I just paid $3600 to a rehab facility for my 92-year-old father because Medicare wouldn't cover it.

[joeybee12]

He has congestive heart failure, multiple myeloma (a blood cancer), one heart valve not working, legally blind, was transferred there from the hospital today because his heart rate fell to 30, and he is too weak to lift himself up now much less walk, and Medicare would not cover because there wasn't a valid MEDICAL REASON.

The $3,600 is upfront for 2 weeks only. Then I've got to figure out what to do, other than quit my job and move in with him, there's not really any options.

Anyone want to tell me how Medicare costs can be further cut and provide quality care???? Anyone think this Super Congress will do the right thing down the road?

Disclaimer, my father turns 92 next week.

[Mimosa]

1. Is there any way to get him on Medicaid? n/t

[joeybee12]

5. Have a meeting with a Case Manager tomorrow...I'm not optimistic...

Problem is, he owns a condo...a few years back I told him he should give it to me, or sell it to me on paper so that he wouldn't have any assets, but he was worried about the liability issues. Anyway, Medicaid will cover really if you're flat broke, and he isn't, but he could get there pretty damn soon! Thanks.

[Armstead]

32. hate to say it, but that's what you gotta do. Let him go broke

I have an aunt in similar situation. She's got to be in a nursing home the rest of her life. She has had some savings but she has to spend that all down to nothing before she can get any Medicaid.

[joeybee12]

48. Yup, you either have to be very rich or very poor in this country

for healthcare to pay off.

[roguevalley]

13. I'm sorry, Joeybee. Been there, done that. Hug your papa for me.

[Divine Discontent]

19. +1

[joeybee12]

Thanks!

[joeybee12]

28. Thanks!

[karynnj]

2. That is pathetic

I can imagine this is a nightmare for him and the whole family. Have you tried calling one of your Senators or Congressperson to see if their staff could be an advocate for you. It sure seems that his condition makes a rehab facility necessary.

At any rate good luck finding a solution to this.

[joeybee12]

7. Thanks, yeah, it is...

The system is set up to cover your care after you go bankrupt.

[napi21]

3. Talk to the social workers at the hosp or nursing home.

If one doesn't help you, ask for another one. Most of them are very helpful. Worst case that I can thinkof would be to have some fulltime caregivers be with him at his home. For sure those people don't make $3,500 i two weeks. I have no idea how much they charge, but i know it's much less than that.

[joeybee12]

6. I have a meeting tomorrow...live-in care at home is $220 a day...

A little less, but not much. Thanks.

[anneboleyn]

15. Well, the live-in caregiver we had for my grandmother cost $5,000 a month in 1993

This was in Southern California. My gandmother's pension and savings paid for it as her insurance (Kaiser and Medicare) would not pay for it. My grandmother had just had a major stroke and needed full-time care as she had to be lifted, taken to the bathroom and cleaned, and fed every meal. She also had to be watched at night because she had a tendency to try to get out of her bed (which had railings, a hospital bed). She finally managed to tumble over the railings one night and broke her hip badly. It was so hard for all of us, as she had been the most active and vibrant person and everything had been taken away from her.

I hope the OP can find out if her father qualifies for medicaid, as then the financial burdern would be lifted considerably. It is tough though -- my mother-in-law was told that every asset she had (savings and home) would be taken away if she were put into a nursing home, in order to pay for her care. So much for Medicare! She had Blue Cross also.

[CountAllVotes]

16. I hate going political BUT

you know, this is one of the things they are trying to take away from the old and the sick and now we can see how great it really is or is not.

It is there nonetheless but when the need is great, they want every cent you've got first.

DAMN THEM.

[joeybee12]

50. Yup, the system makes no sense the way it's set up...

and I doubt all the "change" to it they're talking about will make it better.

[joeybee12]

21. That really is too bad about your grandmother...the system is

set up to bankrupt you before care kicks in...it only pays to get old in this country if you're very rich or very poor...there is no middle ground. Home care for my father would be about $6500 a month now...could run through his savings very quickly.

[NYC_SKP]

4. You have my sympathy.

My mom and dad have been taking turns at their 90 day maximum stays at long term care facilities over the past two years plus.

To answer your first question, there's a lot of waste due to poor handling and mishandling of cases, misdiagnoses, archaic record keeping plans (when they do exist) and fraud and greed.

I've estimated that we could save 30-40% while improving care. Will it ever happen? Probably not.

To your second question, no.

And, in general, you have my sympathy because your parents and mine are living well beyond where the same folks would have lived a generation ago or more.

We have to seriously question what the quality of life is after so many artificial medical procedures and supports.

I spent the weekend convincing my mom that I would support her wanting to pull her own plug (she was going to do it Sunday night) while simultaneously telling her that life was worth living.

She's not enjoying having to be helped to go to the bathroom, to be fed, to wear diapers all day and night.

And it's her life, she doesn't want to die in a hospital, better to her to die at home with her several care providers (who aren't covered by medicare).

It sucks.

Hang in there.

:hug:

[joeybee12]

8. Thanks...a friend's father passed two weeks ago, had lots of problems like my father...

and once he was unable to walk anymore, he just gave up...I'm worried my father will decide that also. In any case, I see this rehab as short term because it'll cost pretty much the same for round the clock care at home, and he'd rather be there.

[indurancevile]

26. is it feasible to get a caregiver for the hours you're away only? or do you know someone

you trust who needs work & wouldn't charge $220/d?

[joeybee12]

27. Don't really know someone like that...and actually, if you get help

in shifts as opposed to live in, it can be more expensive...go figure. Thanks.

[Maru Kitteh]

45. If his needs are primarily activities of daily living, call a local nursing school.

Preferably one that offers 4 year degrees and advanced practice degrees. Many students do home health while they attend and they may have a graduate you could hire short term.

I don't know if this is feasable where you are but it's an idea? Best to you and your father. I'm a caretaker too. :hug:

[joeybee12]

49. Thanks, actually it might be feasible as he lives in East Hartford and

a couple of the hospitals in Hartford have nursing schools...it'd be close for someone.

[nadinbrzezinski]

9. To both of you, my sympathies

and yes fraud and abuse is part of the problem. Dad died at home... and that was a blessing. (And no we did not have to deal with the social security system in Mexico)

[joeybee12]

34. Thanks!

[Warpy]

10. If his heart rate fell to 30, there is a medical reason to keep him in the hospital

and it's called heart block and it can be fatal. Who's the genius who discharged him? Did anyone refuse to have him evaluated for a pacemaker? If a pacemaker is not going to be an option, were you offered hospice care? Medicare will pay for hospice care.

It sounds like you need to have a long talk with the doctor of record and the nursing home social worker to get him the appropriate services.

Rehab is simply not appropriate placement for someone with a heart rate that low.

And yes, there are huge holes in Medicare. The only alternative you have is to get power of attorney and spend down everything he's got to keep him in a nursing home instead of a rehab facility until he qualifies for Medicaid.

Until they manage to gut Medicaid.

[Ilsa]

17. I agree with Warpy. This sounds like patient dumping.

My guess is the hospital maxed him out and was starting to lose $$ on him, so they discharged him to rehab. Makes no sense to me.

[joeybee12]

56. He actually did have a pacemaker put in...should have mentioned that...

but there's something else going on if he's still that weak.

[Warpy]

64. Nothing kills an elderly person faster than bed rest

However, he still has the capacity to surprise you now that he's not falling over because his brain isn't being perfused by an inadequate heart rhythm.

About all you can do now is wait and see if he makes progress over the next couple of weeks. If not, you might want to inquire about hospice care.

[DURHAM D]

11. I believe that a home is excluded when determing medicaid eligibility.

[BeanCounting]

18. Nope, can not get medicaid until you sell the house

And prove you have spent down (paid medical bills out of pocket until the money is gone)before you can qualify. I just went through all this with my mother, who had private health insurance also. I have great empathy for you and best of luck with an extremely shitty system when your caught in the cracks. It's not like you can sell your parent's home in this economy at a moments notice, and it's WRONG that our older generation has to have everything they scrimped and saved for all their lives be sold to cover their care in their old age.

[DURHAM D]

22. All I know is what I read on HHS website.

http://aspe.hhs.gov/daltcp/reports/hometreat.htm

And varies from state to state.

[joeybee12]

24. Bean is right...this is Connecticut...went through this with my mother a

few years back...my father was sure he was going to have to sell the house, but my mother passed long before we got to that point, but he had to be really careful about what he spent money on because they go back three years of spending before they see if you qualify even if you have no more money...I think now it's five years.

[DURHAM D]

25. Did you read the article? nt

[joeybee12]

29. I just did...my father's house would no longer be considered a "home"

No spouse and no dependents...they'd make him sell it before they cover him.

[indurancevile]

46. nope, it depends on the state.

The Home

Depending on the state, nursing home residents do not have to sell their homes in order to qualify for Medicaid. Under the DRA, principal residences may be deemed noncountable only to the extent their equity is less than $500,000, with the states having the option of raising this limit to $750,000. In some states, the home will not be considered a countable asset for Medicaid eligibility purposes as long as the nursing home resident intends to return home; in other states, the nursing home resident must prove a likelihood of returning home. In all states and under the DRA, the house may be kept with no equity limit if the Medicaid applicant's spouse or another dependent relative lives there.

http://www.elderlawanswers.com/Elder_Info/Elder_Article.asp?id=2751

[CountAllVotes]

12. ask the hospital social workers for help

They may know of a place he can go that is for hospice patients and others as well. They tend to have many connections and you are not the first sad case like this.

They call them residential care homes/rehabilitation centers or some such thing. They are often not properly licensed facilities I found out when I attempted to have the bill reimbursed (!) but they do exist.

I found one for my mother when she was dying of cancer for the last 2 mos. of her life. It was paid for by her even though she had Federal retiree benefits and Medicare; had no long term care nor was she eligible for Medicaid. :grr:

Best of luck finding help -- the local church might be able to direct you as well if you want to try that route as they too know a lot of people in the community.

Give your old dad a hug :hug: & here is one for you too! :hug:

[joeybee12]

40. Thanks...all good advice!

[The Velveteen Ocelot]

14. My sympathy -

I can relate. My dad, who passed away a couple of months ago at 91, was in and out of Medicare-covered (and not covered) rehab several times. We also discovered that if you are discharged from a hospital to a rehab facility and you are there less than I think 4 or 5 days (can't remember exactly), Medicare won't cover it. But I took him out of the facility because it was so awful and he was so miserable. The care was decent but they had so few beds he ended up stuck in a dark, gloomy double room with a guy who talked and yelled about Jesus all the time and smelled bad. I just had to get him out of there, so as soon as I could I found in-home care for him - which isn't covered by Medicare - and took him back to his apartment. This was expensive but we knew it wouldn't last long because his health was so poor, and it turned out to be the best thing we could have done for him under the circumstances. As he got sicker his doctor recommended in-home hospice care, which is covered by Medicare. It isn't round-the-clock care, but they send people in every day to help with a lot of things, and they are wonderful people.

If Medicare would cover at least some in-home care it would go a long way to reducing costs in the long run. One reason we had to get in-home help is that my dad kept falling. If he'd hurt himself he'd have ended up in the hospital for a long time, which would have cost Medicare even more.

I'd suggest getting some help from his doctors, who can prescribe treatment that Medicare does cover. Unless he has used up his 90 days, from your description I can't imagine why there isn't a medical reason for getting him to rehab. Good luck. This is a tough thing to deal with.

[joeybee12]

20. Yeah, it's crazy...

Part of the problem is the length of the hospital stay, but he obviously isn't well enough to be discharged, and with hospitals discharging patients asap, it's difficult to gte that lenght of hospital stay to qualify. He has been in the hospital a few times the past few months and has qualified, but not this time. The problem really is he can't walk without falling, and now he;s so weak he can't even stand...if he fell and really hurt himself they'd cover it, but that makes no sense...how about some preventative coverage? Thanks.

[tnlefty]

23. I have no answers...

just wanted to send good vibes to you and your father. :hug:

[joeybee12]

41. Thank you!

[riverwalker]

30. some advice Joey

ask the social worker for a Medicaid application. They won't kick him out when you don't pay, if your application is "pending". Medicaid is retroactive to the date of the application. So start the process as soon as possible. Yes, they will take the condo, whatever savings, and his social security, but just start the application for him. Get power of attorney (very simple process). Medicaid will allow him to spend some of the money from his assets on things like a pre-paid funeral plan, as part of the "spend down". (You will hear that term a lot.) I've been through it with my mother.
Is your Dad a Veteran? Because the VA has a program that may help pay for assisted living or home care. If he is service connected disability 60% or more, they will cover ALL of the nursing home.
My heart goes out to you, it's rough.

[joeybee12]

37. Thanks...good advice...

Yes, he is a veteran...my sister thought of that today and was going to make some calls tomorrow...thanks again.

[riverwalker]

43. Joey here is help:

http://www.veteranaid.org/

INTRODUCTION TO THE VETERANS' AID AND ATTENDANCE IMPROVED PENSION

The Veterans Administration offers Aid and Attendance as part of an "Improved Pension" Benefit that is largely unknown. This Improved Pension allows for Veterans and surviving spouses who require the regular attendance of another person to assist in eating, bathing, dressing, undressing, medication dosing, or taking care of the needs of nature to receive additional monetary benefits. It also includes individuals who are blind or a patient in a nursing home because of mental or physical incapacity. Assisted care in an Assisted Living facility also qualifies.

This most important benefit is overlooked by many families with Veterans or surviving spouses who need additional monies to help care for ailing parents or loved ones. This is a "Pension Benefit" and IS NOT dependent upon service-related injuries for compensation. Aid and Attendance can help pay for care in the home, Nursing Home or Assisted Living facility. A Veteran is eligible for up to $1,632 per month, while a surviving spouse is eligible for up to $1,055 per month. A couple is eligible for up to $1,949 per month*.

[joeybee12]

52. Thanks...that's great...I read a little and bookmarked it for tomorrow...

When I'm somewhat coherent!

[Forkboy]

31. I don't have a vehicle, but I am in Mass.

If there's any way I can help, I will try to find a way to where you are and do so. Please, don't hesitate to ask if there's anything I can do, even if it's just keeping an eye on him while you get some sleep. I only sleep 3-4 hours a day, so staying up is not a problem for me, trust me.

[joeybee12]

33. Thanks...maybe I'll ask you to come watch tennis for me when I'm not able to!

:hi:

[Forkboy]

36. Don't push your luck lol.

;)

[joeybee12]

39. Figure skating?

:evilgrin:

[Forkboy]

42. Is it Nancy?

:rofl:

[joeybee12]

47. Who else????????????????????

[Lars39]

35. Is he a veteran?

In some places there are programs for them that can help with sitters or other benefits. My sil managed to get some money coming in for her fil because he was a veteran. He's in a pricey Alzheimer's unit right now.

edited for late night grammar :silly:

[joeybee12]

38. Thanks...yes he is...

We'll have to look into that.

[EFerrari]

44. Oh, these seniors on Medicare with their cadillac plans.

Sometimes I think they use a chart in DC of people who can't jump into a car and occupy their buildings.

[joeybee12]

51. Yeah, it's people like my Dad they need to cut...

freeloaders!

[elleng]

53. Is he a Veteran? If so, look into it.

Good luck.

edit: Happy to see you've learned something here about Veteran's benefits.

:thumbsup:

[joeybee12]

54. Thanks...he is...others have suggested it...

I bookmarked a site and will apply tomorrow...if I'm finally coherent then!

[elleng]

55. Bet you will be, and able to sleep tonight.

:hi:

[eridani]

57. Always been the case. Any longterm care requires spending down assets and

--going on Medicaid. 70% of nursing home patients are on Medicaid.

[FlaGranny]

58. I hate to say this, but

my mother died from multiple myeloma, so from experience - if your father is too weak to lift himself, you need to call Hospice. Hospice is free and he will get excellent care, although no treatment other than for comfort.

I've got to ask if the hospital social services suggested this to you.

As for the rejection from Medicare for no medical reason - that is absolutely crazy. My mom was transferred to a nursing home from the hospital twice with multiple myeloma. She was miserable there though and wouldn't stay. I took care of her until I no longer could physically do it and then she went into Hospice and passed away there after a few days.

[Name removed]

59. Deleted message

Message removed by moderator. Click here to review the message board rules.

[PRETZEL]

60. Sorry to hear about you dad,

but there are options.

One thing I think is key is to have his doctor write the script for hospice services. Medicare won't cover it without a doctor's script. It won't cover everything he needs, but will help.

His VA benefits will cover some things also. Not sure about where you live, but in my neck of the woods most counties have Veterans Affairs Offices that would be able to counsel you on his rights and options.

[Shagbark Hickory]

61. That's when Bernie S. says "Medicare for all" I say you can still easily go broke with medicare.

[xchrom]

62. Recommend

[kiva]

63. You've gotten some good suggestions here...

I have none, but wanted to say I'm sorry you and your dad are having to deal with this...you're right, this shouldn't be happening.

[Maat]

65. In the same boat.

My mother had to go to a facility due to her dementia. As soon as the facility became aware that my sister and I were around, oh, it was, "By the way, two weeks ago, she went 'private pay.' Medicare covered it, but she refused physical therapy, so we reported it, and Medicare disqualified her." This was the institution that had a contract with the public guardian's office, who asked us to step in and take conservatorship. Well, as soon as they smelled private family money, things changed. They struggle to take care of the seniors, as they are only being paid a Medicare rate (which is due to be cut). My sister and I are struggling to keep her in a facility (she requires an awake attendant 24/7)(she will forget to eat and take her meds, if not prompted).

It is sad that assets have to be depleted before government help kicks in. I've been through this with two parents now (Dad died in 2006), and his care cost hundreds of thousands of dollars over the years, literally.

Now, it's Mom's turn.

Why don't we have a country that pays for long-term care in the appropriate facility? We really are a poor excuse for a country - all the money in the world is there for black ops, torture, rendition and wars and conflicts all over the place, but not for adequate care for the elderly. They want to pass on their life savings and assets to their kids and grandkids; but, no, it has to go to pay for residential and medical care.

[Hoyt]

66. Remember, the original hospital that transferred your dad gets paid a flat fee by Medicare.

So, once your dad goes over a certain period in the hospital, the hospital managers consider it losing money.

The hospitals "early discharge" may be a violation of Medicare law, especially if he has all the conditions you mentioned. That makes no sense. What do his doctors say? If they think he needs to remain hospitalized because of his conditions, they might help in an appeal.

In any event, good luck and let us know what happens.

[Cleita]

67. Are you sure he has Medicare or is he on a Medicare

Advantage program like Secure Horizons? Medicare Advantage programs are run by private insurance and have been known to refuse payments for gotcha rules. They did it to my husband. They refused to pay for emergency services because I called an ambulance without asking for their permission. I was out in the middle of the forest and had to run to the only pay telephone within miles. I called the ambulance not the company to get their permission because it was a matter of life and death. Traditional Medicare has never refused a payment for my husband or me for their approved coverage and I know your father would be covered.