Mom broke hip and rehab will not keep her because she will not walk again. How do i get help?

There was a recent finding in a US District Court in Vermont entitled Jimmo vs Sebelias. I would google this finding and then fiind an elder care attorney. Based on this ruling Medicare cannot discontinue just because the patient is not responding. Also call your state Ombudsman and see if he/she can help, but I think the Jimmo case is really important.

A therapy plateau no longer ends Medicare (yes, I mean Medicare, not Medicaid) coverage. You can read about the new rules in this New York Times article from February 4, 2013

Thank you everyone for the advice!!! Well 3 months later we made it thru..I was able to get them to keep her few weeks plus the week in Hospital. we got 3 weeks to heal and then I had to bring her home several days early, or I was gonna stroke out! The rehab facility was a nitemare....mistakes, filth, bedsores, unproffesional/grumpy employees from floorstaff to top management! So I did dig and found that Home health would come in and help us...not daily or as much as we needed, but they were wonderful group of people and trained me how to work with her new disability... I swear it was like nite n day.....Rehab nitemare to the most sweet caring professional group of people...I cried tears of joy so many times when they were here working with us!!! anyway mom is doing good, but her loss of the ability to walk has put more demands on me...it was gonna happen eventually I guess but wasn;t ready for it yet, lol! Well just glad we made it thru and hope I can do her right...the future looks so scary now!!! I have kinda been in denial about her mortality..or a CGburnout coma...would be more appropriate... Today, Mothers day, I will do something nice for her!!!

Juju - 2much & Kiwanis has given you some good advise.

I'd like to add my experience in dealing with the elder having a home, it's expenses and MERP (estate recovery after death). Yes, their home and a (1) car is an exempt asset for Medicaid. However, the $ the elder has after they get into a NH is usually limited to whatever your state has set as their "personal needs allowance". The $ varies by state - just as the Medicaid rules vary by state.
My mom is in TX in a NH on Medicaid and still owns her home. Her PNA is $ 60 a month and is totally spend on stuff she needs to live at the NH like cosmetics, clothing replacement, hair salon. The reality is that the PNA is designed for doing just that and no more. Some states have a PNA as low as $ 35.00 a month. All expenses for her home (taxes, insurance, utilities, yard stuff, etc) is paid for by myself & another family member, there is no mortgage and the property is modest and we are fortunate to be able to do this. BUT if there had been a mortgage (traditional or reverse), then the house probably would have been sold as the monthly mortgage costs would have probably become an issue eventually. Now when she dies, we will let MERP know within 30 days that we will file a claim against her estate for all our expenses related to the empty house. This has to be done in our state within 30 - 45 days in order for the MERP expense exemption to be done.

As you live in the house and have been a caregiver for more than 2 years, you qualify for the caregiver exemption, but you will need to properly file for the exemption with your state's MERP program so there is not a problem with a MERP claim or lein against the house later on. My mom's state (TX) has all this stuff on-line so it's easy to find. You need to remember to do whatever your state's MERP program wants after mom dies and within the timeframe set by the state.

Now once they are in a NH on Medicaid, all their monthly income less PNA must be paid to the NH. If they get $ 1200 a month, then the NH get's paid $ 1,040.00
if they live in TX. So if you want to keep the house or live in the NH, the state expects you to pay on your own whatever to do that. If the house has a current Realtor listing, then you can apply for a waiver to divert some of the monthly money to pay for whatever needed to have it market ready. This usually is limited to a couple of hundred $$ to pay for yard, utilities and seems to be limited to a few months as it is expected that the house will be sold. But if it's the situation, that you are living in the home, the state expects you to pay for all without ever coming back for a claim for expenses. The expense claim seems to only be able to be used if the home is considered empty.

The cost of the mortgage is the big issue here. Can you on your own continue to pay the mortgage? Or do you really truly need mom's income to do this? How much is owed and is there anyway to pay it off completely? Go through the mortgage paperwork to see how to do an early payoff and what it might cost you.I'm assuming this is a traditional mortgage or a HELOC and she has owned the house for quite a while and there is alot of equity in the house and most of it has been paid off. If the amount owed is just for a few years more and you can possible pay more on the mortgage each month, look into doing that. Even if it is just like an extra $ 75.00 a month added to pay down the mortgage. You need to do whatever you can so that you don't find yourself homeless. Good luck.

you would think there is more help out there but it is like pulling teeth to get it!

Wow sometimes this place/forum does work....I jsut reasoned this whole thing out by venting/sharing....Kharma is fine...this was meant to be, these challenges would eventually beset me so why not now! If I can do this today I know I can be home with her indepentently and can do anything I will be better informed to budget/sked her care/aids! everything happens for a reason rite!!!

and i am in contact with the medicare quality of care board and as time allows will report this facility...i kept detailed notes pictures video and have the director of nursing lying to me in writing (maybe) so I will follow that up too......

I am not a vengful person but i have been pushed to my limit with this whole matter.....I do not wsh to even spend one more minute on it but then i thought.....this cannot be in vain.....
If something comes of my report that wil help the next family be treated with more dignity then it is most certainly worth my time!!! THat how disturblng the experience was even if they themselves "shake things up" over there because of all my documenting/ranting then it will have paid off! (but I doubt it will phase em.)...My leaving thoughts were " i have never met such a collective group of stupid people or I just got played.....Neither one I am comfortable with in a "healthcare role" "

oops *once she "HEALED" she will need the attention

I am hoping so, i will be persueing all these options as time allows. Her hands on care is first then bills and this mess of admin n laundry and finding aides to Prvt Pay I did call several people last week, only one had avail in their schedule....i have been living outta the car for 3 wks practically! I needa recoup a lil too! breathing a sigh of releif and new care plan....fortunately her Orthopedesit sed we have not missed a window to still give her best care possible now is mild maintenence p/t when she will need more attention/lotta work so i got some time there like i sed it just next few days of getting order n control back in our life and her care plan and getting the help set up that really worry me at this point!!!

I assume you have consulted an elder law attorney re the issue of the home and medicaid and any possible options? Also, aren't there other programs that allow higher income /assets than medicaid but still provide some in home care to avoid nursing home placement? i would think if your mother does not get proper care at home to prevent bed sores etc and ends up hospitalized, then govt via medicare has to pay more so it should be in govt's interest to provide less costly in home support.

Ya home health, i got started, wont be out for couple more days meanwhile she is dirty now so I am going in! The rehab n I went to war basically as they made mistake upon mistake with respect to her care on top of this issue so i pulled her out few days ahead of schedule...cudnt sleep or accomplish any task or chores with her there and such incompetent practices goin on...she was comin anyway 3 dys later, but due to those mistakes I spent all my time going in circles with admin nitemare, requested at least 5-6 times care plan and detailed bullets on care after discharde n didnt get it did not get to sit with her there at place n learn (cuz of admin nitemare n mistakes) and when time to go n they gave me 20 min on some p/t maint and home health would do the rest, i explained home health was 3-4days to start still any other training i requested was refused! We cant afford to put her on medicaid, then cant pay bills n mortage! SO yes I pulled her out and am now starting over in my control, try to figure this out with a non medicare driven mindset blinders !!!

meanwhile she is still pooping!!! life goes on! i have to get it done i guess I am just so nervous and dissappointed in those who promised to be there for me...
I;ve learned thru this site reasonings behind this behaviour some are fear based and some are just fake peeps and I can see clearly now who is who. it hurts, thats all, cuz i am a giver and always have and I really need rite now and karma is not helping me rite now im not sure why?

if you get in home therapist, they can teach you how to move your mother without hurting her or yourself . I wouldn't take the rehab facility as the last word, unless they assisted you with an appeal with the insurance or agency denying you assistance you you lost.

It does not seem right that they sent her home without arranging for any at home care, nursing physical therapy. did you attempt to appeal the decision? If your dr thought she would benefit from therapy you could submit a letter from him. Meanwhile, can you ask the dr to order in home therapy and help with bed baths. Medicare does pay for that usually when initially released from a rehab. do you have a hospital bed? Ask your dr if she would qualify for that and ask him to write a prescription. Would she qualify for medicaid or any state program that is designed to keep those who otherwise would qualify for permanent nursing home placement to stay in the home. they provide a certain number of aide hours and meals and other things. In my state it is called the waiver program - the long term care nursing home diversion waiver program.
i see you live in Oregon. I thought Oregon was known for providing some of the best resouces and funding for elder care. have you called
have you check this oregon site for contact. her dr can be your best help b/c if he orders something, ususally it will be covered.

Turns out learning thru this process yes, her DR (ortho) did want her to receive the rehab it was the facility who are claiming because of her dimentia, her cognitive abilities fall outside medicare guidlines for treatment with physical therapy. once they have the diagnosis (code) of dimentia, many of the benefits available to a non dimentia pateint are not covered. So Basically what I am saying is (and been told in so many words) Is a person with limited cognition and ability requires substantially more time to work with and recover and in a state of eventual terminal illness the cost outwiegh the prognosis...I was in a coma for a week practically and sick to me stomach when i figured this out! Quality of life is no where in this equation.....Therefore mom is back home with me 3 weeks into her recovery and I have no help....a sweet woman who worked hard all her life as a nurse n caregiver for our VETS/VA in the phsyc ward being mistreated and assaulted by patients, this is how our government pays her back....

She is in bed with a sh*tty diaper and I have no one to evern help me for 1/2hr get her changed roll method...I had a friend here yesterday for first day to spot me but I am on my own this morning....I am scared to death I wil hurt her all alone or make a dang poop mess!!!!
GIVE ME STRENGTH LORD!
I love how on FB when this happened everyone was "oh sorry, we are here for you, we love you!!! But here we are home calling on all these folks and they are "busy or cant be bothered" cuz no response or negative, I am not going pester or beg, asking 1-2 times i have my answer!!! I am just absolutely floored by how screwed up the system is and my so called friends

thank you very much 2much2cover that was awesome information...you would think the facilities social worker could walk me thru these steps but they didn't have much to say of value, but how we gonna get paid! I asked the facility how they can override DR's orders and inquired to her DR's, their view on it...he sed too many variables will discuss with me on her follow up Tuesday upcoming....but again the lack of professionalism and competency at this facility has me more concerned than any monetary issue now at the moment, the longer this is going on, they are too bothered to copy meeting notes that they ask me to sign, I have to insist plus they are not following notes left on how to care for her, I have to call and remind each shift if i am not there! This causing me great distress, daily! she is 25 miles away! I have been living outta the car! or on the phone here! I also did sit in on her therapy twice so far and witnessed full co-operation. Another reason to question their quality of care in my absence...they say cant try with her cuz she doesn't follow direction! I just don't know, the only other facility is rated significantly poorer than this one by Medicare!

Have you spoken to the doctor yourself but why would the doctor send her to a rehab if he did not think she would benefit. I don't know your mother's particular condition but my mother was in rehab twice for broken hips and they can't bear weight initially since it is healing. From what i remember the doctor does x rays every week or certain number of weeks after a hip fracture to see how it is healing. You can appeal the rehab's decision to discharge. If the dr thinks she can improve she would do better staying at rehab, if they are making an effort. Perhaps you could go to the therapy sessions and observe (which is what I did). when they know a family member is watching they have to make an effort. If she does go home you can get physical therapy at home on medicare but as i said, it is better if they start off in the rehab.

do an internet search for the words "how to appeal a rehab nursing home decision to discharge medicare" and you will find an article which includes this info.

They must give your parent a written Notice of Medicare Provider Non-Coverage (NOMPNC) form at least two days before the anticipated discharge date. On that form there will be information about how to contact the relevant "Quality Improvement Organization" (QIO). The QIO is the group that reviews these cases and makes determinations about whether care should continue.

If you haven't received a NOMPNC at least 2 days before the discharge date, the facility has to keep your parent until at least two days after you do receive

It just irks me that she is just a $$ to the facility and they don't really have the time to spend with her one on one she requires, due to her alzhiemers and that is part of their reasoning for not continuing with therapy. She needs constant prompting while exersizing and to hydrate herself n many other little things that I cant seem to get them to pay attention to. So i wonder if that is the best place for her anyway..Im not sure of the value added other than her custodial care...at $320 a day!

Yes they will waive the lien on the property as I am full time caregiver for 8 ys but the monthly income to support the household will be siezed while she is receiving these recovery services... so if I bring her home and hire caretake help it seems it would be much less expensive as I only do need the help when moving n changing, the rest shouldnt be different from old routine. But I am hesitant to rely on so much outside help at odd hours mini shifts 7 days week. I have started looking into what i can find and just decide what is best for her once i get more idea if this kinda help is there, n work with the bill collectors, I guess!

Medicaid is supposed to leave a person their home and one car if their intent is to return to the community, and they may have a waiver program that provides daytime help at least too. I eventually ended up selling my mom's home, but not until it was very very clear she could never go back, and we never did end up getting Medicaid for her. This was even though she was able to stay at home for a time while my Dad was on Medicaid and covered much of his nursing home care. Don't get me wrong, they are not generous, and they are not in the business of preserving inheritances for children of needy parents (look up "estate recovery program"), but they do not necessarily make it impossible for people either. And you should not have to try to do something you know you can't do. You might be able to find a caregiver training program for some of the physical skills, or get the hospital PTs and nurses to teach you but don't even go there if you know you cannot do it with whatever help and equipment can be lined up.

Yes Medicaid is next however, they will tap into most of her income so i cannot make her mortage payment! She is doing remarkably well but requires two to move her as her shoulder is broken as well. I live alone with her and have no family or support system i dont know how I can manage changing diapers and moving her alone here! I am only being offered few hours a week in home PT. and she does have a nonskilled bather/caretaker 4 hrs week but they cannot be on call for help as needed throughout the day/eve

I'm sorry to hear this. It truly is sad that money does dictate so much. You will probably have to see if your mom qualifies for Medicaid. Then her nursing home bills will be paid. You'd have to apply through your local social services.
A broken hip is one of the worst injuries an elderly person can sustain. I hope she can at least be kept comfortable.
Take care,
Carol