medicare rights?

[jl]

88 yr. old mother is in hospital...we (family) want her discharged to a skilled nursing home for rehab - occupational therapy for a couple of weeks before she goes back home alone.

(she is dehydrated - confused beyond belief). She doesn't feel heat - is outdoors on porch too much; forgets to turn on AC. She walks w/walker; can't cook (afraid of stove); can't remember to take her meds; can't remember to eat; can't hear; can't see; & has developed extreme paranoia since 7/1; she is convinced the aides that come in 2 x's/wk for 2 hrs. are stealing...we've checked everything - they are not (same aides for 10 months). She says they come in the night; take her to basement; they don't have faces; she adds on to the list of everything they have stolen -we have found everything my mom herself has hidden. she can't run her (same) tv remote; she can't use the phone correctly; doesn't know what day it is; leaves her frig/freezer open; she can't put 2 thoughts together, ie, she gets hungry but gets to kitchen; can't remember to look in refrig to get yogurt, etc. Will eat if we are there fixing, bringing food. Hates meals on wheels program.

Question is - we know she has 100 days of medicare treatment @rehab facility if she is goes there directly from hospital....how do we (family) insist she is not capable of being discharged directly home? We think a couple of weeks of Occ. therapy to get her back to 2 months ago would help tremendously. What are her rights? Whom do we talk with? Ombudsman? she has primary insurance as well as Medicare.

 

[clarabelle]

I don't have any recent experience with this -but I understood the social worker at the hospital was there for these kinds of situations.

 

[golfgal]

I can tell you that you aren't going to get Medicare to pay for extended care past 100 days, period. It sounds like she has had some major health changes. The dehydration can cause the mental issues she is having and getting that under control should help, unless there is another medical condition causing this. It is time to start looking for long term care for her-which Medicare won't pay for so you have to find a way to pay for that.

Talking with an Ombudsman is a great idea. They are a wealth of knowledge and resources and they can help you find the best solution.

 

[The Mystery Machine]

Why does she need skilled care in rehab? It does not sound like she needs it. You have to have a reason to get skilled care in rehab. The doctor has to write the orders, I would guess.

Personally I would not let her go home alone and take her in or live with her. Or try getting POA and getting her into a nursing home if you are unable to take her in. Golfgal is right that you need to begin to look into long term care and get that ball rolling.

Talk to the social worker at the hospital or ask the other source.

I feel for you. My sister's MIL is dying of cancer and it is awful. She does not want to go into a nursing home and they are not ready for hospice even though it is time.

 

[jl]

we do have POA; to be eligble for the Medicare benefit; my mother has to have a reason - she is currently dehydrated & they are waiting on labs for B-12 deficiency (which she has all the symptoms of). She was taking shots of B-12 last year but quit - she doesn't like them. medicare benefit will only work if she has to have therapy, treatment - she lives in rural area; possibly OC is only available through nursing home that does do short term rehab.

We want Occupational Therapy to lessen her confusion; to get her to be able to take her daily meds; remember to go to the refrig & eat; to help her w/ this onset extreme paranoia; to realized when it is hot, she needs to turn on her air conditioning as well as drink fluids (any), to let the aides come in; to use her telephone, be able to turn on/off tv, etc., all things she was capable of prior to July 1st. We want a chance to get her back to where she was prior to whatever caused her to be hospitalized.

 

[Mimi1965]

Sadly-it sounds as if her brain cant make the connection anymore, so i doubt Occupational Therapy will work

Another idea is having sitters come in twice a day for a few hours to make sure she eats, turns onAC etc-otherwise she needs to be in Assisted living place.

 

[golfgal]

we do have POA; to be eligble for the Medicare benefit; my mother has to have a reason - she is currently dehydrated & they are waiting on labs for B-12 deficiency (which she has all the symptoms of). She was taking shots of B-12 last year but quit - she doesn't like them. medicare benefit will only work if she has to have therapy, treatment - she lives in rural area; possibly OC is only available through nursing home that does do short term rehab.

We want Occupational Therapy to lessen her confusion; to get her to be able to take her daily meds; remember to go to the refrig & eat; to help her w/ this onset extreme paranoia; to realized when it is hot, she needs to turn on her air conditioning as well as drink fluids (any), to let the aides come in; to use her telephone, be able to turn on/off tv, etc., all things she was capable of prior to July 1st. We want a chance to get her back to where she was prior to whatever caused her to be hospitalized.

Occupational therapy won't help with this stuff in your mom's case. Chances are once she is properly hydrated and back on the B-12's her cognitive ability will improve. If it doesn't, you need to find out what is causing this.

 

[The Mystery Machine]

we do have POA; to be eligble for the Medicare benefit; my mother has to have a reason - she is currently dehydrated & they are waiting on labs for B-12 deficiency (which she has all the symptoms of). She was taking shots of B-12 last year but quit - she doesn't like them. medicare benefit will only work if she has to have therapy, treatment - she lives in rural area; possibly OC is only available through nursing home that does do short term rehab.

We want Occupational Therapy to lessen her confusion; to get her to be able to take her daily meds; remember to go to the refrig & eat; to help her w/ this onset extreme paranoia; to realized when it is hot, she needs to turn on her air conditioning as well as drink fluids (any), to let the aides come in; to use her telephone, be able to turn on/off tv, etc., all things she was capable of prior to July 1st. We want a chance to get her back to where she was prior to whatever caused her to be hospitalized.

OT is for doing things, like walking, speaking, eating, etc. It sounds like she is able to function physically?

Confusion, her dehydration & lack of B12 falls under medical care.

I don't know all the rules though. I hope you get some good help.

Looking into a nursing home or having her live with someone is probably the route you need to go here. If you can take care of her she might improve enough to go back to her home. At the same time you can assess if she is even able to live alone in her home.

 

[golfgal]

OP, just to share what was going on with my Grandpa before he passed away, his 90th birthday was in mid-December (10 years ago) and we went up for a party that his church was throwing for him. He was doing great, very spry 90 year old. DS18 and I went up in mid-Feb for a Tae Kwon Do tournament and he was very forgetful, very tired. He told me he was not able to put on his winter coat because it was too heavy (in NORTHERN MN) so DS and I went out and found him a down jacket-when we got back from shopping he was sitting in the dark and couldn't figure out what to do and had forgotten we were there. He couldn't remember the name of his electric company so I went through his check book to find it-they had to come out and fixed something.

I went home and called my dad to tell him Grandpa was in bad shape. My cousin visited him daily and some of the church ladies were there several times/week. His doctor prescribed a visiting nurse to check on his meds (fell under the 100 day Medicare coverage) but she was also a family friend and made him lunch every day and took his laundry home to do for him. She had her daughter come in once/week to clean for him too. That went on for a few weeks and he passed away in early March. It is possible that her body is just failing .

 

[FINFAN]

Long shot here, but have they checked her sodium levels?Dehydration was the clue to me... If they are low it can cause dementia like symptoms, put stress on organs, disorientation etc. The treatment is easy enough, a sodium drip thru an IV usually 3-5 days depending on levels. Normally a hospital stay is involved as it is an RN monitored treatment and requires frequent checks...unless you would have an RN willing to come to her home to do it. I woudl think if bloodwork was done, the sodium would be checked, but perhaps ask, just to make sure? Strength to you, so many of us are going thru this with family.

 

[NotUrsula]

Another thing that can cause this sort of fast descent into dementia-like symptoms is a UTI. UTI's can cause some amazingly bizarre symptoms in elderly people. If she's been dehydrated she is a good candidate to have developed one.

 

[Breezy_Carol]

I am a PT and have worked in long term care and home care for years.

Medicare covers a stay in a rehab facility when the patient requires skilled care (nursing, OT, PT, or speech therapy) and is making reasonable progress towards reasonable goals. I do know that some OT and speech are able to work with cognitive issues, so this is not an unreasonable request. But, when your mother stops making progress, they may DC. Can you work on a physical request? Help learning stair climbing or tub transfers to get her into rehab then they can hopefully work on some cognitive issues.

Also, don't discount home health care for skilled services because it is rural. I live and work in a rural area doing home health. I can drive 30 minutes between patients at times.

Good luck.