Disgusting Nursing Home to my 89 YO Mother: "We have ways of making you pay."

[demodonkey]

This is a real scene right out of SiCKO, and I am so mad and worried I could spit nails.

First of all my mother, who took a stroke and is trying to recover as much as she can HAS INSURANCE COVERAGE AVAILABLE. Second she HAS A PRESCRIPTION FOR SKILLED THERAPY -- from two world-class specialist doctors. But the "skilled care" facility where she went for the therapy decided that she doesn't need the therapy and refused to give it, and refused to send her somewhere that would.

She got another prescription for more therapy and apparently they did give her a week or two of coverage but now they say that is running out and the last three or four days, two women from the nursing home business office have been coming in to my mother's room and badgering her about the bill of $22,000 (which she does NOT have, but is not eligible for Medicaid) for "custodial care" they claim she owes and which is not covered by her insurance.

Tonight she told me that they said to her today, "we have ways of making you pay." WTF???? What are they going to do to her -- torture it out of her??

She is terrified that they are going to steal her pension checks, which she needs to get out of the home and pay for care somewhere else. She is afraid that she is going to be trapped there in that filthy nursing home the rest of her life.

I think they can not attach a pension or social security, and they have to give her the right to appeal denial of any prescribed therapies, which so far they have not. And also they cannot discharge her without 30 days notice, even for non-payment.

But she is 89 years old and has had one stroke. I am sincerely afraid that these nursing home bitches will make her take another. THEY DON'T CARE, even if they kill someone, as long as their company gets its money and makes its profit, I guess.

I am so mad and so afraid for my mother, as I said, I could spit nails.

[The Straight Story]

1. Kicking for your ma and what hopefully will be good ideas from DU'ers on it all

Give her a hug from us!

[phillysuse]

2. You need to move your mother out of there

and get her the therapy she needs.

This is not a therapeutic environment.

[Traveling_Home]

3. Check for your State's ......

Protection & Advocacy Office

Also might want to check in with local Independent Living Center.

Should probably cross-post to Disability Discussion group

Good Luck

[EFerrari]

5. Also, your congressional rep. I just caught a session on

elder abuse on CSPAN today.

[demodonkey]

9. My rep is Tim Murphy in PA-18. A do-less GOP who was a doctor himself.

He doesn't believe in "socialized medicine".

[phillysuse]

13. I think Pennsylvania has elder abuse laws.

Get a lawyer.

[phillysuse]

16. Link for Pennsylvania SeniorLAW Helpline

SeniorLAW Helpline - 877 PA SR LAW (1-877-727-7529)
The statewide toll-free SeniorLAW Helpline - 877 PA SR LAW (877-727-7529) - provides free legal advice, information and referrals by telephone for all Pennsylvania seniors 60 and over.

[EFerrari]

17. Great job!

:applause:

[EFerrari]

14. But he can't very well sanction abuse. Bad for the market. n/t

[blogslut]

21. Try your State rep

Sometimes they are more willing to listen to and help a local constituent.

[Horse with no Name]

38. Call your Nursing Home ombudsman. The number should be posted in a prominent place in the NH.

They have to have one and it is free and a great place to start. Good luck.

[OregonBlue]

40. YES, YES. A friend of ours is a nursing home ombudsman and she is a holy terror when it comes

to taking these guys one. If the ombudsman is a good one, he/she can resolve this stuff pretty quickly and they do know the laws regarding elder care. At least in Washington and Oregon, they have a lot of leeway and considerable authority when dealing with these guys.

[demodonkey]

46. I hope I am wrong, but I fear ombudsman is just buddy-buddy with the nursing homes.

I have no basis for this fear, as I haven't called the ombudsman, but gee they deal with these same homes month after month, year after year, and they know the administrators, etc. It makes sense they would develop relationships whereas people like my poor mother come and go.

Kind of like Diebold, ES&S, etc. being chummy with election directors and cold as ice to the citizens who vote and pay the bills.

Again I hope I am wrong about this -- I tried to contact the ombudsman once, months ago, and she was on vacation and never called me back. I took this as a bad sign. Sorry.

[OregonBlue]

56. You may be right but my friend is very tough on the nursing homes King County. She knows the ins and

outs of the law and is truly an advocate. Try calling again,if your local ombudsman is good, they will get this resolved. In Washington and Oregon they have considerable power to force nursing homes to do the right thing or loose accreditation. They are of course underfunded and overworked so try calling again. It's possible they are just swamped and therefore didn't return your call. If you do get through to them, you should be able to tell pretty quickly whether they will do anything to help you or not.

[benddem]

12. I'm pretty sure

most states (maybe not mississippi) have a Nursing home inspection unit. I'm sure you can find it on google. Might not be a bad idea to contact local call in for elder abuse. It's elder abuse as far as I'm concerned. I have a 90 y/o mother so I have an idea of how upsetting this must be.

[The Doctor.]

18. And ALWAYS call an attorney...

The worst that can happen is they say you have no case, but where a lawyer smells money, they can do some serious damage.

Heck, call three.

[EFerrari]

4. Call the state. If it were my mom, I'd be afraid to keep her there.

There's got to be an IG or an advocate that can help you.

Bastards.

PM me if you want to split the calls.

:hug:

[proud2BlibKansan]

6. Do you have legal power to make medical decisions for her?

You should. Then make these assholes deal with you and leave strict instructions that they are NOT to discuss your mother's insurance or her bill with her.

My mom died last October and we spent a couple years dealing with assisted living and nursing homes. Stand firm and make it very clear that your mother is there to get well, not to negotiate her own care.

[dflprincess]

7. I don't know the law where you are

but in Minnesota I'd call the state attorney general's office. Minnesota has some strict rules about what tactics are acceptable for bill collecting and what these people are doing sound like they would be violatine MN law. - I'd also have the advantage of threatening them by using the name of our former Attorney General who really made a career of going after insurance companies and others screwing around with people's health care. If you know a lawyer, it probably wouldn't hurt to have him/her give them a call.

You might also want to call the state health department, I'm assuming the facility needs to be licensed by them, they might be interested in the way your mom is being abused.

What do her doctors say about this?

[terisan]

8. Of course you are justifiably angry. Which state is she in?

Does she have private insurance and medicare?

[Traveling_Home]

10. Better Yet .....

Long-term Care Ombudsman or Nursing Home Ombudsman

http://www.ltcombudsman.org/static_pages/help.cfm

[kurth]

11. Call your local newspaper, TV, congresscritter

Make noise and tell the world.

[Glorfindel]

15. Alas, it's not the nursing home that determines levels of care

It's Medicare guidelines, no matter what the attending and/or consulting physicians prescribe, and private insurance will not usually pay in the absence of Medicare approval. If Medicare says a patient does not need a "skilled" level of care (which is only ever for a very short, limited period of time during which the patient must be shown to make progress toward recovery), then the level of care reverts to "custodial," which is not covered by Medicare and usually not by any private insurance, either. Generally, only Medicaid (welfare) pays for custodial care, and you have to have exhausted all your resources to be eligible. It's a horrible, worst-of-all-worlds kind of system, and the major reason I'm glad to be out of the health care field. It sounds as though your mother is in a really bad nursing home. Have you tried contacting the state or local long-term-care Ombudsman program? They can sometimes be of great help in cases like this.

[demodonkey]

19. She has 365 days BEYOND Medicare, plus $1Million beyond that -- good insurance.

She is a retired Pennsylvania Public School Teacher and she does have good insurance. As I said 365 days plus $1M and this is beyond the 100 days of Medicare coverage -- but for any of this she has to be getting skilled therapy. The insurance RN case manager acts like they WANT to help her, but she has to be getting the therapy.

I spoke to one elderlaw attorney and he said we would have good grounds not to pay because she had both the prescription AND insurance coverage available, also she was never given instructions on how to appeal the first denial. I think they are getting wise and want to tell us how to appeal this second cut-off (which I know will be a waste.)

Yes, she does need out of there. Problem is she has developed contractures of the legs while she was there and now needs surgery which she is on the waiting list for. In the meantime if she does not get therapy she will contract further and may become permanently bedfast.

Oh ya, we have the "best healthcare system in the world." NOT.

[FooFootheSnoo]

63. That sucks

Your mom developed contractures of her legs while in a skilled nursing facility? YOU may be able to make them pay. If her legs were fine when she went in, they should be fine now. I've worked with adults with CP and from what I understand (I'm NOT a physical therapist or doctor) they can be prevented with range of motion exercises and splints. I could be wrong, but that's what we did with our clients and it seemed to work fine except on the ones that already had contractures.

[Tandalayo_Scheisskopf]

20. Keep an eye out for...

Them billing for care that they haven't delivered. It sounds like such a thing has real possibilities.

Where is this nursing home?

[begin_within]

22. Move her out of there ASAP.

She has the right to leave any time she wants. I don't see any good that can come to her there.

[Midlodemocrat]

23. I'm sorry, but this doesn't make sense.

Once a person is actually a resident of a long term care facility, it is a violation of federal law to 'kick them out'. Regardless of the reason that they are initially placed in the facility, be it because of long term or rehab needs, once the person spends a night in the facility, no one can force them out.

Additionally, if she has insurance like you say, there is no reason that they should be 'badgering' her for the money. LTC facilities are routinely 90-120 days behind in filing paperwork due to snafus, work load, etc., so that shouldn't be an issue.

They cannot attach her pension or her social security without her permission or the permission of her POA.

Private pay LTC residents are golden to nursing homes, which is why I don't understand this post.

And, lest you think I am talking out my ass, I am EXTREMELY familiar with all CMS legislation.

[demodonkey]

25. Well it doesn't make sense to us either.

1) She has insurance.
2) She has prescription for therapy.

All they need to do to get the money is keep providing the therapy. She could be there for a year or more (not that we want her to be) if necessary, as long as she is getting skilled therapy.

Yes, I called the insurance and they said they have not been billed yet for most of this. So yes it makes no sense that they are badgering my mother for the money, except MAYbe for some of the "custodial care" from several months ago -- but again it was the HOME's decision not to provide the therapy.

I know they can't "kick her out" (well they can, but they have to give her like 30 days notice in PA) but in the meantime they claim she is running up these big bills and of course is not getting the therapy she needs which will jeopardize her long-range chances of recovery.

Yes. It is crazy.

[EFerrari]

26. I wouldn't leave her there or not alone anyway.

When my grandmother was hospitalized the last time, I got there and they had the IV in wrong and her hand was swollen the size of a grapefruit. She was sweating because they hadn't given her the meds she needed to move her bowels -- for two days.

I ripped the staff a new one but, I hired someone to sit with her until she was released back to us. The family chipped in because none of us could afford it alone. At least we knew those damn people weren't going to kill her without a witness.

This was at an upscale hospital in Silicon valley. Where there are vulnerable people, there are vultures. :shrug:

[Traveling_Home]

30. Even with a prescription ....

If the therapist says that she has reached her maximum level of benefit from the therapy then the insurance would not cover and it would be the custodial care issue already raised.

[demodonkey]

43. Insurance says to find another therapist. Attorney says therapist may be liable.

If some therapist's decision to override the prescription of a world-renowned physiatrist and surgeon (2 separate doctors) causes my mother harm or further loss of function, the attorney said we should just not pay and if they sue us countersue the therapist,nursing home, and G.P. doctor (who literally comes in for less than a minute sometimes and calls it an 'examinination'.)

The point is -- we shouldn't have to. A person who takes a stroke needs CARE. And in this case, she actually has insurance available to pay for the care.

[emilyg]

31. Have you talked to her nursing home doc?

[KT2000]

35. Not in Washington state

Owing money is a justifiable reason for eviction.

[Horse with no Name]

39. Hey there friend

If I am not mistaken--but I might be--Medicare won't cover her if she has another policy (other than a supplemental).
We ran into this with one of our clients, she was eligible for Medicare but her husband was still working and had health insurance available to her so Medicare wouldn't cover her.
Is that correct?

[demodonkey]

44. The extra coverage she has kicks in AFTER Medicare -- IF she is getting the therapy prescribed.

:shrug:

[windbreeze]

47. That's not what I found to be true...

I had my husband's insurance...AND medicare...but...as long as he was working....his insurance was primary.....and medicare was secondary....they both paid claims in that order...however, when he retired...Medicare became primary, immediately...and his retiree insurance became secondary...and now that's the way they pay...(but talk to me about how frustrating it can get...there for a while, all the two of them did, was fight over who wasn't responsible for any bills...with me caught in the middle, trying to make sense of it all)wb

[Midlodemocrat]

57. Hey, sweetie!

Anyone over the age of 65 is considered to be a 'federally covered life', and therefore entitled to Medicare AND Medicaid if they either don't have any assets, or the disease process is extreme enough.

The OP's mom should be having the bill sent to Medicare based SOLELY on her age and then paying the difference with her private insurance.

[Teaser]

24. Nurse Ratched is still working?

Thought she would have retired by now.

[begin_within]

27. Can you bring her home?

My mother is 88 and had a small stroke 3 years ago. I have been taking care of her at home ever since then. It's a huge burden on me but I have adapted to it. And we have hired help 4 days a week for 6 hours at a time, to give me a break. She had some short stays in Skilled Nursing Facility and had therapy in the hospital, the SNF, here at home and at the outpatient therapy facility. She had physical therapy, occupational therapy and speech therapy. She wasn't treated like your Mom has been in the SNF, thankfully - what they have done to your Mom is completely unacceptable in my opinion. It is harmful to her and what they are paid to do is to be helpful to her. Even though they didn't treat my Mom that way during her stay in the SNF, she still hated it there and begged me to take her home the whole time she was there. She fell into a depression there, which lifted immediately as soon as she got back home. I don't know what your situation is, but if you have enough brothers and sisters who could share the responsibility of taking care of her at home, then it would not be too much of a burden on any one of you. I have 2 sisters but they do nothing to help me, in fact one of them just moved to another state. I think your mother will do much better at home with her family and with the necessary medical care workers coming to the house. I hope you can have her doctor discharge her with a prescription for home health care, including physical, occupational and speech therapy plus a social worker if necessary to help sort out what her needs are and what resources are available to meet those needs. You can have therapists come to the house to give her the therapy she needs to get her walking and functioning normally again. The environment she is in at that SNF is not doing her any good. I would bet that she will become far more relaxed, peaceful and happy if she is back at her home. It may be a enormous task to take care of her, but if her friends and family all pitch into help, it can be done. Even if you find it very difficult, you will also find it very rewarding and you will be glad you did it for her, in her years of need. So my recommendation would be to get her home ASAP with the appropriate in-home care.

[demodonkey]

41. Not At This Time, But Her Coming Home Is The Goal

The stroke she had was massive, and she has been allowed to develop these contractures in both legs which absolutely will require surgery to release them. Until then, she is mentally alert but physically like dead weight -- due to the contractures she can't even help with her "good" leg. So right now I just can't do it alone. She will get hurt, or I will.

My only sibling -- my brother -- ironically died in May at age 49 due to septicemia (2 concurrent infections) he got in another "skilled facility" while there for rehab for a broken shoulder!

Our house is not accessible, moving is not an option, although remodeling may be but I am going to have to get people to help raise funds and do the remodeling. I hate to ask, but my family has been fighting a developer who flooded our family farm, developer's insurance Co. CNA is stalling payment for all these years, and every last resource we have is down to nothing except the property we have itself. The stress of this is almost certainly why my mother took the stroke.

I can't hire anyone because I am basically unemployed, fighting for election reform and voter-verified paper ballots in Pennsylvania. People who have said they would help raise funds for our group so I can be paid for my work (or even just my expenses) have petered out after sending out like one fund-raising letter that brought in only a few bucks. Even if I let it go (which I hate to, because Pennsylvania is SO targeted for 2008), I don't know where I could find other work quickly. I can't do something like go work in a minimum-wage fast food or convenience store, even full-time, and make enough to pay for the help we need.

[begin_within]

52. Well at the very least I would try to get her into a different facility.

The one she is in is obviously harmful to her, based on what you have said, and things will only get worse with them if you keep her there. I would recommend that you spend as much time there as you possibly can. Not only will it make your Mom happier but they will also treat her better if you are there. I spent many long hours at the facility when my Mom was there and I believe the care they gave her was better, simply because I was there watching the whole time. Your Mom should probably qualify for state medical benefits, I would think. I don't know what the requirements are in your state. Here in California, my Mom could qualify for Medi-Cal except for the fact that she has too much savings in the bank. They don't count the value of the house she owns and they don't make her sell the house to qualify. Once she qualifies, that opens up the door to a whole array of "in-home support services" and other types of services that she can get in addition to those provided by her own insurance. There may be all kinds of benefits the state can offer her. The state would rather pay out these benefits than pay the much higher cost of keeping her in a nursing home. I would suggest that you look into that as soon as possible. I would contact your county health services offices and ask there, as a starting point. Even though it is funded by the state it is probably run by the county. Also look into caregiver resources for yourself. There are state-funded programs that provide a variety of services to the caregiver (you). They include classes, counseling, support groups and respite care, where they either send someone to help you, or refund you for money you spent on hired help. This is probably a separate agency. If you can't handle taking care of her at home, I would try to get her into an assisted living center or other facility ASAP, since the one she is currently at is only harming her, in my opinion.

[CitizenLeft]

49. bless you bob weaver

Been there. Not everyone can do this, but I was unemployed for the last 18 months of my mother's life, and I was able to take care of her at home (though the depression that set in because I couldn't find another job to pay for the homecare she was getting before, while I was working, so that I COULD go back to work, wore me down). It's very difficult, and puts extraordinary pressure on the homecare giver. Wishing the best for both you and your Mom.

[begin_within]

53. Thanks

[cutlassmama]

28. I would find out the names of these "people" that were harrassing her

and write letters to the administrator of the nursing home, your state representative, the state, and anyone else you can think of. I'd get their butts fired.

[Lydia Leftcoast]

29. I've been through this with three different relatives in the past ten years

Get your mother the hell out of that place. There has to be somewhere else that's better.

There are a lot of sleazebags in the nursing home industry, and they pay so little that the help isn't always of the highest quality.

Also, in anticipation of such time as she may be unable to make her own decisions, make sure you have power of attorney.

Get her doctor in on the act, too. If she's not getting what she needs, her doctor should be informed.

[dickthegrouch]

32. Get the lack of therapy documented BY THE DOCTOR

Get it into her medical chart that the therapy the doctor ordered has not been performed. Preferably by a different doctor.
Then go to the best lawyer you can find. Cast Iron Case.
I normally despise lawyers almost as much as money lenders, however, when I need one I've spent top dollar and got my money's worth.
Happy hunting.

[Bitwit1234]

33. The can not take her social security..Remember

they just had an article about that. Some people were doing it and they got caught it is against the law.

[pop goes the weasel]

34. who have you contacted?

The groups that have the most experience in fighting abuse and imprisonment in nursing homes are disability rights groups, especially centers for independent living, and civil rights projects. They can help you figure out what the next steps are.

[happyslug]

36. Does your Mother owes her home?

If she does, the Nursing Home providing her care MUST sue her and get a Judgment against it. If she does NOT own her home, the Nursing home can still sue her and get a Judgment against her, but the Judgment will only be valid upon her death from whatever assets she has at that time (and if her husband is still alive, special Rules apply to preserve his rights to the property).

Whatever her Insurance does not pay, and she herself can not pay, Medicaid will pay. The above regulations are set forth by the Federal Government upon both the State and the local Hospitals, neither group can do anything BUT go after her assets (If the Hospital does NOT, the Hospital will lose whatever right the Hospital has to Federal Money to help people like your mother).

Furthermore, if she is under Medical Care, she can NOT be moved from the Hospital UNLESS THEY IS SOMEPLACE SHE CAN GO AND GET THE CARE SHE NEEDS.

As to her pension, the group providing Care to her, must demand she turn that money over to them (Again Federal Law). Now if she went to her own home her pension can NOT be executed on by the Sheriff (if a Judgment is entered against her) for Pensions are exempt under Pennsylvania law from such execution (Through I do warm my clients that, unlike the Federal Law regarding Social Security and its exemption from execution sale, once the money is in a ban account it can be executed against (Pennsylvania law does NOT exempt bank accounts from execution, through Federal Law does Exempt Social Security Benefits and SSI from such Execution).

Yes, the Hospital could be doing a better job about discussing with you WHAT THEY HAVE TO DO BASED ON FEDERAL LAW, my local Hospitals rarely talk about these things with their Patients, but do sue them on a frequent basis. Such Patients end up calling me, and once I find out they have no assets I tell them leave the Hospital get their Judgment. My clients have NOTHING the Hospital or nursing hoke can take, and more then anything else the Hospital or Nursing Home want the Judgment so Hospital or Nursing Home can show the Federal Government Hospital or Nursing Home have made every effort to collect the fees from the Patient.

Thus unless your Mother owns her home, I see no problem except for the bad statements they made to you and her about why they are doing what they are doing AND not explaining to you it is federally mandated.

[DemocratSinceBirth]

48. I Have A Question

The nursing home can't attach your pension or SS...

But I believe Medicaid can...

Am I correct?

[demodonkey]

50. Medicaid takes EVERYTHING you make, except $40 a month in my state.

You can keep title to your home if you intend to return to it, but if you are getting temporary Medicaid help in a facility they take all your income leaving you with nothing to pay your bills, so I guess the reality is you lose your home anyway.

My mother wants to use her income to pay for help, so she can get OUT of the nursing facility, not give it to Medicaid to stay there. Ironically, in PA, if she made less in pension / Social Security (remember she is a retired teacher) she COULD get a 'waiver' and get full Medicaid help IN HER HOME.

But because she served society and taught children all those years, and makes a few hundred dollars a month 'too much' in income now, the thanks she gets is that Medicaid will ONLY warehouse her in this hellhole nursing home for the rest of her life -- nothing else is available -- and THAT is what we are trying to avoid by going for the therapy and surgery. So she CAN come home later.

It is a hell of a mess.

[happyslug]

59. Medicaid is welfare, and all the rules of Welfare applies.

Including that you have to have NO income. You can "spend down" your income on medical bills to the Welfare rate for your County, to get on welfare, but you have to do that EVERY MONTH. The amount varies from county to County ($174 in Cambria County, $206 in Allegheny County). Now in a nursing home ALL of your income goes to your care thus even the Welfare amount has to go, the Nursing home generally leaves a patient with $30-40 Dollars for supplement purposes, but all other Income goes to the Nursing Home. This is all Federally mandated.

[demodonkey]

60. And it leaves you with nothing to maintain the home that you need to return to if you get better.

So you are, basically, assured you will lose your home even with a few months in a nursing home on Medicaid. Once the home is gone, where the hell are you supposed to go then? Nowhere. You stay in the nursing home for the rest of your life, especially if you are an older person. I see them in there, where my mother is. There is one lady, only age 54, who took a stroke and even though she probably COULD be in a community setting, she is now stuck in that nursing home.

You get $40 out of which you are supposed to buy all your clothes, toiletries, non-covered medical care, and other needs.

But, as I said, if my mother had a few hundred dollars less income per month she could get a "waiver" and get all the services she needs RIGHT IN HER OWN HOME. But because she has a little "too much" income, she has no choice but full nursing home institutionalization if she does have to eventually go on Medicaid. This is Pennsylvania's "thanks" to my mother for doing something for society by teaching children for decades and trying to make something of herself.

[happyslug]

61. You are correct, the thrust is to save the Government money

I use to have copies of the Regulations regarding Welfare, it was about four feet wide (About 5-6 huge notebooks, each about 5-6 inches thick). In that mess of regulations ONE PAGE CONTAIN WHAT THE STATE PAYS AS BENEFITS. The rest were regulations to keep contain costs. I use to Joke about Reagan Statement about getting rid of the waste rand Fraud in the government. The joke was the biggest source of waste was the controls to prevent Waste. Government, Unlike private enterprise, is willing to put a ten dollar lock on a 50- cent item (Private Enterprise, when it operates property, will spend no more than 50 cents on a 50 cent item). Reagan "Welfare Queen"s story is Classic, the regs WORKED to catch the person suing fake names to get more than one welfare check per month, but that was NOT praised, instead more regulations were made to make it "Impossible" for anyone to do it again (and I put the the word in parentheses to show it is NOT what the new regs did, but what was said about the new regs).

I am sorry, but the Regulations are more to private loss to the Government than to people who need the help, and that has ben the rule for at least since the Great Depression (When the last major revision of Welfare occurred).

[Yellow Horse]

66. You sound pretty comfortable with the system, but I am not -- USA needs Universal Healthcare!

Including long-term care, in a person's own home if they want it.

Healthcare should not be "welfare'" as you call it -- it should be a basic human right. Retired teachers should not have to go on "welfare" to get the care they need to survive in their older years. Especially if that survival means being held like a case of meat in some understaffed private enterprise nursing home, where everything is directed toward making money for the owners.

Making people lose their homes to Medicaid and then trapping them in nursing homes the rest of their lives is NOT cost effective to anyone but the nursing home industry.

You say you have "clients" but you sure don't sound too keen on changing this.

I say we MUST change this and would rather talk about how we can do that (and how we can help the OP) than how the system won't do anything but take everything you have so you can be on "welfare" if you get sick. We can and we MUST change this.

[happyslug]

67. I work with the system, so I have to understand it,, but I dislike it.

I have to KNOW the system, thus my explanation of the System. A better system would be one where people KNOW what they are entitled to AND those rights are Clear. Most nursing homes work like similar rules, but such clears would make it clear who get what and would INCREASE THE COST of Welfare, which the State is more concerned about the care of anyone.

[demodonkey]

68. The best system would be where everyone is covered. Period.

My mother didn't ask for this to happen to her. She worked hard all her life, is being screwed by the developer ruined our farm and his COMMERCIAL insurance that refuses to settle, and now she is being screwed by this for-profit "system".

My question to you would be what have you done to change the system from within, Happy? Let me know, and my mother and I will do whatever we can to help, assuming we can get her out of there and get her the surgery, therapy, and help she needs.

My own work is with voting rights and advocacy for good voting machines, so I am aware of rights and how to fight for them, but nonetheless these jerks are still trying to bully both my mother and me.

Tomorrow morning I start making calls.

[happyslug]

70. I'm an attorney working with low income people

I have tried to get the system to work, for my clients. The problem is the states want to minimize costs more than help people. That is the general rule of welfare benefits. FDR when he formed SociaLS security made sure EVERYONE would be in the program. Since most people believe they will get a benefit form Social Security, it has wide support. On the other hand Welfare has almost NO support for most people believe they will NEVER need welfare, so it is viewed as an expense to be minimized NOT a benefit. Somehow we have to make Long Term Care a right that EVERYONE can expect AND demand. Right now you have to many people who do NOT believe they will ever need Nursing care. As long as that is the case they is NO support for long term nursing care or even long term medical care. That has to change, and hopefully it will. I try to convince people Universal health care is the Answer, but that has to be done by Politicians who will only do it when the vast majority of Americans want it. We (and it Have) MUST inform people of the benefit of Universal Health care to each person. That message must be made clear, it is cheaper all the way around for people to be covered for ALL medial problems, including Long term Medical Care.

[demodonkey]

71. Well, I am working for Universal Health Care (incl. Long-Term) too.

Even my mother wants to help. (She's physically very affected, but her mind is great.) She would like to testify -- I already have had her in several PA Senate offices in the PA Capitol, on her way home from doctor. She's a perfect example of why we need to change things.

And, BTW, I am uninsured myself because working for election reform doesn't pay, let alone bring so-called "fringe" benefits.

Health care needs to start being recognized as a human right.

[happyslug]

72. I agree with you that Medical care should be a Human right

But what you should do is get your Mother out in the Public so other people will see her. Politicians respond to what people are thinking and people think about what is brought ot their attention. Thus any way to get this issue to the people as a whole helps. Look at the comment I quote below, it is from a politician who accepted that to get reforms you had to get the people to think about the issue. To think is to talk about that issue. The problem is NO ONE WILL TALK until it is brought to their attention. Thus my comment about getting your mother out among people, in the mall, on the streets, anywhere. It is sometimes hard, but a little sign saying "I will lose my home do to the lack of Medicare Coverage" might just do the trick. It will get people thinking about the subject. Once people think about it, they will discuss it. Discussing it beings both he good points and bad points to light. People will see the Bad points are NOT that severe, while the Good points of universal medical care are quite clear and huge. Sing on your car as you drive your Mother around will help, the issue is getting the issue to the attention of the Public. It is to a limited degree, but the opponents of Universal Car, keep on pointing to the "lack of choice" and the Costs involved with Universal Care. Your Mother is a good example why those two issues are minor, compared to your mother's need for care.

[happyslug]

58. Social Security is exempt under Federal Law from ANY attachment

The only "Exception" to the rule are over-payments to SS recipients. Thus Medicaid can NOT attach Social Security, nobody can. Now a nursing Home can demand that you turn it over to them IF THEY ARE KEEPING THE PERSON WHOSE SOCIALS SECURITY IT IS, but that is about all.

[Horse with no Name]

37. My mom is an Occupational Therapist

and she has told me stories....:scared:
Anyway, the Nursing Home CAN DO NOTHING except ask her to leave.
That's it.
Medicaid, however, is a different story. IF she received state benefits (which it doesn't sound like she did, they can attach her assets).
Also, be aware that MEDICARE only pays for a finite number of therapy days ANNUALLY...regardless of the diagnosis OR the necessity (again, horror stories).
If the nursing home FAILED to authorize her benefit days AND also accepted Medicare assignment (ask if she is in a Medicare bed) AND DID THE THERAPY ANYWAY, then THEY are basically shit out of luck. Sorry for their loss.
Your Mom shouldn't worry--although I am sure she will.
Find her another home--sooner rather than later--because Nursing Homes DO kill.
Federal Medicare law limits the days on ANY rehab or therapy. Find out how much she has used and how much is still available to prevent this from happening again. All of the prescriptions and necessity in the world cannot overturn that federal law on number of skilled days.
Just an FYI for next year...make sure that her skilled and therapy days are used wisely.
Make sure that she isn't put somewhere that "claims" to do therapy but does not do effective therapy.
Many hospital run "skilled units" are famous for this.

[w8liftinglady]

42. some links

http://www.medicare.gov/FraudAbuse/Tips.asp

http://www.elderabusecenter.org/

[DemocratSinceBirth]

45. Nursing Homes Suck

Shoot me in the head before you put me in one...My mom is 89 years old... She's an amputee and has stage 3 colon cancer... But she must have some awesome genetics...She had a colon resection in 00 when she was eighty two and there has been no recoccurence despite having one or two possitive lymph nodes...I take care of her at home...When she had her leg amputated she was seventy eight years old... She was discharged to the nursing home...The folks in physical and occupational therapy were nice but everybody else sucked...She would have to pee and she would ring the bell and nobody would come...One night they called me up to tell me she crawled out of the bed (rememember one of her legs was amputated below the knee)! I took her to my apartment back in 96 and have never looked back...


Obviously I know a bit about Medicare and Medicaid from all this... Medicaid doesn't kick in until you have drawn down all your assets and they will take you Social Security and pension to pay the nursing home bills and Medicare only pays the nursing home bills for a short amoint of time after you are discharged from the hospital...


Good luck and God bless...

DSB

[CitizenLeft]

51. almost the exact thing happened to my mother...

She was in the nursing home for therapy following a prolonged hospital stay. I won't go into details, but the promised physical therapy was never given, yet they took the money from Medicare for it, oh yes they did. Then when the coverage ran out, they declared her permanently unable to walk, kicked her out, then sent her a bill for the therapy she never got that wasn't covered. In fact, after she was home again, I had to take 5 weeks of family leave so that I could stay home with her while an independent therapist came into the home and gave her the therapy she should've gotten at the nursing home - YES, she was able to walk with a walker. It was incredible. And they got away with it becasue the cost of an attorney was too much, then and now.

If you're at all able, get an attorney. If not, make some kind of declaration of the facts, gather documentatio, and have it notarized - or something - for future use for when they come after you. It's scandalous, what some of these places do. To the elderly! It's just overwhelming.

Bless you and your Mom, and I hope for the best for both of you.

[Blue Diadem]

54. Here's the website for information in Pa.

http://www.dsf.health.state.pa.us/health/cwp/view.asp?A=188&Q=200693

Good luck. We went through it with my Mom too.

[knitter4democracy]

55. Whoo-boy, would I go on attack.

My MIL used to be a nursing home manager. She would know just how to mess with those people, though she was in Ohio. Her home always got the highest ratings--perfect score her last year, and then she was let go because it was "too expensive" even though making a profit for the owner. Anyway, she'd know just how to make all that stop. PM me your info, and I'll forward it on to her, if you'd like. She couldn't do anything for another week or so, though.

Anyway, I'd be calling up that manager and letting her know that I would be reporting her to the state attorney general's office, to Medicare for Medicare fraud, to the insurance company for fraud, and to the state ombudsman for elder abuse. I'd have copies of all the letters, too. There's no way any of that should be going on.

Get your mom's doctor involved, too. Hubby's an internist, and he's had to step in to help patients in bad nursing homes and get them out. He does it gladly. I'm sure your mom's doctor would love to know which home never to send any patients to. I'd make sure that manager would know that as well. Heck, I'd drag him to the meeting with me.

There's no excuse for elder abuse. None. Go on attack.

[orleans]

62. "we have ways of making you pay?" what the fuck is that?

i'd call the police and have them write up a report--tell them who is threatening your mother

and get her transfered to a different facility. now.

[sarcasmo]

64. Kick. This is one FUC*ED up Country.

[Elspeth]

65. Put the name of this place on the net. Make it public. Write Congress and local reps.

AS long as no one knows, these evil people can do what they want.

[THUNDER HANDS]

69. get yourself a lawyer, ASAP

one who knows about this stuff.

[lonestarnot]

73. Did your Mom sign over the checks?