MEDICARE CRUELTY. After 3 weeks paralyzed father told to hit the bricks from nursing facility, 48 h notice. HELP!

[ryanmessy]

My father is in a skilled nursing facility after suffering a stroke during an operation. He can barely speak, barely swallow, and is paralyzed on his left side. He has a feeding tube. He has been in this facility for three weeks.

He has Medicare and a secondary policy through Atena

They told us Friday that he's out as of Tuesday. We do not know if he has any money (accounts are impossible to access, we have PoA but banks are slow) and his home cannot accommodate him (stairs, no bathroom on ground level). We have no specialized equipment (beds, ways to move him).

I filed the appeal-- denied.

I'm working on second appeal now, but that's due today.

My sisters and I are glad to advocate on his behalf and we're happy to take on his permanent care. We just can't do this with two working-days notice. Plus, he's benefitting from speech, swallowing, and physical therapy.

We're desperate for advice or solutions. Any ideas? Thanks Reddit

 

[elev8]

@ryanmessy This is very common. Does he have any long term care insurance?

You'll have to expedite access to his assets information. If he has the funds to pay out of pocket, that will buy him some time. He can apply for Medicaid but the income/asset limits are pretty strict.

Does the facility have a social worker available? They would usually have expressed interest in completing a Medicaid application...

 

[ryanmessy]

@elev8 Thank you. I don't know the limits of his supplemental insurance. I'm guessing from this that it is not long-term care.

We're trying to assess his financial situation. We know he has some debt, but can't get banks to work with us quickly. All local branches need to submit docs to national centers, they come back asking for more info after 48-72 hours and we can't access his accounts.

Most of all, we lack the specialized equipment and a home that can accommodate him. We can do this in weeks, but not by Tuesday.

The social workers are great, but they don't know of recourse other than the appeals process. Thank you for your thoughts.

 

[yeswin]

@ryanmessy

We're trying to assess his financial situation.

Does he own his home? Is there a mortgage? Is he married?

Chances are pretty good that if he owns his home outright and is not married then his care will be out-of-pocket until you spend down his assets and qualify for Medicaid.

Debts don't matter- just assets. Homes, cars, liquid accounts, CDs, stocks, etc.

If the social workers can't help you with that then you're talking to the wrong people- every facility should have a patient advocate to guide you.

What state are you?

 

[ryanmessy]

@yeswin He's a widow that owns a home, but has has loans against it and we're trying to figure out what he has. My guess is that we'll burn is assets until we hit bottom. The social workers have been some help. He's in Illinois, I live in FL. I'd love to get him down there, but he's in no condition to move across a country. Thank you.

 

[elev8]

@ryanmessy Which state?

Also the debts aren't relevant. You'd need to know about all of his assets.

 

[ryanmessy]

@elev8 He's in Illinois. We know he has some assets (the building his business was in) but we don't know what is leveraged with loans, we know some things are. Obtaining financial information is impossible from banks, we're just opening mail as we can.

My feeling is to find a place where he can stay for a few weeks until we can sort it out.

 

[elev8]

@ryanmessy Banks are used to providing bank statements for Medicaid applications, have you expressed that's why you are asking for it?

This is the application: https://www.dhs.state.il.us/page.aspx?item=86436

His first property (if he owns where he lives) and his first vehicle aren't counted. If approved, Medicaid Estate Recovery reserves the right to place a lien on his property to recover what they paid for him for long term care services. It's really best to sit down with an estate planning attorney.

Info about spending down his assets is here: https://www2.illinois.gov/hfs/info/Brochures and Forms/Brochures/Pages/HFS591SP.aspx

You can ask Medicare about approving a lower level of care. But paying out of pocket unless/until Medicaid approval is what most people are forced to do if they haven't already planned for this.

 

[resjudicata]

@ryanmessy So what does out mean? Will they evict him from the facility or does just the medicare coverage end?

States have rules about who can be released back into their homes. It sounds like your father doesn't qualify for home release.

Access to his financial records is everything at this point.

This from the 1987 Nursing Home Reform Law:

"If a resident is to be transferred or discharged, the facility must provide adequate notice to the resident and the resident's family member, guardian, or legal representative, in writing, at least 30 days in advance"

You legally have more than just a couple of days to work this out. Don't let them bully you.

I went through a lot of this crap with nursing homes when my mom's health failed her. They will try to push you around. Acquire a lawyer who specializes in elder law if it is at all possible.

 

[ryanmessy]

@resjudicata Great advice. I’m having a conversation with them tomorrow. Glad I know this.

 

[resjudicata]

@ryanmessy Unfortunately this is the way it should go. Medicare covers up to 100 days of skilled nursing facilities. It's meant to be a short term thing after hospitalization, to help the patient recover enough to return home. The patient needs to keep showing improvement.
In the case that the patient is not improving, or unlikely to be able to return home, then they don't qualify for SNF and should go to a long term care facility.
Medicare does not cover LTC. There are private insurance plans that cover LTC, but it's probably too late for that at this point. He will have to apply for assistance through the county. Or if income is too high, he'll have to go private pay until he runs out of money and qualifies for medicaid.

 

[resjudicata]

They said he’d been there 3 weeks though…?

 

[ars]

@resjudicata I believe the patient needs to keep showing improvement, they don't automatically get 100 days. It sounds like he may not be improving at the level/rate needed for his stay to qualify to continue.

 

[psalmbook]

@ars That's exactly right. You have UP to 100, it doesn't guarantee 100 days. Medicare only covers short term care as you said. It does not cover long term or custodial care. If the patient is not expected to recover, or sometimes even if they are recovering too slowly and not meeting the metrics, their coverage ends.

 

[bell168]

@resjudicata Probably a Medicare Advantage plan through Aetna. So they authorized his stay week to week.

 

[marytx0]

@resjudicata It’s important to note that Medicare doesn’t pay for the 100 days in full. Only the first 20 days are covered in full. After that the patient pays a daily copay of around $185 per day (unless they have a supplemental plan that covers rehab/LTC).

 

[bell168]

@ryanmessy Sounds like he is enrolled in a Medicare Advantage plan through Aetna that the facility only received an initial authorization or coverage. It's a week to week review process and they made the decision to terminate coverage. If you have determined that you are not capable of providing his care needs, then you need to work towards arranging for his care costs to be paid for at the facility on a private pay arrangement.
Work with the social worker if you want to transfer or discharge him elsewhere as they can order equipment if needed.