Hi all,
My mother (87) has had a rough 6 months. She has been living independently for 15 years since my father passed with no problem. Six months ago, a door at a bank unexpectedly opened which caused her to fall and break her sacrum. She was just starting to recover from that when she (probably got cocky and) tripped and broke her hip. She had been recovering nicely from that, when all of a sudden a nasty case of lymphedema occurred, causing her legs to weep, which led to dehydration and wounds on her legs.
She was admitted to the hospital and they began treatment for her dehydration and wounds. She was in the hospital for four days and she has been transferred to a skilled nursing facility. They are treating her wounds daily (wrapped leg bandages, etc.). She has been at the skilled nursing facility for 10 days. On admission, they set a discharge date for 3/23.
She has a Medicare Advantage plan with United Healthcare, so I am preparing for them to issue papers to go forward with the discharge. I am familiar with this process, as I won one round of appeals when she was in a skilled nursing facility for her broken hip recovery.
Does anyone have any advice for dealing with the MA plan in treating wounds? I don't believe she can function by herself at home at this time. I live out of state. After her fall, we put a plan in place for her to move out to my state. I was hoping she could move when she was fully recovered.
So, now I am in the gray area where I am not sure what is best for her. If they try to discharge her, I will appeal it. I am also considering just doing cash pay at the skilled nursing facility to allow her to recover for an additional week or two. Also, I have reached out to a board and care facility that can take her on a month to month basis. She does have a part time care giver who has helped her after her first fall. The part time care giver doesn't like the board and care place, because this is where people go to die.
I am leaning toward the facility because there is a much better care ratio than an assisted living facility. She did spend one day at an assisted living facility after her first skilled nursing stay, but only stayed on night. She paid her part time caregiver to stay with her 24/7 for a couple of weeks (which was quite costly).
So, two basic questions:
Any advice would be greatly apprecaited.
The medical issues your mother is having sound both chronic and concerning. I have had to do substantial wound care for my bedridden mother for a class 1 pressure wound on her buttock. It was caused by neglect at a facility. I brought her home with me four years ago and it has been a constant battle to get it to heal and stay under control. If it is possible for you to get her moved closer to you so you can keep a close eye on her care that would be optimal from a medical management point of view. Do the best you can to stay on top of the situation- it is not easy and there are things beyond your control sometimes. Best wishes.
Her PCP orders Home Care, since I doubt Medicare will pay for LTC for wounds. Home Care nurses come 2-3 times a week, take her vitals and change her wound dressings. They furnish all supplies, and Medicare Advantage pays.
These great RNs were a blessing when I was home alone and miserable. It took 15 months for my leg wound to heal!
They will call her Doctor directly if they see anything wrong. They text a day ahead with arrival times, are in and out quickly. They will come to her in a Board & Care as well. Best thing ever! The lower leg lymphadema is hard to heal, trust me. They tried a few things, what worked was called an "Unna Boot."
I think she will need long term care whether in a skilled nursing facility, or in a private home care setting. Just make sure that the board and care home will have sufficient training to manage her wound care, or have a wound care nurse make house calls to tend to her so it does not become worse.
You should start thinking of her next move to become her final lifetime destination. It is time to sell her house, if she owns, or plan to use her housing budget, if she has been renting, toward her new care facility. If she can not afford it still, or when the money starts to run out, then she can apply for medicaid which will help cover the additional cost.
I don't think many board and care homes will take medicaid payment, so plan in advance. When that time comes, she may need to move to a skilled nursing facility. At that point, her care needs will probably be more advanced and more than a private care home can manage.
I am working on a plan to get her moved to a AL facility close to me. I just need to get through the next 3-6 months.
Any advice on appealing the discharge? I believe the best idea is that she still needs skilled nursing to treat her wounds.....
When she went home, the wound care continued and the PT has continued. She goes for chemo once a week at a new chemo clinic, a couple of hours away. She lives alone. Has a weekly housekeeper and her nephew who takes her to chemo picks up her groceries. My friend lives in another state so they have a SNF picked out for her sister to go to should the current system fail. But her sister is at least 10 yrs younger than your mom.
I like your idea of a care home if you have found a good one. There are some great care homes in some areas. But some of them are horrible. I found out about some through a home health agency. I also found an ALF that had a respite room they allowed me to use for four months. Home health can come to either of these to do the wound care and the PT. Your mom could do telehealth appointments with a doctor if needed and you had someone to help her with them.
Good luck. Let us know how it works out.
It was a minor surgery, no general anesthesia - during a Doctor's visit in her room. She stayed a while longer there for treatment then when she came home a Wound Care Nurse came to the house from her Medicare Advantage Plan and treated her, and showed me what to do.
It was almost magical the way her legs healed. I massaged in A&D Ointment on her legs twice a day for the rest of her life. Used to tease her and tell her she had Betty Grable legs - they healed so well. Her legs looked like legs on a 30 year old. So, maybe a Wound Care Doctor would be a right choice? That is what made the difference in my Mom. The one she saw was out of Network. We had to pay out of network costs for the visit, but it was only one visit and it worked amazingly well.
My main question, and forgive me if I missed it in the fine details--is your mom in care. Because with you not there, quite honestly she MUST be.
Some very few SNFs have a LTC wing that will accept people into long term care, but the government funding for SNF, Rehab and etc are somewhat SET IN STONE. You must move on to care, whether at home or in a long term care facility. You cannot insist on staying because a move "home" isn't safe. You have to MAKE IT SAFE by having discharge seek long term care placement.
This lymphedma isn't going away. Without someone constantly on mom about getting those legs up, constantly able to assess her wounds, constantly trying to prevent falls this is going to go on and on and on.
Wound care is crucial and it's crucial it's a wound care team.
Your not being there makes placement 100% an absolute necessity.
This cannot otherwise be managed and it can only be managed with GREAT DIFFICULTY in any case.
I am so sorry. I wish I had better news. But they WILL discharge and if they do not she will become SELF PAY, and trust me, neither you, she, nor the two of you together will long be able to sustain that.
I sure wish you luck. She needs Board and Care at the LEAST. As an RN I can tell you it is unlikely her legs will ever heal again. If you have viewed them, or go online and ask for images, you will see that complete healing with swelling and skin fragility and the poor circulation almost NEVER happens in these cases, and if it happens there is almost always reoccurance.
Good luck. There are going to now need to be BOOTS ON THE GROUND here. That's you or it is a nurse manager. Other family? This isn't manageable long distance without secure and involved placement.