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.
-Retired Nursing Home Adminstrator.
Is what it sounds like!! and you just tell them you are going to be staying with your mom! and that you have private caregivers set up! not to mention neighbors, and family !! Do not say any more than that to them .and you can call the onbudsman yourself !! My daughter checked herself out of the hospital against medical advice she was16 nothing happened ...call a lawyer they talk to you free and will give you advice but if mom Can not aford it then they are wrong !! I have my aunt and mom at home .....but I NEVER EVER EVER LEAVE THEM ALONE NEVER, My neighbor lives alone and shes always alone!!after falling ! IF MOM IS WITH IT THEN its OK but just to be safe stay eith her at 1st ..good luck I dont want to say the wrong thing because i do not actually see and know except what you say and I beleive you ...but sometimes we may think our parents are ok to be alone because we may not have seen the dementia sometimes they can cover it up very well but not for long GOOD LUCK!!!
I did this because several years ago the hospital was going to put my husband in a skilled nursing facility to teach him to walk. To make a long story short, he had been walking fine when they admitted him for a heart problem. They had kept this 83 year man in one position for a week. No turning, no moving around. The last day they had a Physical Therapist get him up and he had a hard time walking. I told them it wasn't going to happen. All he needed was to get up. They were getting the AMA paperwork ready when (Wow) the regular release papers showed up. In an hour he was walking just fine. All he needed was to move around a little bit. Of course I am leaving out my "talks" with the Doctor and a lot of other garbage.
https://www.medicare.gov/coverage/skilled-nursing-facility-snf-care
It is the role of the discharge nurse to arrange for home care.
Follow the previous good advice.
I would like to add that you may have a doctor in charge sitting on the fence.
On one hand, he/she is saying your Mom can receive the needed care at home.
On the other hand, he is listening to staff say different.
On his third hand, if there is a real medical necessity for her to stay, doctor should be writing for an extended stay appealing the insurance decision, seeking medical approval for a longer stay (longer than Medicare has allowed for what is usual, customary, and reasonable for Mom's condition UCR).
This means, there is not enough information yet. When no one is running the show, exploitation runs rampant. Especially during the holidays, neglect to follow through.
If you are afraid Medicare will not pay for her nursing home bill if she leaves AMA, I have previously researched this with Centers for Medicare and Medicaid Services (CMS) and that is not true. It is another falsehood nursing homes tell families and residents.
Your mom may fall at home. She may fall in the nursing home. But, she will likely get stronger at home with therapy where she has to do more for herself---but more importantly she will be happier at home.
Very informative and helpful. It is good to know terminology and what is available because I have found you have to ask for things but unless you know about them you can't ask. The don't tell unless they ask has gone to far with our vulnerable citizens.
Thank you.
At the conclusion of a very recent ER visit, they did they usual - can she walk with walker, etc... Mom has dementia, has been using a walker for almost a year, has been in MC for almost 2 years. She was there to figure out why she is having extreme leg pain, enough that she has difficulty dressing, showering, walking and sometimes refuses meals because she is in so much pain. That said, she was NOT able to stand for them, not even long enough for me to pull up her panties and pants. She could/would not walk with the walker even with two staff members by her side, yet they discharged her. Test results revealed nothing. Granted she is in a facility, but still, her condition was really poor at that point (we were not looking to get her into rehab or SNF, just trying to determine the cause of this pain), yet they let her go back to the MC facility. Looking back, she was probably upper 80's when she tore her rotator cuff. She had surgery and was released home to her own place the same day (lived alone then, no dementia) and PT was brought in to help her recuperate. How bad was mom's break that she even needed to be placed there? Why not treat the arm and release to home, with services brought in? If she was able, within a month, to do all you say, I would question even why she was there to begin with!
So, given that your mom can ambulate, care for herself, etc, I would have serious concerns about what their reasons are for refusing to sign her out. Yes, she should have some kind of support system at home, at least for a while, to ensure she is doing well and can manage on her own again. One option, can you have her released to move in with you, temporarily, so that she has more support and you can monitor everything for a while before moving her back home?
As others have suggested, I would demand information and reasons for keeping her. If all they can say is she is tentative about doing something, that really isn't a reason to keep someone in rehab in my opinion. Telling them she cannot pay for the stay might help push this along (they CANNOT force YOU to pay.) It cannot hurt to ask Medicare or any supplemental insurance why payments are denied (I thought Medicare covered 120 days???) PCP might be able to intervene as well. Worst case, threaten with legal intervention! From your description, it sounds like she is being held against her will and they just want the money (although there are often waiting lists for rehab, perhaps they have no one waiting and want to keep their beds full!!) Would her doctor be willing to come to the facility and "test" mom himself? If he can see how well she is doing he may be able to override (one would think PCP and family have more authority than some random facility - and again, why did she need to be in this place to begin with?)
Take Care
My mom 84 lived alone, also. Wants to manage her own meds (adds to fall risk?) my feelings are if she wants to go home she should. I can get an electronic med dispenser which she will refuse to use.
If making it very clear that the only payment they will be getting is what they get from her insurance (she sounds well insured so they aren't suffering) because she and the family don't have money to supplement with doesn't work I would consult with her primary and or specialist and even the hospital or doctor that signed the orders sending her there about what they can or can't do in this case. It may differ from state to state so these are the people who will either know or know where to send you to get the truth about options as well as raising suspicion about this facilities practices. If they want to keep her or feel it's that necessary they will find a way to get the expense approved or keep her anyway beaus they truly have a responsibility to do so. Funny our problem was as much as the facility agreed mom need the intensive speech therapy and we needed the help, they couldn't find ways to get it approved by Medicare so she was being sent home before she was really ready. They would have approved and sent her to a NH but we knew that was going to hurt more than help her at that point (much like your mom her mobility was great, far advanced in comparison to other in a NH) so we chose to take her home with us, she wasn't able to be on her own yet.
It would be better if you or a healthcare provider would call the state and demand that they give her back her care services. She needs it. This is the real issue. No one should be left to live alone with 167 bucks a day or 4000 a month to care for themselves. If that is not feasible then find her an ALF to go to so she can live in it. it includes everything that she will need and still give her some independence.