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Replies: 22
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Legend [19808]
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Prayer Request & update...
May 19, 2014, 9:52 PM
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Mom is getting stronger every day. It's still going to be a long journey, but we are seeing progress (albeit small!) every day. Continued prayers are appreciated!
What I want to share is what I have learned about Medicare coverage and stays in a Skilled Nursing Facility (SNF). over the past couple of weeks we were told that mom had "plateaued" in her therapy, and was no longer improving, and would have to be discharged from SNF. Her discharge date would be on day 83 (of the 100 days Medicare pays for). This meant we would have to look for another option for her care, most likely Assisted Living (AL). I want to share here, in case you or your family are going through something similar, or know someone who is.
When they told me that she was going to be discharged based upon this "plateau" something didn't feel right to me. I told them I could tell she had improved over the past 3 weeks, which was the period of time they were basing this on.
A quick google search yielded some amazing results. In January 2013, there was a court ruling which resulted in "a Plateau, or the lack of improvement of a patient, is no longer a reason for discharge." The Medicare manual was updated ONLINE in April 2014. This means that your common, every day social worker probably has NO IDEA that this statute was updated.
I will spare you the details, but after meeting 3 times with the SNF's social worker - who I asked to her face "You are supposed to be my mom's advocate, right? Not therapy's advocate? I just want to make sure I have the straight." - and getting my paperwork in a row, making them show me her therapy notes, questioning them on every detail that made no sense to me (I'll admit I'm not a therapist, but don't use that to try to glaze over something I asked you to explain. And don't tell me that last week she was "moderate assist" this week she is "minimum assist" and that is "basically the same thing, no change."). At my 3rd and final meeting, they finally cave:. "We have decided to let her stay until day 100. I also went ahead and sent her information to her secondary insurance company to see if they will approve her continued stay here."
So, if you find yourself in this similar situation - educate yourself. Don't trust the overworked people who should know what's going on. I also highly recommend http://www.medicareadvocacy.org/ for assistance. I got all the proof I needed to show them right there. And lastly, DON'T BACK DOWN. You're loved ones have a right for their care to be covered by their insurance, even Medicare.
The short version is mom's 100 days are up at the end of next week. We are awaiting a response from the secondary insurance. If she does not get approved to stay in SNF, then we will be facing a move to AL. I'll keep y'all posted. I know a move will be a little stressful for her, because she will have to get used to new CNAs, nurses, and a new facility. But she will persevere, I have no doubt!
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CU Guru [1427]
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Re: Prayer Request & update...
May 19, 2014, 9:58 PM
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Continued prayers and great advice Suzi!
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Hall of Famer [22811]
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Thanks for the update; sounds like a great mom... & daughter***
May 19, 2014, 9:58 PM
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CU Guru [1261]
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Re: Prayer Request & update...
May 19, 2014, 9:59 PM
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Best wishes.
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Legend [15530]
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Re: Prayer Request & update...
May 19, 2014, 10:13 PM
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God bless you, your Mom and your family.
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All-In [35206]
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Prayers sent from my family to yours
May 19, 2014, 10:16 PM
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Best wishes.
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Hall of Famer [24226]
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Will keep her, and your family, in my prayers.
May 19, 2014, 10:20 PM
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Psalm 55:22 Cast your burden on the LORD, and he will sustain you; he will never permit the righteous to be moved.
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Team Captain [471]
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Re: Prayer Request & update...
May 19, 2014, 11:29 PM
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Bless your heart, Suzi for looking after Mom;
and best wishes for her future.
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Orange Blooded [4504]
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Thanks for the update and prayers for continued improvement
May 19, 2014, 11:36 PM
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and I know God will guide you in your decision making on your Mom's continued care.
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Orange Blooded [3456]
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If she has to go to Assisted Living
May 20, 2014, 12:20 AM
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and any of her children qualify as disabled by Social Security, go see a elder law lawyer immediately. Ask about a non-revocable trust for the disabled child (age is irrelevant, my wife was 60 when we set up a trust for her). This may allow her to qualify for Medicaid to essentially make all the payments for her. As you have found out there are all sorts of weird rules. Keep plugging away and we will keep praying.
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Legend [19808]
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Re: If she has to go to Assisted Living
May 20, 2014, 9:44 PM
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Good info. No disabled children.
But, she may be eligible for some extra VA benefits since she should qualify as a 'surviving spouse of a wartime veteran'
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Commissioner [901]
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Re: Prayer Request & update...
May 20, 2014, 6:35 AM
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God Bless you and your Mom and we will definitely be Praying Brother
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Orange Blooded [4521]
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Suzi, thank you for what you did/do for your Mom...
May 20, 2014, 6:57 AM
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Although my Mom has passed, I am inspired by your determination. Both of my in-laws are still with us.
Robert
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Letterman [270]
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Re: Prayer Request & update...
May 20, 2014, 7:04 AM
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Way to stand yor ground. Thanks for the update
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All-In [49613]
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Continued prayers for you and your mom ...
May 20, 2014, 7:11 AM
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...and you're right: you have to be the advocate because no one else has the emotional investment to do so. Their case loads and pressures to make room for the next person almost assure the best road isn't taken.
We went down this road 9 years ago next month, with Meredith's mom. If you hit any sticking points we can help with (and, trust me, there will be some), drop us a t-mail.
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Legend [19808]
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thanks Rev! certainly will do***
May 20, 2014, 9:45 PM
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Orange Blooded [2533]
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she's prob better off going to AL anyway
May 20, 2014, 8:36 AM
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my mom was, after the same experience. She recovered better "back home" than "away from home" in skilledn nursing care. Just flow with it.
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Heisman Winner [105574]
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Prayers for you and your mom Suzi
May 20, 2014, 8:55 AM
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Keep fighting for her!
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CU Guru [1803]
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You're absolutely right. We had same situation with my Dad.
May 20, 2014, 11:55 PM
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They decided he had reached his plateau and stopped working with him, letting him regress. We had a few strong discussions with them.
Mom, after open heart surgery, eventually went to AL and she did very well there, however insurance covered only meds and hospice at the end.
We did find with all the SNF that they lined the patients up in wheelchairs in front of the desk. Makes u sick to see that. At least AL gives them some semblance of normal living and treats them like humans.
Prayers sent for both of you. It's really hard to work and be your mom's advocate as well. Stay strong, both of you.
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CU Guru [1898]
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Prayers continue, Suzi.***
May 21, 2014, 12:53 AM
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All-In [25393]
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Continued prayers and best wishes.***
May 21, 2014, 5:07 AM
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Orange Blooded [3311]
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Prayers Sent.***
May 21, 2014, 7:19 AM
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CU Guru [1163]
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Re: Prayer Request & update...
May 21, 2014, 7:24 AM
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Prayers continue for your mom and her caring daughter!!
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Replies: 22
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