Do I appeal the discharge date?

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J

Jennifer3 Asked July 2020

Do I appeal the discharge date?

Bill (91 with ALZ) was admitted to the hospital Saturday 7/11 and transferred to an acute rehab center on Tuesday 7/21. His diagnosis was UTI and fluid on his lung. On 7/11 he was dead weight and unable to sit up, so I called his VA doctor and she said to call 911. I did a window visit yesterday and took him some personal items. His care meeting was that morning and a discharge date of Friday 7/31 was set. I had not seen him yet, but thought he must really be making progress. He has not progressed! He can’t sit up or do any transfers without substantial help. I can’t see how it’s possible for him to make enough progress in a week to be safely able to get out of bed and walk on his own (with a cane). Is anyone familiar with the appeal process? Am I thinking too far a head; should I wait and see how he is on Wednesday?
My other concern is his recent weight loss. No changes in his diet or consumption and in two months he went from 192 to 190 to 184 and now 172. I asked his VA doctor about it and was educated by the nurse on proper nutrition. The man eats two hot meals, a lunch in between and an evening snack daily.
Thanks in advance,
Jennifer

Alzheimer's & Dementia Hospital Discharge Mobility

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score 0 · Answer 1

Medicare pays per diagnosis and expected recovery times. Your husband had a UTI/fluid on the lung. While it may take weeks for any mental status changes to completely resolve from a UTI, I’m not sure those diagnoses qualify for more rehab time.

What was his baseline level of function prior to this episode? If there is a marked change your husband may need to change over to the SNF/NH for a time to get more rehab if Medicare denies your appeal.

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GM,
I sent the transfer request to the center he is in now, if they don’t reply I’m going to appeal with Medicare. He no longer needs medical attention, so my hope is that they will send him to a SNF for a couple weeks just to get him back to his baseline. My fear is that he is coming home before he is back to his “normal” physically, and he could fall and be seriously hurt. He is too much for me to lift or even push and pull at. I want him to be safe.

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score 0 · Answer 2

Jen, is the acute facility talking about dischare HOME or discharge to a subacute facility? This are two very different things. Please talk to discharge calling at the current facility.

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Home discharge on Friday. He is doing very well with PT and OT, I just think he needs another week or so for me to feel comfortable with him being safe at home.

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score 2 · Answer 3

I believe you should attend care conference, request same from Social Worker, and discuss. Sounds as though hospice may be a better choice now than rehab. In general they know if a patient is capable of progressing at all after a week and it seems that they feel that further time will not be in any way beneficial. You may want to request, if you are POA for health, a reading of the Physical Therapy notes to see what their thinking on any progress is.

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score 3 · Answer 4

I read your profile. Wow, you are only 45 years old, and Bill your H is 91?

Considering how things are going with covid-19 in GA, Bill is going to be yours to take care of until you can get him into the veterans home, and that could be a while.

Can you do it?

Remember that key term UNSAFE DISCHARGE if they want to discharge him to home and you feel unable to take care of him.

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Perhaps not the convential marriage with the age thing, but 27 years ago it seemed like a good idea. I am concerned for his safety and my ability to even change him if he does not improve significantly. I don’t expect him to be better than he was but as close to the same as possible. As far as I know he is participating in therapy, but I really can’t hold him up, even with his weight loss. Window visits are useless and he doesn’t understand using a smart phone or device. It’s so very sad.
My current savings can pay for a nursing home, but I will quickly run out of $. My business is only running at about 15% because of Covid.
There is no positive outcome in this situation.
thanks for replying

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score 2 · Answer 5

When you questioned them about his lack of mobility what did they say?

Is he willing and able to participate in physical therapy? If not, that will create a discharge, they have to be making progress to continue getting coverage for rehab.

If you can not care for him as he is, you must tell rehab that he is unsafe to discharge home. Period, end of discussion. UNSAFE DISCHARGE! That is the term that gets them looking for alternative living solutions. This may be what opens that bed at the veteran's home.

Best of luck getting this sorted.

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Everything is by phone, and I was told that he is making progress in PT and OT. The function status sheet I received yesterday basically says that as of then he can only feed himself unassisted.
Thank you 😊

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score 2 · Answer 6

Is Bill on Hospice? Weight loss if that magnitude when still eating heartily seems to often be a signal that the body is no longer processing nutrients the way it used to.

I would certainly appeal the discharge if your previous experience has been that he usually makes progress. But be prepared that this time may be different. As his dementia advances, his ability to cooperate with therapists and comprehend what is being asked of him may have changed.

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He was evaluated by Hospice in May and on the FAST scale he scored 6e, the final stage before 7 which qualifies you for Hospice. The window visit yesterday was very sad. He just has no quality of life anymore.

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score 0 · Answer 7

He has only been there for three days. Perhaps the next week will show more improvement. He has a bed in the Milledgeville War home, but we are on hold due to Covid. He normally receives 30 or more days of rehab and while he always has some decline, he manages to get back to walking short distances.

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score 1 · Answer 8

When someone goes to rehab, the discharge date is determined in large part by how the patient is progressing. If Bill has "plateaued", he is eligible for discharge. It is NOT about getting him back to where he was.

If this is "the new normal" perhaps it is time for him to be admitted as a long term care patient.

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Do I appeal the discharge date?

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