Our father is in rehab. They have said they will discharge him to Hospice due to having plateaued or not improving with therapy. Family and father wants to continue rehab. Can the center discharge him without approval from an immediate family member? Wife, son, daughter? We are in the commonwealth of Virginia.
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This is completely false. Nothing further could be from the truth. This is a falsehood perpetuate by the for profit health care industry.
The real criteria is to slow further deterioration. Not to improve. Not to hold steady. But to lessen the degree of loss of function.
Here it is directly from the horse's mouth.
In plain English on the CMS website, they run Medicare.
"Such a maintenance program to maintain the patient's current condition or to prevent or slow further deterioration is covered so long as the beneficiary requires skilled care for the safe and effective performance of the program. "
https://www.cms.gov/Center/Special-Topic/Jimmo-Center
From chapter 8 of the Medicare Benefits Manual. The chapter that governs SNF. I capitalized the relevant words.
"Skilled care may be necessary to improve a patient’s current condition, to maintain the patient’s current condition, or to prevent or SLOW FURTHER DETERIORATION of the patient’s condition."
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c08pdf.pdf
Don't make me reference the U.S.C. that governs all this.
"No improvement" has never been the criteria. I don't know how it became a thing in the for profit health care industry.
Just so it's clear, it's not that Medicare won't pay. The facility is just afraid they won't. So when you get that discharge notice, fight it. The first best chance to win an appeal is the third one. The first two are done by another health care provider. That third one is with a judge or a Medicare employee. At the third one, you should be appealing to someone who knows the real policy and law.
If your father qualifies for Hospice that means there is probably no chance for him to improve, no chance that he will "get better" more than likely he will decline and the decline will continue.
You do not have to accept Hospice. If a person wishes to continue treatment then they are not Hospice candidates.
Hospice is a WONDERFUL option when there is no chance, no hope for improvement.
The support both for the patient and the family is amazing.
Hospice will care for your dad, they will not "kill" him with over doses of medication. They will make it their goal to make sure he is not in pain.
They will educate you, the family what is next.
But again you do not have to accept Hospice. You can have him seen by his primary doctor.
The rehab facility will discharge him to where ever he was residing previously to the rehab stay. If that was an Assisted Living facility he may not be able to return if he needs more care than they can handle. If that is the case he may have to be discharged to a Long Term Care facility or Skilled Nursing facility. The discharge staff can help with that.
When you are ready, when the family is ready please consider Hospice to help you all through this difficult journey.
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Be aware that if Hospice is done at a LTC facility that the room is private pay. Hospice provides a Nurse, an aide, supplies and medication. Dad will be taken off any lifesaving medication. He will only be kept on comfort/pain meds. (If diabetic these will be continued but dialysis won't be) If done in the home, someone has to be with him 24/7. The doctor will give Hospice an order for care. A Nurse will come in to evaluate and if the need is there, she/he will admit Dad. A Nurse and aide will only come about 3x a week. Family will be responsible for the rest. So if Dad can afford Hospice in a facility, u may want to go that way. When the Hospice staff is not there, the facility staff takes over. You should be able to contact the nurse 24/7. Make sure you understand how Hospice works. We have had members feel their loved one was overdosed. That LOs wishes were not taken in consideration. Ex: that patient said he didn't want a pain killer because he didn't need it and it made him sleep. The nurse gave it to him anyway. If LO can decide for themselves than the nurse needs to abide by it. Some don't care for the Hospice Agency being used. You can change agencies. Just make sure u understand the process. The Nurse s/b available to answer any questions u have. There is someone above the nurse if u have a problem. My experience with Hospice has been good in my area. I just think sometimes its a lack of communication. Remember that there is a lot of stress for the one closest to the patient. That person does not always hear or interrupt well. I used to have to re-explain things to my Mom that was said. "No Mom, thats not not what was said". It only takes missing one word to change the whole sentence.
This is completely wrong. Not improving is not a reason for discharge as far as Medicare is concerned. Look at my response to AlvaDeer for proof of the real policy.
Over the years I've seen more expansion of medically owned LLCs, providing a range and step-up of care. And from another angle, I've seen some venture capitalists involved. Big bucks involved, and the VC's want returns on their investments.
Capturing clients and keeping them in the larger medical chains is I think a way to get those desirable big fat ROIs.
You've gotten very good advice. The decision to go from rehab to hospice seems to be a radical, drastic one, unless there's more to the situation than we know. That did happen with my father; he was nearing the end of life and just couldn't complete rehab, but I had already done hospice research and made decisions so it was a matter of segueing from rehab to hospice.
But do get not only the facility's doctor's opinion as well as your own physician's, perhaps the one who scripted for rehab.
It might also be helpful here to share what his medical conditions are to create perspective on the severity of his situation.
However, remember that (to the best of my knowledge) the facility can't consent to hospice on his behalf unless they take legal action and get control of his life. Make sure that doesn't happen.
And slightly off topic, but a caution: I've just been through a situation in which medical records are "supposed" to be entered online, through a portal created by a venture capital firm which requires the patient to indemnify, hold harmless and defend the VC firm. DON'T ever agree to this. I doubt if there's anyone here on this forum who could afford to defend a VC firm for ANY of its decisions or actions. It's a bankrupting concept.
I did some more research and learned that the VC firm focuses on the medical field, including "capturing" relevant data to "help" improve the patient's "decision making and choices". What it wants to improve is its own bottom line.
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There is a vested interest with hospitals and hospice to move patients into hospice to avoid readmits for which they are penalized by Medicare. There are also financial fees for referrals for hospital to hospice. There is a local hospice here where their employees' motto is "Get them in, Get them out."
medicare won’t pay for rehab if he’s plateaued, but you do have a right to appeal. Where did he live before going to the SNF rehab facility?
During my father's last year of life, when he was in a nursing home, physical therapy was attempted, but the therapists finally said "he is simply incapable of doing anything" so it was terminated.