Kaiser Should Be Ashamed Of Itself!

[clinicalteach]

I won't blatantly say medicare fraud, but something sure looks like a duck and walks like one. I had a new admit who the kaiser hospice nurse told me during my initial report was completely unable to use her right side, and could not walk. When i met the woman, i saw her moving her arm just fine, i handed her a cup of coffee and a donut, and the hospice nurse and the daughter were about to have a coronary until they saw my resident using both hands and doing just fine. The resident told me, i want to walk again. i asked her why hadn't she been, and she told me that they said she was hospice and no one would help her retain her ability to bear weight, that and she had +3 weeping edema bilat on the lower extremities and it hurt. i asked the kaiser hospice nurse about PT and she said in a very rude manner, "NO, She is hospice!" , i waited a moment and then asked how about adaptive eating devices and the nurse repeated in an even more annoyed and patronizing tone, "I said she is hospice, so no that falls under occupational therapy'. Just to make sure I heard her correctly, I asked her, " So you are telling me that since she's hospice we shouldn't try and keep her as high functioning as possible, and her quality of life as full as possible?". She told me once again as if i were a complete Dolt, " I told you she is hospice, there is nothing more we can do but keep her comfortable." let me explain exactly what this hospice patient is like, as she describes herself she is "Fat Sassy and ****** and not just going to lay there and Die". The family had been listening to this hospice program and had been keeping her in a state of learned helplessness, well this woman is a fighter and and she and I both when I wrap her legs with kerlix (i'm going to hell because the hospice nurse told me i'm not to do it..but yet, my resident cried when she woke up and saw her ankles for the first time and no longer has any weeping edema)" I'm not dead yet" upon investigation , just because every day I battle with Kaiser and i'm getting sick of it, I found the federal statute that states that hospice patients may get PT/OT/ST. I gave the family information, and my ED and the family who has a sibling that is high up in the kaiser family is ****** OFF! i informed them about the Kaiser contracts many other organizations have with them that can provide the same assistance which kaiser did not disclose to them and they are in the process of questioning why they weren't told and why federally mandated therapy if requested was denied. This is not an isolated case, i have heard from several in my vicinity that it is standard practice, but no one wants to say anything because of fear of losing their jobs. I've had enough, so has my ED when repeatedly Kaiser tries to dump our residents (one they wanted back in our facility one day after 5 stent placements and another that had GI Bleed, and as the ambulance was gurneying our resident into the facility the case manager was on the phone saying that they were discharging and where could she fax us his papers). I have urged my parents to leave kaiser which they thankfully have. Please continue to advocate for your patients, especially hospice. While it is a "death sentence" it doesn't mean they are dead yet!

[LadyinScrubs, ASN, RN]

If you believe there is elder abuse, you are a mandated reporter.

[clinicalteach]

If you believe there is elder abuse, you are a mandated reporter.

Thank you for the reminder! I discussed it with my ED who is going with me up the chain of command there and I am also going to call the number I just found.

[shirleyujest]

That sounds to me like it would be reportable to the state, and possibly JCAHO. If the patient is a senior, then, it's true, you are a mandated reporter for elder abuse. And if the patient is an elder, she is probably on Medicare as well as on Kaiser. If she is a Medicare patient, based on your story, Kaiser may be billing for services they aren't actually providing. I've noticed that CMS has been on a roll lately cracking down on insurance companies who are billing "erroneously" either for diagnoses that are incorrect, or are billing for services that weren't performed. The bottom line is, what they are doing is unethical at best, and could be outright illegal.

Kudos to you for advocating for your patient! We learn that principle in nursing school, but apparently some haven't retained the knowledge very well.

[netglow, ASN, RN]

Some hospices are only about the money:

Warning signs:

Nurses told to only document decline. This is to assure patient recertification, eg. hospice gets continual income, no matter what is going on with the patient.

***Family told that basically any and all treatment that is not directly pain and anxiety-related, will be detrimental and will harm the patient. Almost all meds are discontinued (even when patient can benefit and is not near active death) Hospices have to pay out cash for the patient's medications, they do not want to do this. So, often as part of admission the med list is reviewed. It should be reviewed for difficult to tolerate medications, and medications that do not benefit the patient anymore. But, unfortunately some hospices will convince everyone involved to discontinue cardiac medications including lasix when edema is painful and should be treated. PT/OT can be just as simple as some ROM taught to family, to ease the pain involved with immobility. Massage is part of hospice when beneficial and accepted, so why not some simple ROM?!

[LadyinScrubs, ASN, RN]

that sounds to me like it would be reportable to the state, and possibly jcaho. if the patient is a senior, then, it's true, you are a mandated reporter for elder abuse. and if the patient is an elder, she is probably on medicare as well as on kaiser. if she is a medicare patient, based on your story, kaiser may be billing for services they aren't actually providing. i've noticed that cms has been on a roll lately cracking down on insurance companies who are billing "erroneously" either for diagnoses that are incorrect, or are billing for services that weren't performed. the bottom line is, what they are doing is unethical at best, and could be outright illegal.

kudos to you for advocating for your patient! we learn that principle in nursing school, but apparently some haven't retained the knowledge very well.

good catch....medical fraud is reportable.

[mazy]

I'm not going to say too much here because just the mention of Kaiser sends me off into a dark well of insane ranting and raving that leaves me in a VERY. BAD. PLACE.

I've been a Kaiser patient and I've worked with Kaiser patients. It is the MacDonalds of health care.

[NRSKarenRN, BSN, RN]

This is not Elder Abuse but an issue of Denial of Care by Kaiser RN upon patient now expressing desire to get better and maxamize her potential. Reading between the lines, I surmise this patient is in a nursing home under Hospice benefit. Sometimes, when a patient has deteriorated, they suddenly realize they are not ready to die and rally with desire to live. Choice at that time is to provide PT/OT eval and education to caregivers or discuss with patient terminating Hospice benefit and returning to previous insurance benefit to get services under home care + Palliative care or SNF benefit if inpatient in facility.

What to do when services being denied under ANY benefit:

a. Provide patient/caregiver with knowledge of benefits.

B. Encourage them to contact Hospice Management staff to alert them of denial servoces.

C. If situation doesn't change, encourage then to call insurance company complaint line,--unresolved, then call Medicare when having that benefit. In PA, we also can call our facility ombudman who can involve state ombudsman if necessary.

D. Need to go higher: report to state insurance comissioner.

[dthfytr, ADN, LPN, RN, EMT-B, EMT-I]

Healthcare: It's all about the Benjamins. Sadly!

[SuesquatchRN, BSN, RN]

I work in hospice - not for profit organization - and we routinely schedule anyone able to benefit from restorative therapy for same. We also sometimes d/c for improvement. Hospice done right actually extends life and its quality.

[tyvin, BSN, RN]

You rock clinicalteach!

Ashamed ... they should be investigated.

[classicdame, MSN, EdD]

this really could happen anywhere. Nurses ought to be like you and report it to JC or the State Dept of Health or the Hospital Asso for that state. Any and all of those will do an investigation and you are more legally protected.