UPDATE: What can we do? (medical insurance related)

[MushyMushy]

I took my 78 year old father to the ER last week with a nasty infection in his leg, which turned out to be MRSA and gout. They admitted him and didn't start treating with the proper antibiotics until Tuesday, and said that he would need to be on at least one 7-day course, and possibly a second. In the meantime, my sister and I have hired someone to come in and help clear out his house and disinfect it to get it ready for him to come home. Because he and my mother were hoarders for so long, this is going to be a herculean task! We based our cleaning schedule on the 7-14 days he'd be in the hospital.

Every day I've gone to visit, I've asked when they thought he'd be coming home. Even last night, the nurse said he'd at least be in until next Tuesday.

Well, the hospital called a little while ago and is releasing him TODAY. The house isn't ready, we're not ready, and he can't even WALK yet. They told us that the doctor already eked out another day from the insurance company. Excuse me? Why are they just now telling us this when just last night they said he'd be out Tuesday or later? My sister and I had plans for today. Mine are unable to be canceled because we paid in advance for what we're doing. So that leaves my sister to have to try to take care of this herself.

Do any of you know of any recourse we might have to try to get another day short of paying for it out of pocket? Who would we even try to talk to? We only have a few hours to do this because of the false communication from the hospital assuring us we had until at least Tuesday! We could have been dealing with this for days if they'd only told us the correct information.

Thanks for any advice you may be able to give.

 

[disneyfans95]

Put him in a hotel room for the night.

Really that simple and much cheaper then trying to hammer out an extra bed in a hospital on short notice.

 

[chloelovesdisney]

If he was able to walk before being admitted to the hospital, and can't walk now, he should not be returning home. They should be transferring him to a rehab facility for a period of time before going home.

I would talk to the doctor and social worker ASAP. They can hold him another night to get that worked out. We've held people for days in the ICU waiting for a rehab bed to open up.

 

[MushyMushy]

Hotel room an idea, but I'm worried about the MRSA. Last night we still had to gown up and wear gloves to visit him, so how can he be sent home if he's that infectious? We're getting no information about this.

And that's exactly right -- he walked into the hospital himself and can't walk out. Unbelievable.

 

[piglet too]

Does the hospital have a "patient's addvocate nurse" or someone similar? They should be able to help you too. Call the nurses station for his floor and ask to talk to the charge nurse, and ask her/him about this. Good luck, there is no reason that he should be allowed to leave yet.

 

[disneyfans95]

Hotel room an idea, but I'm worried about the MRSA. Last night we still had to gown up and wear gloves to visit him, so how can he be sent home if he's that infectious? We're getting no information about this.

And that's exactly right -- he walked into the hospital himself and can't walk out. Unbelievable.

More then likely it was for HIS protection, not yours.

You are not a doctor. Sorry to be blunt. But if he says time to go, looks like he is going.

A ton of people leave hospitals when they can't walk. They recover at home. That is standard. Again sorry to be blunt.

But it looks like you are more put out because his house is not ready and you were expecting the hospital to keep him while you were caring for his house.

 

[chloelovesdisney]

In my hospital the patient services department is only available Monday - Friday, but on the weekend there is an administrator on call for any of these types of situations. Get in touch with them ASAP. I would refuse to take him home and needed to go to rehab if he walked in and couldn't walk out, that's what rehab is meant for. Is the leg wound closed? I would ask if it is still open and he hasn't finished the course of antibiotics is he possibly still infectious and is your elderly mom at risk.

 

[minniecarousel]

NO!

There should be a social worker on duty on the weekend. That is the person to talk to. We were adamant that we were bringing my Mom home, but I just wasn't able to handle her on my own. She went to a rehab hosp to get PT & OT. We wanted to get her to where she could at least assist in her transfer from bed, to wheelchair, to chair.

It's correct that if he could walk before he was admitted, he will to going to rehab before coming home. Medicare and his supplemental insurance will pay for "X" number of days. Unfortunately, if they're insisting that he must leave today, it doesn't give you any time to preview rehab facilities. His insurance needs to give approval too. So I think you have a case to leave him where he's at for the weekend. Insist that he can't care for himself at home and there has been no time to line up help.

Good luck!

 

[chloelovesdisney]

More then likely it was for HIS protection, not yours.

You are not a doctor. Sorry to be blunt. But if he says time to go, looks like he is going.

A ton of people leave hospitals when they can't walk. They recover at home. That is standard. Again sorry to be blunt.

But it looks like you are more put out because his house is not ready and you were expecting the hospital to keep him while you were caring for his house.

This is not entirely true. Doctors do sometimes discharge people too early at the behest of the insurance company. They do not have to. If the doctor says they must stay, they can stay. The doctor must stand up for his patient.

If someone walks into the hospital, no, they should not be sent home to recover. That is not standard unless you are going to a substandard hospital to begin with. It is standard at my hospital to be sent to a short term rehabilitation center if you walked in and can't even get yourself up and down from bed and to the bathroom. If you weren't able to ambulate before admission to the hospital that's a different story.

You do have a say in the care you receive, and that even includes when and where you are discharged to. I feel badly for people that don't know how to navigate the hospital system because they often end up with the short end of the stick. Those that actually know what the rules are and who to contact and get things done and don't have things like this happening.

The social worker should have come stopped by to discuss your home issues and discharge plan. That is standard care at my hospital as well. You shouldn't just be told someone's going home that day.

 

[chloelovesdisney]

More then likely it was for HIS protection, not yours.

You are not a doctor. Sorry to be blunt. But if he says time to go, looks like he is going.

A ton of people leave hospitals when they can't walk. They recover at home. That is standard. Again sorry to be blunt.

But it looks like you are more put out because his house is not ready and you were expecting the hospital to keep him while you were caring for his house.

Just wanted to clarify the gowning up before entering the room is not for the patient's protection. It's so the visitors don't spread the MRSA to others.

 

[MushyMushy]

Just wanted to clarify the gowning up before entering the room is not for the patient's protection. It's so the visitors don't spread the MRSA to others.

Thanks so much for your advice.

You're right about the MRSA issue. All week, I've been the only person able to visit my dad for fear of others being affected. My sister recently had surgery on her ankle, and my nephew has a heart condition, so their whole family has to stay away. My uncles and aunts are all in ill health, so there was a fear they'd catch it too.

His doctor is working now to get him into a personal care home for a week so he can get some rehab to regain his mobility. He knows our family's situation and is doing his best for us! Love that guy.

Oh to answer your other question, yes, his wound is still open. None of us are in any physical condition to give him the care he needs. I can do light work with him and that's it (like helping him from room to room, dressing, etc).

 

[npmommie]

If he was able to walk before being admitted to the hospital, and can't walk now, he should not be returning home. They should be transferring him to a rehab facility for a period of time before going home.

I would talk to the doctor and social worker ASAP. They can hold him another night to get that worked out. We've held people for days in the ICU waiting for a rehab bed to open up.

This is not entirely true. Doctors do sometimes discharge people too early at the behest of the insurance company. They do not have to. If the doctor says they must stay, they can stay. The doctor must stand up for his patient.

If someone walks into the hospital, no, they should not be sent home to recover. That is not standard unless you are going to a substandard hospital to begin with. It is standard at my hospital to be sent to a short term rehabilitation center if you walked in and can't even get yourself up and down from bed and to the bathroom. If you weren't able to ambulate before admission to the hospital that's a different story.

You do have a say in the care you receive, and that even includes when and where you are discharged to. I feel badly for people that don't know how to navigate the hospital system because they often end up with the short end of the stick. Those that actually know what the rules are and who to contact and get things done and don't have things like this happening.

The social worker should have come stopped by to discuss your home issues and discharge plan. That is standard care at my hospital as well. You shouldn't just be told someone's going home that day.

I ditto everything she says. It is all worth repeating

OP update us when you can.

 

[MushyMushy]

I ditto everything she says. It is all worth repeating

OP update us when you can.

Now the insurance company is denying him the personal care home. What a mess. I'm going to lose my mind and my sister is right behind me.

There should be some kind of karmatic law that says children of abusive parents shouldn't have to deal with this crap when their parents are elderly. Sorry for the TMI, but it's true and I've about had it. Another poster said I sounded "put out" at having to deal with the house -- well, you're damn right I am. Who wouldn't be? My sister and I grew up in near squalor conditions (hoarding mess, not poverty), couldn't have friends over very often, were called every name in the book, had fists, belt buckles, and boards taken to us and now we're doing the best we can and have to fight tooth and nail to get some kind of care for my dad (mother passed away 2 years ago after very similar crap). The two of us can't go through another summer of this. We just can't. But we also can't just not do anything because we do love him despite our childhood and we're just not that way. I don't care what anybody thinks of us, but we can't give him the care ourselves. We're not physically OR mentally able. I think we're doing an awful lot for him by fighting with the insurance company and trying to clean out that horrible house.

Sorry for the vent. I'm just frustrated. I wish that someone could just take over and DO this for us.

 

[LoriABil]

There should definitely be a social worker or case manager involved. And if they say he does no qualify for rehab (patient's have to be able to tolerate 3 hours of therapy a day) then ask about a Skilled Nursing Facility.

Not only do physician's sometimes clear beds for the insurance company, but most likely it is the hospital's policy to turn those beds over as fast as they can. After 3-5 days, the likelihood of a hospital making a profit on a patient is slim, due to all of the DRG rules (I am assuming your father is on Medicare - shame on me for assuming).

I hope everything goes well! I wish there was some kind of program with people you can call to be patient advocates that don't work for the hospital or insurance companies. Maybe there is - I bet the DISers would know!

 

[Katie's Butterflies]

Thanks so much for your advice.

You're right about the MRSA issue. All week, I've been the only person able to visit my dad for fear of others being affected. My sister recently had surgery on her ankle, and my nephew has a heart condition, so their whole family has to stay away. My uncles and aunts are all in ill health, so there was a fear they'd catch it too.

His doctor is working now to get him into a personal care home for a week so he can get some rehab to regain his mobility. He knows our family's situation and is doing his best for us! Love that guy.

Oh to answer your other question, yes, his wound is still open. None of us are in any physical condition to give him the care he needs. I can do light work with him and that's it (like helping him from room to room, dressing, etc).

Since his wound is open call the state infectious disease dept. (You can contact them through your county) MRSA is a reportable disease and hospitals ARE NOT to release people with open (infectious) wounds into the public!

I don’t know what state you are in, so I can’t look it up.

Also, does he have medicare? If he does, Medicare will have to pay for a home care nurse, especially since you said no one can really take care of him.

ETA: These are suggestions from my dad who has been in your dad's position too many times...

Find out if he has an infectious disease doctor as his attending physician.

The infectious disease doctor (not just random hospital people) should be the one dictating his treatment (or release) and should be able to discuss options with you.

This can be a very dangerous infectious disease should it get out into the public, so they should not be discharging him willy-nilly.

There are of course more steps that can be taken including going to the media... but first talk to the doctor and get options.

 

[Disney Doll]

Mushy, you need to say that he is not safe to be discharged home.

Safe is the operative word.
A patient cannot be discharged from the hospital if the situation the patient is being discharged to is not safe. The hospital bears the burden for making sure the discharge situation is safe.

So, that being said, he should be going to short term rehab, from the sound of it. His insurance is denying short term rehab? What kind of insurance does he have? I assume if he is your Dad that he is Medicare age? Even if he has private insurance or an HMO, they all base their coverage on Medicare guidelines.When I worked for the HMO, we had to cover at least what Medicare would cover, especially since we received $$ from Medicare for each of our members.

Someone who came into the hospital walking and is leaving not walking cannot go home. They just cannot dump someone out.

Speak to the social worker, speak the the supervisor on call for the weekend, speak to the senior administrator on call for the weekend...that's usually how the chain of command goes up the ladder on the weekend. You may refuse to take him home, they will tell you that he will be repsonsible for the bill, that's fine because you tell them that on Monday that you will be reporting them to the state Department of Health and to JCAH (Joint Commission for the Accreditation of Hospitals). Take my word for it....they aren't going to want those 2 entities taking any real close look at their facility, so they'll find someplace to put him. Insurance company....threaten to call the insurance commissioner.

As far as MRSA, there are millions of people walking around with it...you'd be amazed how many people have "colonized" (not infectious at this time) MRSA. Even MRSA in an open wound, as long as it can be contained with a dressing, is not grounds for holding someone in the hospital. Your Dad may no longer be acute hospital level of care, but he certainly doesn't sound ready to go home. Someone is dropping the ball at the hospital....and perhaps at the insurance companyas well.

Sorry, but you'll have to be raising a big old stink!

 

[Lanshark]

What would happen to him if Mushy or her sister couldn't pick him up,take him home and care for him? What would a hospital do in that situation where his needs couldn't be met at home? Just wondering.

 

[minniecarousel]

It surely sounds like the Discharge Planner really dropped the ball here.

He stays "put" until a rehab facility is approved for him - period!

 

[MushyMushy]

Just a brief update -- they released him today and now he's incontinent!!! He's in so much worse shape than when he went in there. He also can't get from a chair to a walker to the bed. None of us can physically help him if he falls.

We have spoken with his nurses and doctor this evening and they told us to take him back to the ER and insist they readmit him. The nurses said that the incontinence issue will force them to take him for fear of urinary tract infection.

Thank you all for the advice.

 

[dislaney]

No advice just Sorry your having to deal with all this!