Brain storm needed...

[Antikigirl, ASN, RN]

So I have this patient who is having a very tough time, and his wife even more!

The patient was in a MVA a few weeks, and suffered closed head trauma and spinal fx. Actually the situation directly post MVA was horrific! Clot, large one C2, and he actually was vented and they controlled it! WOW! Kudos to that hospital (another hospital)...but now he has severe short term memory probelms. He is now on recovery and is in rehab status...doing well until he fell at a rehab and sent to us...he is not injured from the fall and was basically on observation.

When working with the pt, I found his condition to be worsening mentally. He was starting to aspirate on everything, started getting very impulsive and getting OOB every few minutes, speach slurring...it wasn't looking too well. Found out by working closely with his MD (who is not only my own MD, but a friend) that when we cut out the narcotics things returned to normal and just had some short term memory deficits. So he is back to his norm and rehab situation.

Okay..well so much for pain control huh? We are trying non narcotics, heat therapy and what not. Well the poor guy is also going through nicotine withdrawls too (2 pk a day smoker), and is on strict bedrest. No wonder he is so jumpy! We have him on a patch..but not working! So basically he is not not in much control pain wise, and going through withdrawls...and his wife can't work because she has to be in the room with him all the time to prevent falls (he has fallen 2 times in a rehab so they kicked him out, and now 2 times here...he is a quick one that rolls over the bedrails before the ambu and bed alarm sound! Even on the most sensitive of settings!).

Okay...well that is not the delema sadly..and this is where I could use some help from someone that may be in the know...

It was found yesterday that his blood ETOH content was way above the legal limits and he was guilty of causing the MVA (he hit a tree in a storm). So his primary and secondary insurances dumped him! Now he has been denied at any rehab or SNF since he has no ability to pay! He is not really appropriate for a hospital setting (he is basically a rehab patient at this point, and well...with 5 other patients...we can't keep him safe...and just running like crazy trying to find a 1 on 1 so his poor wife can get some sleep once in a while or get to work!), and we are going nuts trying to come up with ideas on how he can get placed...he can NOT go home unattended at any time...he will need 24/7 caregiving because of the mental status and impulsiveness.

His wife contacted the VA but it can be months before he could be admitted and then there is some missing paperwork on her end that is delaying things (like the hubby can remember where it is..not!). The poor sweet wife is going nuts, trying to be his nurse/social worker/wife/and bread winner, and I fear for her health badly! I just know she is feeling guilt too because she is ticked at herself by even thinking when she is frazzled and tired that it may have been best for both if he didn't make it...and that is depressing her horribly...I talked to her and said that was a normal occurance called bargining where you look at the scenereos of "what ifs" in order to achieve acceptance of a hard situation. And referred her to councling..which she wants but has NO time for obviously ...

Does anyone know of where there is a place this man can go without insurance besides a hospital? I can't let them down, I need to find options for them and our staff to submit so we can help both of them through this situation. To me it was like a miracle that has turned nightmare...and I can't accept this!

Thanks in advanced...just looking for some other options someone may know about...(BTW we are talking NW USA area).

[SharonH, RN]

1. Did she appeal her insurance companys' decision to drop their coverage? I have never heard of an insurance company having the right to drop coverage in the middle of treatment.

2. If the appeals process with these people didn't work, has she tried Oregon's insurance commissioner for help? I think I would start there, I don't know what it's like in your part of the country but resources are scarce and finding placement for a patient like that would be a nightmare without insurance.

[AnnieOaklyRN, BSN, RN, EMT-P]

Carefull HIPPA, HIPPA, HIPPA...

No trying to be a turd here, but that is a lot of info about this patient, enough to give him away....

Swtooth

[Antikigirl, ASN, RN]

NO kidding...I didn't know they can drop you like that, but I guess the insurance and the facilities for rehab can deny you coverage because it isn't acute hospital care anymore...and can be done at home..yeah right, only if she quits her job, tends to him full time, and suffers no income??? Who is that helping???

They are applying for state assisted healthcare, but the state health care plan is suffering badly and the waiting list is years and almost impossible now to get any decent coverage at that. Uhgggggg! But that is an Awesome Idea!!!!!!!!!!!

So far my hospital is going to have to choke the bill, which is by law and oh well...it HAS to be done! But he needs to go to a home like setting soon, for his mental health as well or he will wind up in restraints and on bedrest for months (restraints are next...we have tried all other options, and since we can not use narcotics to help with pain and anxiety issues..this is tough!).

Drug and ETOH rehabs aren't set up for pts like him, so that is out...halfway houses too...so there goes that help...

I guess he is an american indian too...so they are trying through the tribe...but he is like 5th generation mix off res so I don't see much happening there...that is a option the wife hates to ask for, but she is in dire straights...and will move to the res and help in any job they ask so that they can get help...she is willing! Poor sweety..she is just despirate and feels so powerless and hopeless...and both she and I are confused on the whats and hows!

[HyperRNRachel]

Carefull HIPPA, HIPPA, HIPPA...

No trying to be a turd here, but that is a lot of info about this patient, enough to give him away....

Swtooth

What? No she did not. In fact, other than the state, I had a patient with a very similar history.

Triage RN,

What about medicare days? Do you have a caseworker involved in helping find a place for him?

[Antikigirl, ASN, RN]

Changed some things to be more vague as not to Hipaaize...LOL!!!

Also..there are 13 hospitals within a 30 mile area...if someone wants to try to find this person...good luck! You won't get past any hospital info desk with their HIPAA coverage .

You are not being a turd! Always good to warn and make sure your fellow nurses are safe from devulging too much info! I have been online chatting about these things for years, and state was a bit grey of an area...but sadly relevant to a point...I took that out. Age was too because of benifits available but I also took that out...

[Antikigirl, ASN, RN]

They are working on that, but running into troubles with what they will cover since this was an ETOH MVA...I don't know...social work and wife are running into road blocks since this news yesterday...before things were fine....

Uhgggggg!

[RNSUEIA]

I know of a very good brain injury rehab facility and they do work with title 19 as well as having done some hardship cases. Its called On With Life in ankeny iowa. They do miracles there.

Another suggestion, how about a Vail Bed. This is a bed that is fully enclosed by netting the pt can see out, the nurse can see in. Pt is safe. These beds can be rented by the hospital...

Hope this helps:nurse:

[P_RN, ADN, RN]

We kept our guy for a year and a month. (more or less) and not the first one we kept that long either. Our social work department was fantastic. They got medicaid involved in a couple of patients, and the hospital realized they could even foot the bill for a rental house and a sitter for a lot less than they were losing keeping them in hospital.

What about social security disability? Surely this guy would be a candidate, and some states actually have a rather short time frame-gov't experiment that actually works.

Ms. Wife shouldn't have to shoulder the burden alone, get SW going......not you personally but surely you can make another referral. My DH is a VA patient and all he had to do was fill out an online form.

I realize that VA nursing home has waiting lists, but couldn't your docs interface with their docs and arrange an inpatient transfer. That would get him on the short list.

[Antikigirl, ASN, RN]

OKay now we are cooking! Love these lastest ideas!

I will make sure social work is doing the necessary medicaide stuff, and delving into SS, and that bed sounds AWESOME...now the trick is finding one! LOL! (never heard of it, but I am sure I will be seen in quite the rosy fashion if I find the info! Thanks!!!!!!!!!!!!!!1).

Cool...keep these ideas comming..at least I am getting a good list going, and hey...that is a GOOD thing!!!!!!!!!!

THANKS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!1

[Antikigirl, ASN, RN]

RNSUEIA! Thank you as well! I called social work and they are looking into that organization! TOO COOL! Thanks a ton!

And yes, they are looking into short cutting the SS and medicaid but running into road blocks..but they aren't giving up! :)

Thanks all! I just need to get some of this burden off the wife or she will be the next one hospitalized r/t stress and anxiety not letting her care for herself in this process!

Anymore advice gladly accepted!!!!!!!!!

[P_RN, ADN, RN]

I had never heard of a vail bed, but on a search I found the FDA had recalled them.

FDA Notifies Public That Vail Products, Inc. Issues Nationwide Recall of Enclosed Bed Systems