Nurse skill? for medicare

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    I have a question....I have a patient who in april had a colostomy put in...it will hopfully in around 6 months be reversed....but for now she has it. Her family brought her back here to from another state. The family if very rich. They have a non-speaking maid that does everything for the family....and the most important thing...take care of the patient. This maid is leaving. This family is losing a wonderful lady....I know little spanish...but she is very smart, and does wonders. She actually does the colostomy care. She actually did the care today...and changed it for me...while her family sat there and watched. This patient has two daughters. One right now is fighting cancer...on chemo/radiation...so she cannot do this. The other daughter has scleroderma...and states she cannot do this. The family I will repeat is VERY rich. I think it is more that they do not want to do. The patient daughter can open small jars, sew purses together...(here in the south they like to make purses from the hi-c, capri sun packets? is that everywhere?) But all the sudden when it is time for the bag change...she cannot do it. She got very upset with me today when I told her Colostomy bag changeds are not a skilled nurse "need" medicare will not pay for us to go out there once a week for 6 to how ever many months to do it for her.

    any suggestions? The patient is wonderful. she is too confused to learn to do it herself. Is there a way we can help this patient out? or am I right in saying this is not a skill for medicare to cont to cover? Any information would be great.....I want to help...but at the same time I know the patients daughter just does not want to do it. It is like when I first arrive....she is fine.....when I then say lets do the change.....he cannot....then when I leave...Oh...I am feeling better again. I know there is pain with scleroderma...but I am not sure what to say or do. sorry I went on so long here.....anyone that made it through my whole post here! thanks! and any info! THANKS!

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  4. 5 Comments so far...

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    Being rich has nothing to do with this situation. Same thing happens in family's without 2 cents. Family's lack of understanding that "someone else" isn't guaranteed under insurance to provide care!

    Medicare pays for intermittent skilled care homecare, not 24/7 care.
    This is a perfect situation to use Medicare's Advanced Beneficiary Notice:
    http://www.cms.hhs.gov/medicare/bni/CMSR1312.pdf

    Inform the family they will be resposible to obtaining someone to learn/ be responsible for colostomy care after discharge date as not considered "skilled service". Is another maid being hired that could be taught in the future? Document discussion in your notes, family's unwillingness to perform care. Inform them that private pay sevices can be arranged for routine changes and personal care. Since patient is confused, family needs to learn in off chance something happens in the middle of the night/weekends/time paid caregiver unavailable. Place the ball in their court where it belongs to have mothers care provided. Offer Social Work Eval if indicated.
  6. 0
    Quote from NRSKarenRN
    Being rich has nothing to do with this situation. Same thing happens in family's without 2 cents. Family's lack of understanding that "someone else" isn't guaranteed under insurance to provide care!

    Medicare pays for intermittent skilled care homecare, not 24/7 care.
    This is a perfect situation to use Medicare's Advanced Beneficiary Notice:
    http://www.cms.hhs.gov/medicare/bni/CMSR1312.pdf

    Inform the family they will be resposible to obtaining someone to learn/ be responsible for colostomy care after discharge date as not considered "skilled service". Is another maid being hired that could be taught in the future? Document discussion in your notes, family's unwillingness to perform care. Inform them that private pay sevices can be arranged for routine changes and personal care. Since patient is confused, family needs to learn in off chance something happens in the middle of the night/weekends/time paid caregiver unavailable. Place the ball in their court where it belongs to have mothers care provided. Offer Social Work Eval if indicated.
    thank you.....i just was making sure I wasn't thinking the wrong way.....I will do just as you said....and I will show my DON that website you gave me! thanks for your help! I really don't know what this family will do when this maid leaves! she is the best thing that has ever happened to them. I know she understands english...but she tells them she doesn't. Listening to her I know they don't pay her what they should...and they treat her bad! anyways! thanks for your help!

    this website is great!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
  7. 0
    Sad but maybe they can go the private pay route. UH no J bave never heard of making purses out of juice pouches? Is that for wee ones?

    renerian]
  8. 0
    I was thinking the same thing---private pay would be an option.
  9. 0
    I think they have the money for it! and no...the juice box purses.....for the "big girls" its a big thing down here....My husband is military...so I am not a southern girl....but they are cute.....but don't think I would use one...and then they usually top the purses off with like the fake fur? funny.

    no really...thanks everyone for your help. I just wanted to make sure I was not thinking wrong in this one! thanks....


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