My mom has COPD and Emphysema she is 78 years old. About once yearly past two years she needs to go to hospital for oxygen, steroids, and Bipap them go to a rehab for two weeks. The doctor told us there was a bed for my mom at the rehab she went last time which is near the hospital. The social worker called to say there's no be and won't be for a few weeks. After further inquiry it was insinuated that the rehab is refusing to take her. My mom is a very nice person she dies not yell scream or hit anyone but she does have phobias to medications and as she gets better and stronger she will refuse certain things. Is that enough for a rehab to black ball her from the facility? This is awful as the others are so far away and my brother and I don't drive and live far away last time we had to spend over $1,000 in cans and hotel just to see her in the rehab. Now we are trying to get her back to the close one and they are refusing to take her and won't clarify why? What are our rights? Her insurance is great so we know that is not the problem.
You're lucky if your mom is easy to get along with. My mother was hateful and spiteful her whole life, only getting along with my dad long enough to have children. Mom getting older, arthitic, and somewhat demented hasn't helped, so it's difficult to find anyone, that can even get her to do the simplist, most effortless exercise, so usually, after 3 or 4 paid visits, with Mom satisfying her need to "feel" in control by not cooperating, even rehab people, who might be unscrupulous enough to get paid for no progress, tell us we are wasting time and money, because they can't do anything with her and, they don't come right out and say it, but it's obvious, that they can't stand the aggravation and frustration of dealing with such a hateful, spiteful, and melancholy person. If she was pleasant, they'd at least be able to make small talk and maybe eventually "get through to her".
I beg to differ. It may depend on insurance. (Although I would note that she said the NH wouldn't take her mom, not that insurance refused to cover it) Before we learned my husband had a urine retention issue, he had two bouts with toxic encephalopathy (due to his lithium not getting passed out of his system). He was admitted to Hosp & NH after both times.
of staff,facilitiesand beds. Faced with anger from hospital management
or doctors when they admit long term difficult patients, like alziehmers
or the elderly with frail aged problems who use up too much bedtime and staff
they in the end put up barriers to not acceptl these patients, sending them away
for families to cope with the problems themselves.
It is often not pissible for people to do this lng term without their own mental
and physical health suffering.
But the staff at hospitals are in the end loyal to the will of the hospital managers
as opposed to the patients, because they want to keep their jobs.
So hospitals,nurses and social workers, can come up with a lot of ways
to stonewall patients at the admission desks, in fact they are experts at it.
Your choices may be limited, You may not know, but rehabs,skilled nursing,etc pay a referral fee to hospitals as gratitude for getting a new customer. Depending on how much they pay, it may take more than 2 weeks to recoup their costs, plus make a profit as well.
It is in the best interests, financially, to have her moved to rehab, since rehab will pay a referral fee to the hospital.
Acute hospitals often dump patients into NH's or rehabs, to open up beds...they will write transfer orders with entirely wrong orders, just to get the patient transferred....prescribe all oral meds, self-transfers and other orders for patients who are bed-bound and cannot swallow, who actually still need acute hospital care. Instances like that, killed Grandma prematurely.
Too often, I've accompanied patients to various E.R.'s, only to be faced with ER Docs who refuse to listen to reports of the actual condition of the patient; those Docs assume conditions based on exterior appearance, order wrong X-rays, wrong lab tests, wrong everything, then bustle the patient upstairs to admit.
Social Workers will tell people there are "no rehab beds" for all kinds of reasons, some are not true, others are. It's very like store employees telling consumers "that item is no longer made", when the item really is still made, but that store no longer carries it...they want you to buy what they Do carry, instead.
The broken systems health care workers must contend with, are madness.
If someone has care levels that require too complex care, they will refuse the patient. If insurance dislikes the diagnosis codes, the facility can refuse the patient.
If the patient has mental issues, the facility will refuse, but give other excuses why.
If the patient has alcohol use problems, facilities will refuse.
If the facility lacks staff, they can refuse admits.
If someone blows against the wind on the wrong Tuesday in the 13th month, facilities can refuse to accept the person.
So do PCPs and acute hospitals...systems play "hot-potato" with elders all the time.
Docs, nursing staff, ward clerks, etc. can all make charting errors that can block getting proper care and coverage! Unfortunately, most folks do not know about that, assume those are always accurate....but medical personnel are humans, and make human errors.
NH's that increase the level of acuity of care they can offer, seldom staff to properly cover that [like one NH I worked, where they upped-their acuity rating, to allow IV's, for instance, but kept same level of staff].
It might help to go up the chain of command at a facility you want her admitted to, to learn why they refused admission, instead of being stymied by the Acute Hospital Social Worker, who might be having a bad day, or might not have proper data to make a decision with.
Be persistent asking questions to gain clarity; it might disclose inaccurate charting, inaccurate diagnosis and billing codes, etc., poor communications, which might be easily cleared up in the process.
I hope you can find out why care has been denied, and can get that resolved!
In Australia, the government doesnt provide enough beds and
staff for aged care needs. In the newspaper this week hey said the government
had pulled 3billion out of aged care funding.
Do you have what they call respite care for carers in your area, the social workers
here, the government Acat socoal workers can give you a form that grants you
so many weeks respite care.
The hospitals in general in Australia, are underfunded, and they are often hard
pressed to actually have one bed available. So when you arrive at the hospital
with a chronically, ongoing aged person needing looking after, they will do
their best to turn you away and turn you into the caregiver, plus nurse
at home.
I had this talk with my Dad today, I said "Dad, we have to ring assisted housing,
and get your name put on their waiting list for a unit for you". You've got to plan ahead". If your name comes up in 3years, and you are still managing at home, they just put your name further down the list" until you may actually need it."
The point is that once your name is on their list, it is never taken off."
Dad has some early cognitive problems.
Dad doesnt think he needs to do this, he says I will just call you. Hes quite prepared to put all the worry on me, which I dont intend to do to my own children.
I said Dad, " I will have to take you to the hospital, and they might put you in
a place with a bad reputation, because that's, the only ones they have readily available.". He said, "I dont give a buggar as long as they feed me?"
So he is ignoring his own responsibility to help me do this, selfishly just not
wanting to be bothered with it. I didnt say to him,but if I do have to take him to the hospital,
regardless of whether they admit him. I will be leaving him there. Because the one thing I refuse to be coerced into is living with him and being made to provide nursing care.
I do non live in carer things for him, which I have done for the past 15years,
but I will not live with him, he drives me crazy after a day out with him.
And I dont mean that lightly.
So it will be a standoff between me and the hospital if he needs any longterm nursing or around the clock care. They can put me in prison, but I know my wellbeing
and mental health would go downhill very quickly, So, they will come up against one determined person. Im all so fighting Dad because he would be more than happy for me to spend the last decade of my life running after his every need.
Is your mother oxygen-dependent at home? Why did she refuse to "take oxygen home with her"? (I find this statement strange because rehab facilities don't send people home with oxygen---oxygen is usually delivered by a home medical supply service.) Why does your mother require one hospital stay every year? Does she get pneumonia or an exacerbation of COPD? Perhaps she needs better control of her COPD in the form of steroids, a bi-pap machine & oxygen
at home to prevent a hospital admission. You should inquire about it with her doctor.
Legally, people can refuse anything they want and nobody can force anything on them. People are non-compliant all the time, for one reason or another.
One thing I do know is that there are strict limits on payment by Medicare & secondary insurance when there is a re-admission for the same thing within a certain amount of time. Hospitals & rehabs will not get paid for a re-admission for the same problem. Therefore, doctors try everything in their power to avoid re-admitting patients with the same diagnosis so they & the facility will be paid.
Everything boils down to money, in healthcare and everywhere else. Morals & ethics don't matter. Doing the right things doesn't matter. It's all about which insurance is going to pay the most for the stay. It shouldn't be that way, but it is. Rehab facilities and LTC do not want to take patients on a lot of medications---especially brand name, expensive medications---and they want patients that need the least amount of care, so that they spend the least amount of money & collect the most amount of money. It's called a "wallet biopsy". That's how rehabs & LTC places function.
Welcome to America!!
It sounds like the underlying issue is that she needs a higher level of care; someplace where her oxygen use can be monitored and encouaged. Try to see the big picture here.
"Insinuating" that the rehab facility "is refusing to take her" can mean a multitude of different things. They certainly can refuse to take her if there is no bed available. You don't say who was doing the "insinuating". A rehab facility wouldn't---and legally cannot----refuse to take your mother because she refuses certain treatments. But, they can refuse to take her if other people on the waiting list have better insurance, will be admitted for a longer period of time & require less care than your mother does.
Quite honestly, doctors have no idea which facilities have beds and which don't. It is not their job to call the facility to find a bed for your mother----that is the social worker's job. I wouldn't put much faith into what the doctor said----you also could have heard him incorrectly.
Many are unable to cope with serious medical situations such as tube feeding or IVs. They simply don't have the quailed staff to do these things. Of course there are behavioral issues, mental illness, and psychotic behavior. Gather your Mom is only difficult about certain medications. Very expensive meications are also an issue as nursing home are paid a standard rate daily for every patient and theses meds may cost more than they can afford. Patient placement is not a simple issue so you have to find out what is really behind this decision including talking to Mom's secondary insurance company.
Did mom make satisfactory progress last time in rehab? That has to be documented for medicare say when she arrives she can only transfer from bed to chair but within the allotted time she can walk 100 feet but if she won't do PT and refuses to try Medicare will no longer pay. nfortunately it is not as simple as some insinuating that the facility did not want her.
Another possibility I thought of is the possibility that she won't cooperate with her treatment plan caregivers. If you put someone into a treatment plan for rehab and they won't cooperate to get well, there's no use wasting your time if they just don't want to get better by following a treatment plan.
Another thing to consider is what is the doctor was mistaken about the bed availability? People make mistakes all the time, that's just part of being human.
Is it also possible that her insurance will only cover so much for her rehab?
Definitely do your homework and find out some things. What I would do is get a hold of a supervisor at that facility and start probing. Find out why they refused her and ask specific questions
The thing is, I'm not sure it's worth the bother of challenging this.
It's a shame there isn't an alternative within reasonable travelling distance, but if your mother is going to be there for only a fortnight it's not the end of the world - you can get away with not visiting, just calling and sending cards and encouraging messages.
I realise this sounds sad, and of course if it were my mother I would want to visit too, but it is only a fortnight. As long as the care is good and her doctors recommend it for her convalescence, try not to get upset about how far away it is because you'll put your mother off it and she won't do as well as she might there.
It will be nearly impossible to find out why the home is refusing to take your mom because they don't have to disclose that information. Most likely if anything they would simply tell you they don't have room or they can not meet her needs. Either way your only option will be to find alternative placement.
I hope and pray KimberlyP finds facility that will provide her mom with good care and some TLC for both her mom and the family.