My mom is currently in the Rehab facility in New Jersey after the surgery. She is somewhat weak, but not to the point where she can't stand up an use the wheelchair or some assistant to move around. I had a meeting today with the rehab nurse, the social worker and the doctor who said that she is not strong enough to go home. And, if I take her home, I will have to sign that I am taking her against the medical advice and the insurance Medicare would not pay for her medical services once she is at home. This is nightmare and i feel powerless that I can't do anything about it. The rehab is telling me she might need another two to 4 weeks to get stronger, but after that they might say she is still not well enough and can continue to hold her there against her and my will. Is there any law that I can use to force them to discharge my mother and assign her for a home medical care. Do you think i need an attorney to resolve this matter.
Thank you
I found this info on the Medicare website,
What if I think my skilled nursing facility (SNF)
coverage is ending too soon?
When Medicare coverage of your SNF stay is ending because it’s no longer medically reasonable and necessary or is considered custodial care, you’ll get a written notice (“Notice of Medicare Non‑Coverage”—
NOMNC). If you’re getting Medicare‑covered services from a SNF, and you think your Medicare‑covered
SNF services are ending too soon, you can ask for a fast appeal. Your provider will give you a NOMNC before your services end that will tell you how to ask for a fast appeal. (The notice might call it an “immediate” appeal.) If you don’t get this notice, ask your provider for it. With a fast appeal, an independent reviewer called a Beneficiary and
Family Centered Care Quality Improvement Organization (BFCC‑QIO) will decide if your services need to continue. ■It’s important to call your BFCC ‑QIO to request a fast appeal no later than the time shown on the notice you get from your provider. Use the phone number for your BFCC‑QIO listed on your notice to request your appeal. ■Ask your doctor or other health care provider to submit any information to the BFCC‑QIO that may help your case. ■If you miss the deadline, you may still have appeal rights:
If you have Original Medicare, call your BFCC‑QIO.
■If you’re in a Medicare health plan, call your plan.
Pamstegma is right, Rehab will charge her room and board the longer she stays.That is out of your pocket, It's all about the money.
Long answer - As a rehab doc, I have done exactly two AMAs in my entire career. I had witnessed the scandal of a TBI facility practicing what was not-so-lovingly termed "fundsucking" by a disability rights activist I was honored to work with. That bascially meant they were keeping people until funds ran out, being dishonest with caregivers and claiming people were a danger to themselves or others, but then set them up for immediate d/c regardless of needs I was able to assist in a small way in putting an end to it, and after that I made it a point to write into our policies that rehab was elective and AMA was used only under extreme and unusual cricumstances.
In the eldercare arena, I have seen more people just want to quit rehab and go home who are not thinking real clearly about safety or maximizing their function, and it is important to be objective about that. I like the idea of using a third party like an ombudsman to negotiate and help decide, if speaking with d/c planners and maybe getting a team-family meeting to address specific discharge goals and what the person really needs to be able to do to return home safely. These are not cookie-cutter decisions but should fit the individual and their needs and desires first and foremost.
Her leg is still swollen and hard! Should I sue?...one of them told me this morning:"She said to tell you,to bring her check." Why would I authorize such unaffordable and unnecessary expense!?
Medicare will continue paying for a Homecare,Physical Therapist;already have! This is what insurance is for. Right? DAH! That's $162.00 daily=$1,134 a week! One month would cost us,only $4,536!
Thanks for being here for us.
They must think my middle name is Trump! Kapish!? I mean,comprende!?
Humblebrother,
Marietta,GA.
I feel for everyone is this forum and I hope that thing need to change with the care of our elderly. If a facility is to charge a patient $300/day, the care should be phenomenal.
Thank you
This is basically a money thing. The facility/rehab is operating under CYA (cover your A$$). The benefit financially from having patients stay there longer, the staff and the doctor does too. When money is involved you have to watch out, because all kinds of b.s. crops up. All too common in the medical field these days. It's one big money making sham.
The easy way to go after them is to hit them in the pocket book. Explain the longer they keep them, the less likely they will get their co-pay or money (if it's say past the 21 days of medicare and no supplimental medicare). Sometimes economics speaks louder than anything.
One time this happened to my mother. she had the full 100 days or so of medicare, and the facility had no choice but to discharge (again money--they get most of their dough from medicare or the insurance). Then they illegally threatened that they wouldn't let her go if they didn't get like at least half of their money owed at time of discharge. ILLEGAL.
Patient and family has a right to do what they want, period. If that's what your parent /family want and they are still giving you grief, call the police and report an attempted kidnapping. This is a civil issue and nobody has the right to hold someone against their will no matter what they sign or don't sign.
http://www.aoa.acl.gov/AoA_Programs/Elder_Rights/Ombudsman/index.aspx
Generally, you will need to spend time and money on various medical equipment if you have not needed these things up to this point.
If she is still weak you need to guard against her falling in the home. If she wants to come home and is pushing for an early release from rehab, try to reassure her she will be home but needs to get a bit stronger.
I had to move my father from a hospital stay to a rehab, and the rehab was not
that effective and wanted him out in under 30 days, I had to transfer him to another rehab for 30 days. Then the second rehab abruptly called and said I needed to take him home or to a nursing home in the next 3 days. I managed to get the home set up for him and a full time home health aide started the following Monday, I returned to work on Tuesday. I got the medicare PT, OT and an RN who checked on him. I was the home health aide outside of my work hours. My father did ok but he needed a home health aide or me with him the rest of his life --approx. 3.5 yrs.
I know the rehabs are not perfect. Been there. But try to think with your head and heart. Ask yourself, is she really ready to come home? Can she be managed with outside paid help and the family? Will she be a bit better in a few weeks to come home? What does her personal doctor think about her coming home early? If you feel she can be managed at home, I would take her home.
Despite what the lawyer said, I would try not to get on the wrong side of medicare. He may well be right on the law, but if you need to start a legal battle to reinstate her benefits (along with the heavy load of caring for an elder), it is a
battle you will not have the time let alone the money for.
Try to take care of your own health. As mom's caregiver, you need to pace yourself which is next to impossible. Good luck with mom and the rehab.