Kooky Korky 31,584 Views
Joined: Feb 12, '10;
Posts: 3,975 (53% Liked)
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Sounds awful. You need to file a formal complaint with several parties. Hopefully at least 1 or 2 of the complaints will survive the chart culling that seems to be happening.
State the facts, including that your original notes appear lost or misplaced, thus you are rewriting them.
Keep a copy in your work locker (this is likely not really kosher. Let NO ONE know they are there. but do not remove anything from the premises.
Find a new job. Right away.
For Medicare coverage to kick in you need for SNF;
If your break in skilled care lasts more than 30 days, you need a new 3-day hospital stay to qualify for additional SNF care. The new hospital stay doesn't need to be for the same condition that you were treated for during your previous stay.
If your break in skilled care lasts for at least 60 days in a row, this ends your current benefit period and renews your SNF benefits. This means that the maximum coverage available would be up to 100 days of SNF benefits.
You have a great deal of knowledge about this person. I think the best thing to do is contact the state Ombudsman and senior services. It maybe this person needs ALF or SNF assistance. Most people do not want this because they will end up private pay if they own a home until they meet the Medicaid criteria. Basically they sell the home, pay private ALF or SNF room rates and then the social worker helps apply for the Medicare.
What usually happens in these scenarios you have described is the patient's family robs them blind, the patient is injured in the home and then goes to SNF. People have no ideal how hard it is to be a caregiver in the home.
It seems like she is going to have to sell her house and use that money for her care. Hopefully this will give her money for an ALF. If her husband was a veteran, she may qualify for some financial assistance once in an ALF, as well.
Agree with others- you need to take a step back. Do your job, don't get over-involved. Request a social worker eval from the home care company.
Do not write a letter to her son. That is a huge overstep. And, for God's sake, don't take your WIFE over there with you. HUGE HIPAA violation. Don't cross over the professional line. Don't go when you're not being PAID to go. Yikes.
You have to have 3 nights (3 midnights crossed) of a qualifying stay inpatient at the hospital, with need for rehab noted. Then, you get 100 days for a year if you have not been admitted to the hospital for the last 90 days, and d/c dx cannot be same as any in last year used for rehab or does not qualify. There is no extension past 100 days. After that, or outside of that, either private pay or dwindle resources to qualify for medicaid. I did LTC/rehab for years, that's the long and short of it. And yes there is at least a 5 year look back period depending on the state (each state sets conditions for their program)
If the patient is receiving private duty nursing, who is paying for that? Medicare doesn't cover PDN.
I was in the same personal caregiver situation but with a relative who has TONs of money to pay for care but would rather guilt one into doing for her. She actually refused home care after a fractured hip as she figured I would be there. I drove 100+ miles every weekend for years and finally I blew because of the subtle degrading remarks she made every week finally got to me. I had to walk away due to the burnout and abuse. Please refer her to social services or office of aging. They can set up meals on wheels and other assistance from possibly volunteer, etc. The Burnout one in this story should not be pushed any more; as for the other family members, you can't change their circumstances. It is a very unfortunate situation but not your responsibility. Learn to live guilt-free or it will eat you up inside.
Is this patient really in need of all this help, or could she be in a depressive state and not want to help herself? I think what needs to be addressed is the cause for needing help, other than the accident. I think she needs PT for sure and someone to push her a bit to start living independently again.
I am not sure at what stage of her injuries she is in, but if she truly needs this much help because of physical limitations she does not yet belong at home.
To answer your question. Medicare does not allow for 100 days of coverage after an acute hospital stay. After and accident or illness that result in an acute hospital stay Medicare cover's 60 days of post acute care to help you recover and receive rehab. It should be noted that during the rehab phase if you stop making progress with rehab Medicare may stop paying. Medicare does not cover care that is considered custodial... ie.. Bathing, cooking, transportation etc...If your rehab stay goes beyond 60 days you must have secondary insurance to cover additional cost. It is a sad state of affairs that people live under the assumption that Medicare will pay for their final expenses. In most cases people who have not planned for their care are forced to go through all their assets then qualify for Medicaid.
Your actual role in this scenario is to request a SW consult through your agency. Maybe visit SSA or other agency to gather information. If you have extensive senior services in your county, I don't think it would be out of line for you to visit some resources there and find out information that could apply to an individual in a different county (info about M'care, SSD, recommended lawyers, stuff like that) - - if you wish to volunteer time in this way.
I have sort of chastised a few coworkers before for being really angry that family members declined to come to the aid of some of our elderly ED patients. Coworkers can't imagine what kind of a sick, selfish individual doesn't come to the aid of their elderly family member when needs arise. Well - - sometimes it has to do with what all has transpired in the past 60+ years. It's very sad to witness but sometimes it is just no one's fault. Sometimes it's actually due to relationship choices the patient freely made earlier in life.
You can't allow yourself to be guilted into putting yourself in the sort of position you're talking about. As the sometimes "resident warn-er" I will add that these situations are often not safe for parties such as yourself in the midst of family dysfunction. What happens when you volunteer time and possibly personal funds to continue helping this lady and they find fault with what you do (or don't) do? What happens when it's not enough and they make a complaint about something? What happens when she deteriorates under your (unofficial) watch? Or her needs conflict with your/family's needs? You're still an RN and that will sensationalize whatever way this goes wrong.
I say you take a few steps to gather information and present it to them; names, entities, etc., where they can consult for help with their situation. Don't forget her PCP office (or the office of whomever ordered the services you are currently providing)!!
After these efforts, leave with a clear conscience.
If it this point she cannot live independently and requires some level of nursing home placement and has too many current assets to qualify for Medicaid coverage for nursing home then she would have to do a "spend down" until she qualifies.
Doesn't your agency have a social worker who would be knowledgeable about the answers to your questions and be able to direct this individual?
Unfortunately, I think at least some people in this situation dwindle their resources until they do qualify for medicaid and then enter a long term care system. I dare say most people in nursing homes, except the truly fortunate, can't afford it but are receiving aid.
If it's a former patient, you seem to be very, very involved in her private matters. It may be hard to think objectively about realistic solutions as such.
First of all- there's a ton of details in here and you may want to reconsider that.
Secondly- her 100 days allowed by Medicare of what are expired? It sounds like she needs inpt rehab or assisted living.
When the patient needs to be turned, cleaned, nude how do you handle this?
I have never been comfortable with patients being nude in front of just anyone and everyone.
I don't think it's right for kids of any age to see their parents nude or vice versa (with grown kids), for instance, although I know that many people do not feel squeamish about this. Maybe they've even been doing bodily care of their loved one at home.
I just announce that it's time for the patient to get his dressing changed, his bath, be turned to prevent bedsores, etc. and there will be nudity, so that anyone who should not see Joe or Mary nude should go ahead and step out for about 20 minutes. It's amazing how much rancor this can engender. People don't realize that you just can't always do things on their preferred schedule. If they tell me they only have so much time to visit and that I should do my work later, I promise to try but do not promise to be able to because of the possibility of something more urgent arising. That seems to further piss them off, some call the Sup, some adamantly, defiantly stand in the way between staff and the patient, some understand and step out.
Life is fun, huh?
Short answer: yes, I think so.
Probably depends on circumstances, such as self-defense vs. drunk as a skunk and provoking someone else, history, and what state, maybe more factors.
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