here's how medicare works. grandma gets admitted to the hospital for an emphysema attack. grandma stays for a few days getting medical therapies. every day grandma is hospitalized she gets weaker and weaker and weaker. it has now been 4 days and grandma is now ready to go back home and smoke, but she's too weak to hold her own cigarette. so where is grandma supposed to go?
1. I don't put any thought into the comments of "shock" journlists/jocks (this author, Howard Stern, tabloids, etc.)
2. As a nurse I'm not insulted. I think it was not meant to be a criticism of nurses. It's a criticism of the system/Medicare and the foolishness of the laws involved.
3. While not personally insulted, I found the article cynical, rude, and not worthy of my attention.
The writer is NOT a "shock journlist"..he happens to be a physician...and does deal with this issue.
I do medical review for insurance reimburance/cost containment...and this is a pretty accurate account. I have to try to step in and not have the 600 lb lady transferred to the SNF...well, just because she is 600lbs....(but I don't work with medicare reimbursment- I do private insurance)
I don't think there was anything he wrote that was meant to be derogatory to nurses in this article, this MD was calling it like he sees it.
Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
After having worked in various SNFs over the past 6 years, I totally agree with the author of this article. Although he is exaggerating and embellishing some details for the sake of humor and sarcasm, he has hit the nail directly on the head. Many (but not all) SNF residents are definitely not rehab material and will never benefit from costly therapies, but there are people who are readily willing to milk the Medicare system for every last penny.
I had always thought hospitals were obliged to offer the SNF arrangement for the patient with innability (aka unsafe) to perform ADLs on their own in their own home. I assumed that the reason we have to do this is because at one time or another hospitals must have gotten sued by sending some feeble, still slightly sick folks home and then once home these folks died or fell and broke a hip, etc. I had always thought this was just something hospitals were mandated to do. A lot of patients don't have any family to help them. If their insurance is going to kick them out of the hospital, what other option do they have? Go home and lay on the sofa hoping some neighbor will come check on them once a day? I know that SNF isn't the best system. But is there another answer for these people?
I would like to correct this guy though. Most families will want the patient in their home if possible if they are able to handle the responsibility. The families who are not willing to take care of their own probably aren't capable of doing so anyway. I think this article throws more guilt and shame on the families that wont and can't than upon nurses. There are moments I am appalled that certain family members would send their mom to a SNF. But I have to remember that there are reasons I may not understand. People have to weight these decisions very carefully and not everyone would do what I would do.This guy ought to get a clue too. How typical, a physician without insight and compassion. What would happen if his patient was sent home before she was safe to be there alone then broke a hip and later died? What if the family sued him and the hospital for not giving the option of safety at discharge?
Having seen a person who was end stage CHF, COPD and stage IV lung CA pulled out of hospice and put into "rehab" when he couldn't even stay awake longer than about 90 seconds before he tired out, much less achieve any kind of therapy, I can see some of what the writer's saying. But rather than yell "Medicare Fraud" how about addressing the real reason there's nobody home to look after grandma -- we all have to work, and a lot of us are working 2 jobs. If it's quit my job and try to rehab a 350 pound woman with a broken hip who's confined to a wheelchair that won't fit thru the door of any bathroom in the house who I just can't lift vs. place her in rehab where hopefully she can at least get to the toilet and the shower, I'd vote for rehab.
I saw someone who went home after a femur fracture because their family wasn't going to have their matriarch in one of "those" places, only to fall and break the other leg. She was on the floor for 10 hours, came to us with rhabdo, and died of a PE.
But they never sent her to one of "those" places, did they?
Specializes in LTC,Hospice/palliative care,acute care.
I saw someone who went home after a femur fracture because their family wasn't going to have their matriarch in one of "those" places, only to fall and break the other leg. She was on the floor for 10 hours, came to us with rhabdo, and died of a PE.
But they never sent her to one of "those" places, did they?
Not to be picky, but Medicare pays 100% for the first 20 days.
As a 25+ year veteran of SNF nursing, I'm not really insulted by the article. It seemed to me the author was more upset about the 3 day rule than anything else. I agree the rule stinks some times but I certainly didn't make them. There are plenty of ignorant people all over the world and some of them actually get published. I learned a long time ago to just turn the page.
:) It's been a while
It's sad that so many people are talking about people being admitted to SNFs that aren't going to be rehab "worthy"; they're not capable. We didn't admit those to SNF. I had to do the MDS to get a RUG that paid for the stay. If I didn't get a RUG (even the default- and then they were only continued as long as necessary) they were discharged from the Medicare bed. If someone wasn't a rehab candidate, there were VERY few things that would "skill" them (complex medical, decubs that they were admitted with, etc). Maybe it was living in a smallish retirement community; most would need some sort of stay at some point- and there were only a few places to choose from. Didn't want to burn bridges. The administrator, DON, and admissions were good about not pushing to keep someone on "just because they have days". If someone couldn't skill them, they were discharged from Medicare.
I think the author suffers from craniorectal inversion. So where IS grandma supposed to go? The reason Grandma can't go home is because the adults in the family are working or unable to provide the care she needs. Should we let her die?
Correct and funny. "Why do they even need to mention their nurses are skilled? I want her to show up with my dinner tray and a skill set the size of Texas!"
Happy hospitalist is an ignorant SOB who believes that as a physician, all others are beneath him. He may have valid points, but his pomposity hides any point he tries to make. In his little world, he has all the answers, and no one else- and this includes nurses, PA's, NP's- has the ability to formulate an opinion.
Personally, I find all his posts incredibly offensive, correct or not.
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diva rn, BSN, RN
963 Posts
The writer is NOT a "shock journlist"..he happens to be a physician...and does deal with this issue.
I do medical review for insurance reimburance/cost containment...and this is a pretty accurate account. I have to try to step in and not have the 600 lb lady transferred to the SNF...well, just because she is 600lbs....(but I don't work with medicare reimbursment- I do private insurance)
I don't think there was anything he wrote that was meant to be derogatory to nurses in this article, this MD was calling it like he sees it.