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I need help

Geriatric   (2,194 Views 15 Comments)
by jenni82104 jenni82104 (Member)

3,843 Profile Views; 155 Posts

Ok, so I have a challenging situation with my mother, and I am hoping someone here has some ideas. My mom has had surgery for spinal stenosis back in March. She has been in a rehab/nursing home since she left the hospital. So far she has not been progessing too good. She cannot walk or even stand by herself, so she needs help with everything. She can sit up by herself in bed and feed herself, but that is about it. She needs help with dressing, showering, and she is on a cath and is in diapers. The problem is she has told me they are discharging her on Tuesday. Seems her insurence does not want to pay for her stay anymore if she isn't going to get better. I do not know what to do, I do not know if I can even get her in the house. I have one brother who lives with her, but he has medical restrictions and cannot lift her, and I work fulltime and am in Pharmocolgy class, so when I am not working I am studying. I just do not understand how they can just discharge her when she cannot take care of herself at all. I do not know where to get help, and her social worker is not giving me any suggestions. Help!

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jmgrn65 has 16 years experience as a RN and specializes in cardiac/critical care/ informatics.

1,344 Posts; 12,072 Profile Views

Is getting Physical Therapy and is she participating? If she isn't getting better she may have to go to an ECF and has she applied for disabiltiy? They may need to be done.

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155 Posts; 3,843 Profile Views

Well she was doing pt, but she has mental issues that are getting in the way. For instance, when I took her to her 6 week checkup to her surgeon's office I had a really hard time because whenever she tries to walk she starts screaming and crying because she panics that she is going to fall. I do understand this fear, because honestly I think her legs are about useless, they seem worse since the surgery, she now has a drop foot and she also has two bad knees. I have requested a psych consult. I do not even know how to get her into an ecf if the insurence does not want to pay. She is not on disabilty, she is on long term medical leave from work, so she gets 60% of her pay.

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Insurance RN has 25 years experience and specializes in transplant case management.

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Is your mother receiving Medicare? If so, Medicare guidelines clearly state that to continue to receive coverage, a person must have the ability to improve and also to participate in a skilled therapy. If your mother is does not fit into this category, she is considered custodial care, which is not covered by Medicare guidelines. Have you approached the Social Worker to request a Medicaid application be filled out?

If your mother is not Medicare eligible, them most health insurance policies have a limit to the amount of days that are covered at a skilled facility, read yoour mothers policy carefully.

Home care may be an option for your mother for a short duration.

My best advice is to request a meeting with the sociall worker now to determine what is available for your mother.

Good luck.

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155 Posts; 3,843 Profile Views

No, my mother is not eligible for medicare. I did talk to the social worker and basically if the insurence company will not authorize her to stay, then I just have to suck it up and take her home and take care of her. I am just so stressed out because my mom is completly dependant, and I have no idea how I am going to do it all. Thanks for trying to help.

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35 Posts; 1,379 Profile Views

Get that social worker on the ball to find other options for you!! That's what they are supposed to do! You absolutely cannot, and I repeat cannot take your mother into a situation where you are both set up to fail. That SW should see that and be looking into some type of extended care where your mom's needs can be fully met while she continues to recover. If taking her home is not an option, you can just go ahead and say that. Don't feel guilty, I know there's a whole bunch of emotional issues tied to that one, but you have to look at what is best for both of you overall right now.

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1 Follower; 26,410 Posts; 76,600 Profile Views

SNF usually only has covereage for 90 days with most insurance policies, not matter how good your insurance is. This is just how things are done. And unfortunately it does happen. The only way to get coverage longer is to be covered by your state's program.

With the health care system that we have, there are not many options is this case. And there is not always anything that the SW can do to get further treatment for the patient in this case. Acute care hospitalization is one thing, but when out of that, things are done quite differently and with strict limitations as to what can be done. Best way to get help is if your mother can qualify for state assistance, then she would be covered, but with private insurance, there are severe limitations in this case. This is just how things are.

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rehab nurse specializes in rehab; med/surg; l&d; peds/home care.

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.....

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155 Posts; 3,843 Profile Views

Well I did talk to the social worker yesterday. Suzanne is right, her time at that facility is coming to an end, and there is not much anyone can do about that, the insurance will only pay for so long. So, I am going to go get her today and try to see if she can even get into her house. If she can't, I will have to put up a wheelchair ramp. Luckily my husband has family that can help us, we'll only have to buy the materials. I am also going to go to one of my mother's pt sessions and see what she can really do. A lot of the problem is my mother's mental state. Her PT reports that she isn't all that motivated, and she needs constant cajoling to do anything. I am afraid that when she gets home that she will actually regress, and be perfectly happy to have me do everything for her. I know that I will have to be on her constantly for her to do for herself, and that takes a lot out of me. I want to thank everyone for all their advice and support! Rehab nurse, may God be with you, I hope things get better.

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CapeCodMermaid has 30 years experience as a RN and specializes in Gerontology, Med surg, Home Health.

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I can't imagine a facility discharging someone to an unsafe situation. Until you find a better solution, your mom might have to pay privately to stay where she is. Good luck.

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35 Posts; 1,379 Profile Views

If I was not able to take a parent home, I would just say that is not an option. Period. Are you responsible for all of her medical bills? Are you her DPA? If you can't do it you can't do it. I've seen people attempt it, fail, and then bring their parent back in the system through the ED, where placement that should have been looked at in the first place is then done.

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155 Posts; 3,843 Profile Views

I don't have legal guardianship over her, and I am not responsible for her medical bills. I do not know if she makes enough money to pay to stay in a nursing home, isn't it like 3-4 thousand a month? She isn't getting that much. Besides, she wants to come home and doesn't understand why I am so concerned about it. She is delusional about her situation. When I ask her "how am I going to get you in the house mom?" (there are steps she can't climb) she says "I don't know." That's her answer like it is no big deal. I don't understand how she thinks that isn't a major concern. I can't even take her to my house, because I have a lot of steep steps that she won't be able to navigate. I have come to the conclusion that she is coming home and there is nothing I can do about it. I will try the best I can, but I do think I will end up failing her. Like I said before, I work full time and am taking my first nursing class. This is what I am afraid of, that she will not be taken care of properly, and will sit around in crappy diapers all day because I'm not there. It breaks my heart, but what am I supposed to do, quit school after I have worked so hard to get in?

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