Insurances says she can go home. My Grandmother had a horrible fall the weds before Thanksgiving. Two broken vertebrae in her neck, one in her back and multiple fractures on her spine from T12 to L5. She is in a neck brace (the new halo) and a back brace for when she is doing anything other then laying in bed. She also suffered a minor brain bleed during the fall. Thankfully, she is healing, slowly but surely. Unfortunately, she has been doing as she's been told during her PT and OT therapy everyday in the hospital. She is able to do small things, like dress with assitance, comb her hair, brush teeth. She can stand for up to 5 mins and she can walk a short distance with her walker. She still CANNOT get in and out of bed herself or use the restroom herself. The hospital and insurance says she's fine and are discharging her next Tuesday. We assumed she would be discharged into a skilled home or nursing home...imagine our surprise wheme they said NO. She medically does not qualify to be sent anywhere like that. She has to either go home or go to a Personal CARE home and pay out of pocket! How do I get help to prove she is unsafe at home?! I've tried her social worker, he seems to be no help. I'm reaching out to aging services aND her PCP also. Has anyone had this problem? She does not want to go home and she will only be able to afford a PCH for a short time. I've never even heard of this. We all just thought they would out her in a nursing home and that would be it.
I did go through this, last year. A nurse told me my father would probably be discharged, I believe it was the next day. He was unable to walk, was on 6.0 liters of oxygen, couldn't live alone in that condition, and hadn't been in the hospital long enough to qualify( minimum 3 days) for direct placement to a rehab facility.
I gave either a nurse or the discharge planner verbal notice that I was challenging, and also wanted the PCP removed and replaced by a hospitalist. Action was taken before I even had a chance to call. The PCP called 4 times to find out why he was being fired. A hospitalist took over, Dad stayed long enough to get the oxygen level down, and went to a rehab facility.
You can also request a different attending physician, as I did. In your case, I think an orthopedic physician would probably be the most appropriate (b/c of the fractures).
I would push to learn the specific reason why it's been determined that (1) she's medically fit to go home ALONE and (2) why they feel she shouldn't go to insurance paid rehab.
Also, escalate the issue to the Charge Nurse, then up to the Ombudsperson or even the hospital Administrator if you have to. I've involved the hospital Admin person on more than a few occasions.
In addition, contact local Ombudsperson agencies to see if they have any advice or can get involved. It may be that this particular hospital, and the discharge planners, have "arrangements" with specific facilities and steer people toward these places, as opposed to rehab facilities for which Medicare pays.
You're wise and courageous to challenge this decision; your grandmother is lucky that she has such a strong advocate for her welfare.
Good luck, and let us know how this works out if you encounter more resistance from the staff.
As for having to pay for her care, look for a nursing home that will accept her as medicaid pending, if she has the funds to self pay for a while that will be easier.
They can't discharge her if it isn't safe. Are you sure there is a united front from the family making it crystal clear that there is no family help available? No one's saying 'we'll look after you, grandma, don't worry' when you're not watching or anything like that?
I think something else is going on but I don't know what. I'd still challenge the decision and get outside advice even from an elder law attorney if you have to. Since you're the point person, try the local hospital contacts and ask your uncle to do the research on ombudsperson agencies. That way he can participate.
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