I've been trying to get my dad into a SNF since July. It's just been a lot of red tape and I've had to get guardianship (not cheap). The first SNF we were working with decided they didn't want to take him (after weeks of working with them) and basically blew me off, saying they didn't have a bed. I found another and have been working to get his medical eligibility from the doctor, but the doctor is apparently not sending the SNF what they need and so I've been acting as intermediary, trying to get what the SNF needs from the doctor. It's ridiculous that I need to do all this. The doctor agrees he needs to go, but there's no communication between the SNF and the doctor!
My dad fell twice over the weekend and I took him to the doctor this morning and practically BEGGED him to complete an evaluation form and send it to the SNF (which he agreed to do). The doctor said if he falls again to call an ambulance and have him taken to the ER and then refuse to allow him to be discharged to me - basically I tell them he needs to go to a SNF and there's no one to look after him of he is discharged. He said if they try to guilt me into taking him home, I have to refuse! I've heard this before, but since I have POA and Guardianship, can the hospital force me to take him? I've been practically living in his home for a couple of months while waiting for a bed in a SNF to open up but it can't go on - this isn't my home. My work is suffering as I'm constantly dealing with my dad. I know that this is how most people get into SNFs - 3 days inpatient hospital stay then 20 days Medicare then transition to Medicaid, but can I really refuse to bring him home and insist they keep him and then transition him to a SNF?
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No, the hospital cannot force him to go home unless there is a qualified 24/7 qualified caregiver. Yes, if he has been in hospital for 3 days, then Medicare will pay for him in
assisted living/other situation. I do not know Medicaid procedures
. If he continues to improve, Medicare will continue to pay. If not, perhaps Medicaid steps in now or he can be cared for at home with a nurse or other qualified caregiver.
However, this can represent a BIG out of pocket. Ask anyone you can think of for suggestions or referrals to a nurse/aide. Also remember that there are people who will care for individuals in their homes.
Always check references on caregivers - some states register some caregivers - check with State Board of Licencing to see if any complaints have been filed against someone you are to employ.
Good luck and remember to take care of the caregiver !
Just imagine if guardians were required to provide the care, there would not be nearly as many people working in the profession. If providing care was required since many guardians have many clients how in the world could they manage?
The guardians job is to identify appropriate placement and make it happen in collaboration with hospital social workers and other medical staff.
if there is no one to provide adequately for him there.
If it has been necessary for you to get guardianship, his condition sounds as if warranted it.
Social workers are of great help in finding a bed - this is their job.
Please explain clearly to your Father what is going on and that you love him
Stand your ground!.
Take care of yourself and of your husband.
My LO was falling two to five times a week at home, not able to walk or get himself up and down and was totally incontinent, plus weighs 300 lb and I'm am only a third of that, I was his only caregiver and had to leave him alone while I worked which was just not good. I wanted him in a facility for his safety. My situation was such that my health was declining taking care of him by myself while trying to work and take care of all of my chores as well, it was just too much for me and could not afford full time help to care for him. I took him to the ER a number of times after his falls, they always just checked him out and sent him home, so waiting until he fell and broke something was not an option for me. I never tried to refuse to take him back so I really don't know how that would have worked.
I was desperate to get him into a facility and was trying to check places out in the evening or at lunch, was not getting a lot accomplished. So I just went to my boss explained what I needed to do and took two days off of work. Like you, I had been missing a lot of work with him and hated to take more and I was lucky my boss was very understanding and even gave me a few tips. I did some internet research and the Department of Aging here in Tx has a listing of all nursing homes that accepts Medicaid, I called as many as I could to find out if they took Medicaid pending and made a list of the ones I felt were okay. Note, I did not do this on my days off but rather in the evening and lunch otherwise I would have probably had to have taken another day. I made a map and my first day off, I went and visited as many Medicaid accepting facilities that I could including a few that I knew did not have Medicaid Pending available, as they can put you on a waiting list. I visited 8 nursing homes that day and talked to the administrative staff at each one - explaining my story to them, they were most helpful and answered a lot of questions for me, one of the facilities that did not have a Medicaid pending bed actually made some calls for me and recommended a sister facility (this was a Sava Senior) that I eventually placed him in - one that was not on my list so it was a huge help.
But ask a lot of questions - one of the places that was close and I really liked would have crammed him into a room with 3 other people - that was something I noticed in the walk thru that they had some 4 people rooms and I had to ask to clarify that - and indeed the 4 people rooms were Medicaid pending, I did not feel that the transition from home to NH for a dementia patient would be very smooth even sharing a room but 4 in a room (a small room) was just too chaotic. So ask a lot of questions.
By the end of that very long day, I was exhausted but had chosen two that had Medicaid pending beds available, a first choice and then a second for backup and knew what they needed to start the process.
My second day, I collected the paperwork that the nursing homes needed as well as bank statements - SS info etc. (In retrospect - I should have done this the first day, as I could have just given the nursing homes the paperwork when I visited as this could have made things quicker. but as I was going back with LO to have him look at facility as well, I just took them the paperwork that day.
I needed full medical record from Primary Care Dr - along with medical record from his Neurologist (this is very helpful in getting him accepted at the NH especially if he has dementia) and record from his last ER visit. I called the Drs offices and hospital in the morning and explained to them what I needed and that I would come that afternoon to pick them up - did not take no for an answer as one of the dr's offices tried to put me off. I had printed out his bank statements for the last six months, downloaded a Medicaid application and filled it out, made copy of his DL and SS card as well as his insurance information and made a copy of his small life insurance policy, I then carried all of this to Kinko's and had 4 copies made, one for each nursing home, one to use with the Medicaid application and a spare just in case.
When I took LO to NH to visit - we only went to the first one because he was okay with that one, I was able to hand them all the paperwork needed to start the process, and a week later I was able to get him into the facility. Now this was not an easy decision and I am still wrestling with guilt - he is being pretty good but asks to come home - but he is getting physical therapy, regular bathing, his medications and has only fallen once in over two months. I know that a lot of caregivers that comment here do not like NH - and truth be told, neither do I, but I do think every situation is different, in my case - since his children would offer no help or support and with his financial situation the SNH really was the best choice for his much needed full time care and safety. I do feel better about placing him because I did the multiple visits - you would expect the more expensive homes to be the nicest, but that was not always the case and a couple of the places I got no further than the front door and I knew that it was not going to work, however, I did the tour and talked with them, well just because I was there and wanted as much information as possible in making the decision.
Now just so you know, once he is Medicaid approved - you can easily move him to another facility as Medicaid approved beds are more available than Medicaid pending.
I may move LO as the facility he is at is not as close as I would like but will leave that up to him, he is about a 25 minute drive, there is a facility about 10 minutes away so I could visit more, but he is adapting and doing pretty well so will think long and hard before moving him.
For your information, the nursing home submitted the Medicaid application on the day of his arrival - approx 8/15/14 and I just last week got the approval back, I do think that filling the form out correctly and providing them with all paperwork required at the time of submission makes it go faster.
Good luck with your Dad, I hope that this helps. I really think that waiting for a LO to fall and seriously hurt themselves before getting the proper help is a very serious flaw in the medical and insurance care of elders.
Once he gets into the SNF please make sure that you check on him every day and maybe even have a camera installed in his room. My mother was only in the SNF for two weeks and she had a mysterious fall.....story has changed 4 times....she hit her head front and back and they only held ice on it, they did not take her to the hospital for 16+ hours and she died 9 days later of "Blunt force trauma to the head and brain hemorrhages." We are just sick as she was able to walk well and take care of her personal needs when she went in. I have since found out that there is an epidemic of "falls" that happen in these homes and the patient dies. No one is held responsible nor is there an inquiry as to what happened....not by the hospital or the police or anyone it seems. They are old and everyone assumes..."well it was for the best" but if beg to differ if there is abuse or neglect. Just watch him...closely!
Hospital transfers to nursing care take priority and are easier to do. The nursing facility will love getting all the hospital paperwork transferred with him, including doctor's orders. His primary care doctor probably does not have a social worker, or staff to ensure the initial "doctor's orders" that the nursing home needs.
I would recommend that you have a doctor outside the nursing home to provide ongoing care, you can drive your dad there and sit in. I think the nursing home doctor might be more aligned with the home than with your dad.
Have you thought of trying to get a home health aide for him? If the doctor orders it, Medicare should pay for it. I don't know much about that. I doubt he'd get 24 hour care, though.
It's ~$6000/month for private pay and I don't have that kind of money and neither does he so there's no way we can go the private pay route.
Anyway, he does actual meet medical eligibility and that's what the new SNF is trying to get from his family doctor. I just don't see why it's taking so long!
I recently placed LO in SNF in Texas without having to break the bank and I refused to wait until he fell and did serious damage to himself, so perhaps I can give you some advice, but it would be specific to Medicaid Pending.
Now there are very expensive all private pay medically supervised facilities, that will take residents without a skilled nursing orders done. Maybe the sort of place that the very wealthy, like a Sunny Von Bulow, ended up in that cost 20 - 40K a month. If family has the $$$, they can get their family member moved in.
But for the rest of us, the NH needs medical orders done. Pyrr's dad has no real $ anymore, he will need to apply for Medicaid to pay for his NH stay. Medicaid has 2 tracks to qualifying them to pay for care. A financial track - which family has to do to show that the elder is now impoverished with about 2K in non exempt assets & 2 K in monthly income and a 5 year lookback. And ALSO there is a medical track - for my mom the state sent a RN team to the NH to review mom's chart to make sure NH was medically necessary (my mom moved to NH from IL no hospital stay, no AL). Mom actually had a glitch in her chart - this even though her MD was the medical director of the NH!! There is always something!. The intake staff did not transfer all mom's medications to her new NH chart, they just noted the Rx she brought with her. Now that one was a pretty simple fix. But mom - who has Lewy Body Dementia - seemed back then pretty cognitive & competent. So she needed to have something in her chart for a "co-mobidity", so they added .81 of aspirin for CHD and changed the delivery of her Exelon, so she was good for skilled nursing needed.
Most of us fixate on the financial for Medicaid as that is what we have to deal with, but the medically necessary is just as important if your state sends out a medical evaluation team, they can find them not medically necessary, so Medicaid will not pay.
Since she has POA and Guardianship, can she sell his house, thus forcing him to move somewhere else?
I don't know if this is a good idea, necessarily, but once my mother's house was sold, she stopped thinking about moving back home, alone, and she really could no longer live alone, so it was only an option in her own mind.
I'm just throwing this out there...
For mom, it was about 6 mos of every 4 -6 weeks of appointments, and the one she had a 10%+ weight loss & bad h&h Doc wrote the orders for skilled nursing needed. It sounds like your dad already presents with enough critical issues, that skilled required orders can be written on the first doctors visit.
All of this is so emotionally difficult and the paperwork maddening.
Sometimes I can understand why family has a Blanche Hudson moment.