 days that Medicare covers in full, I do not see any reason why you need to provide any financial information.
I did rehab check admittances several times for my parents over the years and the facility never asked us to provide any financials.
Since she has advanced dementia, if you think she might be better off being cared for in this facility under Medicaid until the end of her life, contact an eldercare lawyer. The lawyer can help structure your parents' assets so that she can qualify for Medicaid. She could go into the long term section of this facility under Medicaid Pending status.
Good luck to you as you go through this stressful time, it's not easy.