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I am starting an organization in Ohio, Elderly Advocates (we are on FB). This is the kinda stuff we want to help with once established. I have personally seen how evaluations go in connection with payment in PT. If your primary doctor agrees to release her, that is not leaving against AMA. He has the final say over the PT dept. as he knows your mother best. If you feel you can get her the supplemental care at home, and she is in no danger, there is no reason she can't go home!

This is what is the real problem. The facilities taking over our loved ones, them deciding what is best and making the decisions. Many times it is money motivated. They will usually decline once the PT is over. I know of someone 91 and living home alone. They try to make a big deal out of normal older aging things. They try to diagnose them with dementia, when it is just normal forgetfulness of old aging.

They love to threaten families. Im sure you would not want her to go home if you felt she was not safe. Help her keep her independence as long as possible. As far as being low income, call your local Office on Aging. They can get you connected with State Assistance Programs that can have meals deliever, aids out to help, and many other servcies.

If you get the doctor and Office on Aging to assist, their threats will mean nothing.

Do what is best for your mom always!

Prayers to you and your mom
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Heres how I did it. After a week in a rehab care facility I was not impressed with the care. My mom was dressing, feeding, and making it back and forth to the bathroom without assistance. I told them that we had decided that we had enough help to care for her at home. That her personal physician had ordered visiting nurse and PT and that I was flying in a relative that was going to live with her for a few weeks. I also had a vacation week coming and I would take a week with her. I insisted on being part of the evaluation meeting and sat with the people who made this decision. They were not happy but they did what I asked. It is not AMA if you have the care in place at home for your mom. You can decide that you don't want to use a rehab and bring her home instead. $160 dollars a day can pay for in home care at least part of the day. But you have to be there to let them know that you have organized all this. They can't really say no.....
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Not as simple as it sounds is it. You’ve gotten all kinds of advice. My question is have you been offered to have a care conference about your mom. The social worker or director of nursing should help to arrange this you will sit down with your mom and the people involved with her rehab and discuss her case. There you should get answers in a group setting. Medicare does have its own strict rules about paying for rehab in a in patient setting. And Medigap plans don’t usually cover everythingonce medicare runs out. We ran into a lot of issues with Medicare due to my dad's multiple falls that required rehab stays too close together due to their stupid rules.
A care conference is essential.
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JoAnn29 Dec 2018
If Mom has been in for 35 days and you have had no care conference, I would ask why. My Moms was too late, almost two weeks.
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I just went through the same thing with my Mom. She was in a skilled nursing facility for rehab but when I went in to see the place, they had patients in a hallway so small to do PT. I told them she wouldn't get the PT she needed if she couldn't walk around seeing that was the main reason for PT. I called the family doctor who called the doctor there and said he was taking control of her care. The doctor at the facility said he would not sign off on her release but I still was able to take her home even though the orders said AMA. The family doctor contacted her insurance company to explain the reasoning for the discharge and they covered immediate reinstatement of home nursing and PT. Most facilities have their own doctor so they tell patients they don't need to keep appointments with their PCP but I kept having my Mom go to hers so he had a record of how she was doing the whole time. Get your Mom an appointment with her own PCP and then let the doctors work it out. The other thing is, if she is released AMA, the facility cannot send her home with a supply of meds so make sure she has what she needs at home. It's a process but it can be done. You just need to get the doctors talking and they can work out a plan for a transition home.
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I have been thinking about this. If the telling them there is no money doesn't work call Medicare. Explain that Mom has no money for further PT. You have been told she is progressing well and she would like to leave. Medicare tells them whether Mom can stay based on the reports sent to them from therapy. They will review her progress and they can tell rehab to release her to PT at home. Once Medicare won't pay and you can't pay, she will be realeased. She may do better at home.

I was told my Mom, even with a walker, would need assistance at all times when she returned to the AL. I questioned it because she was only in the hospital, for a UTI, from Tues to Friday. Before that she was walking all over the AL with a walker. When she returned to the AL within 24 hrs she was again walking all over the place.

I really don't see how they can get better when they do PT, OT for maybe a couple of hours a day and then sit them in a wheelchair the rest of the time.
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You need boots on the ground there to see your mother in person. Spend a few days visiting her while she does PT, etc.
But don’t let her sign out AMA for reasons stated in previous posts.
There is a reason they aren’t discharging her and I don’t think it’s fraud. There are probably other folks needing rehab in the wings.
IMO you should visit ASAP & assess for yourself.
Is her home set up to assure she can manage to care for herself? Does she have a Lifeline device to press if she falls again? Her level of care may have changed and her home may need modifications.
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Tell them in writing that mom has no money and will never be able to pay the bill.

They will reassess her and order in home PT and OT, Medicare pays for these services. If she leaves AMA they will most likely resist paying.

I was told that my dad needed 3 to 4 more weeks of SNF but the next day his insurance said they would not pay anymore and overnight he progressed enough to go home. Amazing!

Please make sure she really is ready and able to go home. Try to get the insurance company to do an exception pay if she's not ready. Cheaper for them in the long haul. Then everyone can be assured that she will continue to do well.
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You state that "at day 31 of her stay, her secondary insurance stopped paying and now she is paying $167 per day co pay." Why did the Secondary Insurance stop paying? Isn't it a Medicare Supplemental Insurance that pays for what Medicare does not pay for? 

My 87 year old Mom did NOT have to pay for anything when she was in Skilled Rehab because her BCBS Medicare Supplemental Insurance covered what was not paid by Medicare. 

You and your Mom need to contact the Secondary Insurance Company and find out WHY they quit paying for her care and why she is having to pay a Co-Pay?  What part of her care did the insurance company quit paying for?  Sometimes nursing homes make mistakes on the forms that they have to send to Medicare and to the Medicare Supplemental Insurances which can result in nonpayment or a lower payment from Medicare or the insurance company.

Also, have a meeting with the people who make the decision as to whether your Mom can go home or not.  Ask for the specific reason(s) why your Mom cannot go home.  What do they mean when they say that “she has to be absolutely perfect in the evaluations for her to be cleared”?  Is it something as simple as the need for a permanent grab bar in the tub or shower? Does she need rails on the toilet? Do the dishes in the kitchen cupboard need to be rearranged so that she can reach them easier? Is the microwave TOO high for her to use safely?  Does she need better handrails on the steps into her house or inside her house? Do the people who make the decision think that there are TOO many steps into your Mom’s house and are afraid that she might fall trying to walk up or down the outside steps?  Are there area rugs that need to be removed so that your Mom does not trip over them?  Does your Mom have an “Alert button” in her house that she can push in case she falls again or does not feel well?  Find out what is keeping “THEM” from releasing your Mom to LIVE BY HERSELF again.

WHO at the nursing facility mentioned calling Adult Protective Services if your Mom leaves AMA?  Did they give a reason why they might call APS other than “your Mom left the nursing home and you took her to her home AMA”? What are their concerns? 

You need to ask more questions and find out exactly WHY "THEY" will not let your Mom go home.  It might be because she is 90 years old and you live 2 hours away.  You won't know unless you ask them.  Good Luck.
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JoAnn29 Dec 2018
Depends on how much you pay for supplimental on what they cover. More money better services.
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OliveDup, I remember a couple years ago when I broke my arm falling in my office parking lot. My gosh, it was the most painful thing I ever encountered. My arm was in a sling for 2 to 3 weeks [no more plaster casts for such breaks] and my arm muscles froze.

Thankfully across the hall from my office was a sport's doctor so he helped me straighten out my arm. Due to the break I had the physical ability of a 3 year old child since it was my primary arm that broke. My handwriting was that of a 3 year old, so was my eating trying to manage a fork with my left hand, what a mess.

Getting dress was a major challenge, especially putting on a bra, and tying shoes. Had to type one handed, oh well, that's the norm with some people.

Thank goodness for on-line grocery shopping, otherwise all meals would be based on what was on the middle shelf at the grocery store !!

It took me 3 months of going 3 times a week for therapy. Thus, recouping from such an injury can take a lot of time. Plus one's mind is in a tizzy afraid falling will happen again.

For your Mom, the facility said that she is a little tentative, thus that tells me she isn't quite ready to go home. Do check with the social worker at the nursing facility to see what can be done regarding paying for the extra days.
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cak2135 Dec 2018
This happened to me five years ago. I had a plate inserted into my right wrist to keep everything in place, and I had to learn to write left handed. I did pretty well with that. I now think like a leftie; I can eat left handed and pick up my water glass with my left hand or my soda bottle. It's pretty simple.
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I really hate Rehab facilities; they can sometimes CREATE more problems than they cure. When my dad fell & broke his hip in 2014, he wasn't making 'proper' progress in Rehab so they insisted on putting him in their skilled nursing section which was a DUMP and something we couldn't do. His PT did everything in his power to PREVENT me from getting him *and my mom* into an Assisted Living Facility!!!! He promised to tell the ALF that dad was in NO shape to live there and that he belonged in Skilled Nursing! He threatened me on a daily basis and my anxiety level was thru the roof as a result. I finally told him OFF, suggested he speak only the truth to the ALF when they called and to leave his personal feelings & opinions OUT of the conversation. Dad wound up getting into the ALF, thank God, in spite of the miserable PT and his interference.

I love Joann's suggestion to tell the facility you have NO money to pay for further services. I'll betcha too that they release your mom pronto.

Best of luck!!!
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I told them when Mom went in just to get her strength back, that she was only staying the 20 days Medicare paid fully because there was no money for the $150 days after that. She was discharged in 18 days.

Go to the finance office and tell them Mom has no money for the extra days. That they need to discharge her or agree not to be paid. Bet she is discharged. Mom can do therapy at home, I think. Check that out with insurance provider. If they do nothing, call her primary. If get nowhere with that, call your state Ombudsman.
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Do not have her leave AMA! If she does then, likely, her insurance will not pay for her stay. And she can't afford the copay now. What if she were billed for the entire stay?

I would seek a second opinion from her own doctor, not the doctor at rehab. I am assuming they are different and employed by different employers? If that doesn't work call Medicare to discuss the issue. There is probably a policy in place to address these sorts of issues.
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