I am the POA (health only and not to her Estate) to my 89 friend whom I call Grandmother. She has lived with me in my private home for 3 years and I took care of her FT. She fell & broke her hip in late Aug 2014. After hip surgery she was transferred to a skilled nursing home for rehab. She has been transferred to 4 other facilities (at my request/lack of isolated room availability), due to lack of proper care and in & out of the ER/Hospital. She did not receive proper rehab & now deemed to never walk again by Ortho. Too many neglect issues to list. The current skilled nursing home (in CA) called me on 1/15/15 to inform me they received a call (same day) from Scan Health Insurance that the 100 days Medicare covers for skilled nursing, was exhausted on 12/13/14 (30 days later). Out-of-pocket expenses are due. No written or oral notification given by either party prior to 1/15/15. I told the SNH social worker to immediately contact all parties involved to get approval to discharge her. I also stated, she is not in agreement to pay-out-of pocket or to continue to stay at the facility under these circumstances. On 1/18/15 I called the doctors assistant to find out what was the delay. Can my Grandmother be discharged without harm to her health. The Doctors assistant was "not" informed of what was going on until I told her . She agreed to process the paperwork to discharge my Grandmother back to my private home and would order all medical supplies needed for me to continue her care. I attended how to flush her G-tube and bed transfer. My Grandmother has severe/acute UTI, G-tube (in stomach) & C-Diff. On 1/19/15 I confirmed with the SNH Social worker the that she did receive the discharge notice and the orders of the food/bed etc. She stated she has already began to process the orders. She asked if she could get her qualified for Medicare. I told her she does not qualify for Medical nor should she spend her bank account down to qualify for Medical (under these circumstances). Again, I told the Social worker at SNH (skilled nursing home) she is not in agreement to pay-out-of pocket & not in agreement to continue care. The Social worker at the SNH said she would file an Appeals Notice with Scan on her behalf. I believe I have done "everything" I can do to expedite her discharge, which the doctor assistant said it would be at least 24 hours . SNH has not process the doctors orders and all equipment to discharge her. A week later I'm being told her Primary Care doctor needs to order all her medical supplies. Today (1/29/15) I received a call from the Admin office of the SNH that she "is" financially responsible for private pay since 12/13 and "I" need to file an appeal. The Admin asked for me to come in to sign all the "New Patience" paperwork, bring ID and the POA. (Last week I was told that the paper work would be left in my Grandmother's room. It was not there).
Can I be financially responsible to pay?
Should my Grandmother be financially responsible to pay?
Why is the SNH not releasing her to me?
Do I need to sign the paperwork now?
Do I need to provide them with a copy of the POA?
What are their intentions?
Why didn't I receive a written or oral notice from her Medicare Advantage or the Rehab facility?
When calling a doctor of the skilled nursing facility, within how many days must they return your call? Or they don't have too?
Within how many days should the skilled nursing facility return my call?
Who is responsible to file an appeal? To Medicare or Scan?
Thanks for reading and any questions that you can answer!
You as the medical POA can file for an appeal. But if she has maxed out her days under Medicare, the appeal will go nowhere. Really being able to go the max 100 days is kinda amazing as usually they are non-compliant for progressing if they become bedfast or have other significant co-morbidities - which is sounds like she has.
Her POA for financial should be the point person on all this. Where are they??? If you are just her medical POA, so just where is the POA for finances and why have they not done anything????
Medicare after the first 21 days post hospitalization requires a co-pay. Has the co-pay been paid at all? I'm assuming that whatever SCAN is paid it under a MediGap policy for whatever period of time is per their contract. But you need to find out. But after insurance days are maximize, the patient is fully responsible for paying. If she refuses to pay, the facility can do various things: bill & turn it over to collections if not paid within short order; petition for her to become an emergency ward of the state and a guardian is appointed to oversee her care and all her assets; or just write off the debt if it's small. How much is the bill - 5K, 10K, 25K?
Medicare is self-directed & as such are responsible for understanding coverage.
Non-ambulatory, G-tube (in stomach) & C-Diff are a pretty serious trifecta of health issues. Are you providing all her care 100% solo? Is it realistic for you to do this?
C-Dif is in & of itself pretty difficult to deal with. Are there others in your household?
What I would be concerned about is that taking her home is just a bandaid on the situation and she will be back into the ER and admitted again. Her level of care may be needing skilled nursing care in a facility. Are you financially dependent upon her? And again, where is the financial POA in all this????
Once she runs out money she will be transferred to any facilty that will take her, any one that she can afford out of pocket or based solely on her SSI and other income.
"Medicaid" (if she qualified ahead of these events) usually picks up the remaining payments for her care.If she did not qualify for medicaid or was not qualified in advance then whomever signed her into care may be responsible for payment if they signed on that particular dotted line.
To qualify for medicaid a full financial disclosure is needed; usually all bank accounts, espenditures, SSI payments etc. over a period of the previous 5 years.
An unlicensed caregiver or home provider will not be paid for the care of a elder living with them though some services may be provided to help you in that care.
Also you can not claim them as a dependant on your taxes. If they are paying you for rent or other services or "gifting"you money or other of her assets athen you must claim that money/gift on your taxes.
Nursing homes can have up to a years waiting list and only a few beds for those on medicaid.Rarely ( if ever) this will include a private room.
Do they have to return your call? No but most will.You say she is a friend.Generally these facilities will not talk to anyone other than family or legal guardians.so no they may not call you back.
I would guess the delays you are experiencing are related to the question "who are you?" and do they have the legal right to share her information with you under the privacy act.
PS. her medical supplies may also not be covered by insurance.
You need to read the policy or it will come ou of her pocket.
For a while, my mother, who has a diagnosis of Vascular Dementia, was mistakenly being given all sorts of financial and business office related information by the NH, although we made it very clear at the outset that everything was to be communicated through my brother, who has POA. Mom is very good and nodding and smiling and looking like she understands, but the next time we would visit, she would weep and say that they were trying to take her money, or trying to get rid of her. We had to be very stern and took this issue to social work and eventually to the facility adminstrator before we got it fixed.