OUTRAGEOUS! My 89 year-old stroke survivor mother threatened w JAIL by nursing home over paperwork

http://kdka.com/kdkainvestigators/Woodhaven.Merle.Kuznik.2.628205.html

Like many people of all ages with disabilities, my mother needs therapy and CARE -- not being threatened with jail because we didn't get some paperwork filed fast enough to suit some for-profit nursing home.

BTW, the reason we didn't get it filed sooner is that my mother has been in the hospital since Dec. 15 with seizures and a broken hip! And lest you think she is a deadbeat, she does have insurance that will pay as long as she is getting therapy; her doctor has prescribed therapy but after a short time each round the nursing home keeps telling us and insurance that she doesn't "meet criteria", that she is "custodial", and that her insurance has been "cut". Then we go back to the doctor, get another prescription, and round and round we go on a vicious treadmill.

The nursing home employed passive-aggressive techniques on my mother as well such as patting her arm and saying that "her job is to get better" then in the next sentence they tell her they have "ways of making you pay." They 'lost' her glasses right before they sent an armed constable in to serve her the original papers in this suit to force her to apply for Medicaid.

Yes, I need a nursing home abuse lawyer. If you are one, or know one, please help.

In the meantime, my mother is still in the hospital, in terrible pain, and is not doing well today at all. I just hope she makes it. She is my best friend and only family left.

IF WE HAD FULL, COMPREHENSIVE HEALTH CARE IN THIS COUNTRY, STUFF LIKE THIS WOULDN'T HAPPEN. Please, please someone get this to Edwards and the other campaigns and Michael Moore and Oprah too.

nursing facility?

I wouldn't want my mother in there either. I know its difficult, but now while she's in the hospital might be a good time to make the change.

These places are shit. Get your sweet mama out of there and into another one, preferrably one with only about three other ladies.

That's why this story is so outrageous. It is public record, and anyone can go look it up and read that the motion is against my mother and calls for HER to be jailed for three days. The TV station certainly did, before airing the segment.

They gain nothing by her getting thrown in jail. They're trying to get you to assist them in filing the needed paperwork so that they can be paid for the care they have given and may continue to give her.

I am glad you got a TV station to cover it!

The more people know about stories like this, the sooner everyone in the US can be safe from people like this.

Sorry you and your mom have to experience this, but hopefully your story can help others. (I know that doesnt really help when you are in the middle of this.)

:loveya:

.... whose family refuses to complete the required paperwork to get coverage from the appropriate agency, in this case Medicaid. The article states she has been a resident for a year. She should have switched to Medicaid from Medicare primary a long time ago. The problem is not the NH.

and I do too. Paperwork without compassion, that is what we have here. Peace, Kim

as he's the only candidate who really will help you with this.

vulnerable.

and that is why I say vote for him.

vote for John.

Just sayin.

but you will not get an insurance plan that does not involve the insurance companies. You will get the government subsidizing the insurance companies and the companies refusing your claim. Good luck with that. Peace, Kim

I'll take any of the 3, really. I like them all.

On Iraq Kucinich has the answer. On the Patriot act and NSA once again it is Kucinich. I am not ready to settle for less. I know he probably makes your blood boil. Have a good one and peace to you and yours, Kim

No disrespect of course, but you might as well say to vote for me. I'm kinda asking who then, that ya know, can actually like, win an election and stuff.

I'm going to vote for what I think is right the first time around. The 'top' three will duke it out and then we can see what the fall out is. The media excluded Kucinich first and now it is trying to suffocate Edwards. It looks like unless many Americans stand up that the true choice is being made by the media....again. Peace, Kim

Society excluded Kucinich, not the media. Putting it on the media is a bit of a stretch. I'll give ya Edwards though.

That's exactly the way it is.

but no more crying about Edwards being excluded by the media. You just can't have it both ways. Peace,Kim

2 quick points of note:

1. You have never seen me anywhere cry about Edwards being excluded by the media

2. Your statement about having it both ways made no sense. What both ways? What was the first way? What's the second? Do you even know what it is you're trying to debate?

absolutely no chance whatsoever of winning. Period. NO CHANCE. Anyone who thinks he does is, as OMC says, living in fairy-tale land.

And that's not to say I don't like him. I grew up in Cleveland and remember when he was mayor. He was quite the hothead then, but he's really grown as a man and as a politician and candidate and I agree with a lot of his positions. But I accepted long ago that he's just not viable and it just ain't gonna happen. One of the reasons why we've never made much headway in national politics these past several decades is exactly this kind of "purity uber alles" thinking, where our candidates not only have to agree with us 100% on EVERYTHING, but we don't allow them any room for disagreement or compromise on anything. And that kind of thinking means you stay on your own narrow island, period, because the real world just doesn't work that way. It's unfortunate, I agree, but it's cold, hard, reality. I don't know about you, but I'm kinda tired of living on that narrow, isolated island.

winning. None whatsoever. Zip, zap, nada, nein. And even he knows it. He is only running, as he's said before and as he said in 2004, to bring attention to critical issues that he believes the country needs to address, such as this one. You do have the right to vote for whoever you want, of course, as is the American way, but know that it doesn't matter if he's the most perfect candidate since Jesus Christ, he ain't got a prayer in hell of even coming close to the nomination, let alone winning in a general election.

That being said, my 64-year-old stepfather was finally put in a nursing home last month after my mom cared for him as long as she could, longer than a lot of people could have put up with. She is pretty much losing everything in order to make sure he's cared for properly. She's already spent a lot of their assets on his care even before he went into the home, and now she's applying for Medicaid. She's going to have to give up the house (sign it over to Medicaid), his life insurance (signing it over to Medicaid), and half of his monthly pension, which is what they live on (MEDICAID decides how much she will need to live on, not her). They'd had savings and assets which were pretty much depleted these past several years due to his illness (we thought at first it was Alzheimer's and now it's finally been determined that it's Lewy Body Disease, the second most common form of dementia after Alzheimer's. It's a dementia that's focused in the area of the brain that also affects Parkinson's Disease, and it's a combination of dementia and the physical symptoms of Parkinson's).

By the time he finally went into the home, he was completely incontinent and had been for several months, but was also refusing showers or any kind of cleaning up (he'd go days without being clean at all because she didn't have the physical strength to force him-she'd finally have to hire nurses to come to the house and do it), and was getting violent and uncontrollable. And most of their assets had already been spent on caring for him. So, they worked hard for forty years, worked their asses off, actually, and now have to give up everything just so he gets basic care and is taken care of. Don't even get me started on how much that pisses me off. Mom was worried that my stepsister and I would be upset that there wouldn't be anything for them to leave us in the estate-but I made sure she knew I didn't give a shit about that, all I care about is that he's taken care of properly and that she's comfortable as well.

for the insurance coverage / assistance. That's what this case is about. Family refuses to apply to the proper government funded insurance plan for coverage.

Enrollment is automatic for all citizens.

Read section 101- entitled, aptly enough, Eligibility and REGISTRATION. You do have to fill out an application, just as I pointed out in my previous post.

Don't you hate it when you talk out your ear and get busted on it? :)

SEC. 101. ELIGIBILITY AND REGISTRATION.

(a) In General- All individuals residing in the United States (including any territory of the United States) are covered under the USNHI Program entitling them to a universal, best quality standard of care. Each such individual shall receive a card with a unique number in the mail. An individual's social security number shall not be used for purposes of registration under this section.

(b) Registration- Individuals and families shall receive a United States National Health Insurance Card in the mail, after filling out a United States National Health Insurance application form at a health care provider. Such application form shall be no more than 2 pages long.

(c) Presumption- Individuals who present themselves for covered services from a participating provider shall be presumed to be eligible for benefits under this Act, but shall complete an application for benefits in order to receive a United States National Health Insurance Card and have payment made for such benefits.

I think I confused who qualifies for coverage with automatic enrollment. Of course, even there, I was wrong, the program isn't limited to citizens or nationals, but any resident, I'm assuming this includes Green Card holders, which makes sense, they do pay into Social Security, after all. For adults, I guess this just means one more form to fill out, then you get the card, and you are covered for life. For people born into the system, I assume they wouldn't necessarily have to fill out any forms themselves. It doesn't specify in the above excerpt, except for the mention of families, but assuming you are a resident who has a child in this country that is born in a hospital, one of the forms to fill out is the child's Medicare form, issuing them a card that the parents will hold onto until they feel the kid is responsible enough to carry it themselves. Kinda like a birth certificate, or Social Security card.

She is appealing to Medicare but since the therapy prescribed was not actually given for some of the time, that part of the time won't likely be covered by anything.

My Mom was in a nursing home for four years. Medicare only covers so many days. After that, if you have no private insurance it is Medicaid if you qualify but you must apply for it. Why didn't you apply for Medicaid? If she's been in a nursing home for a year and medicare was her only coverage she's probably got about seven months of unpaid bills.

...health insurance providers is to deny as much health care to people as they possibly can, this country would rise up, en masse and demand universal coverage.

So sorry about the crap they're putting your mom through! :(

doctor, who said their primary strategy was "delay, deny, deceive." Indeed. All they care about is profit and maximizing profit and, while they may be just fine with the manufacture of widgets or the providing of elective services that people can take or leave, it's a horrible model when it comes health care and people's very lives.

I'm glad it made clear in the article though that jail is out of the question, and that she will receive the best care. I just hope this wraps up cleanly and nicely.

The article ending made it sound like all is well, but the truth is that we have no idea what is going to happen. Where is this "best care" going to come from? Being warehoused like a slab of meat in a stinking hell-hole nursing home on Medicaid? I don't think so.

She needs rehab, and does not want to die. She served as Judge of Election in November and still wants to write a book. She wants to come home, and CARE IN HER HOME SHOULD BE AVAILABLE.

And she does not want a Do Not Resuscitate order. She wants to live.

The word to remember is "ombudsman." Most major media outlets have them and they're the people who do the human interest stories. It's also time to call any association in town involved with elder affairs. Be weepy if you have to be, and say you need help in dealing with this (if she's 89, you're no spring chicken, either. BTDT).

When they start getting heavy handed and threatening a frail, injured elderly person with jail, it's time to scream.

However, realize there are different criteria for rehab and nursing home care. The whole fight might be over which your mother really needs. If her seizures are not controlled, it's custodial care, and the insurance company will not pay for that. Medicare will only pay for the first month or so, and then you'll either have to take her home or deplete her assets down to Medicaid levels to keep her in long term care.

In the meantime, try to get a do not resuscitate order for her. At 89, she deserves one, and they'll be able to control her pain better if she has one.

and speak to someone in social services. We did this when we needed an eldercare lawyer. We found a wonderful lawyer who is truly looking out for my mom. The hospital didn't ask for a reason--it is just a service they provided.

when my husband had a major stroke. They were able to guide me as to which way to plan for him for his future medical needs with what is available in Medicare and insurance today.

I have heard far too many stories of people trusting the "nice" social worker only to end up being pushed out too soon or into the wrong form of post-hosptial care.

They want you out, and off the hospital's back.

On edit: In my own experience they are more concerned about insurance and doing CYA for the hospital than anything else. And in my own experience they want you to conform to THEIR idea of what you need.

had have been excellent in evaluating our circumstances and giving us the best plan for our future medical needs. Hospitals as a rule don't want to keep patients any longer than needed. Don't blame the social worker for that. I'm not without resources but I didn't know all the options that we had before we talked to the social workers who were able to help out a lot.

Because they want you out, they will help you find a way. Their bottom line is their facility, not the nursing home's! They always have a list of eldercare lawyers, perhaps to help themselves, but once you become their client, they will work for you.

I am not sure if yours does, but something to check (look up state gvt, call their info line.

Link to PA website, including contact and filing a complaint: http://www.ins.state.pa.us/ins/site/default.asp
Publicity helps too, god luck and I am sorry you and your mom and family are having to go through this.

For all that you are going through.

And no, I doubt anyone here would think your mom a "deadbeat" - anyone who has seen Sicko knows what a mess this damn coutnry is in terms of weird, torturous behavior from hospitals, nursing facilities, etc

because that is what it is-

I would think that if you are so inclined - a lawsuit against the home for elder abuse, and reporting to them to as many agencies as you can find, could be quite
satisfying.

Meanwhile, if it was my mom I would get her the hell out of there and into a better home.

Contact your state's Insurance Director or board, Division of Social Service, Division of Aging, AARP, and anybody else that you can think of. Jump on these assholes with both feet, what they're doing is outrageous, and if you make a large enough fuss they'll back off. Good luck, and I hope that you also find a good lawyer.

Nearly every single respondent to this post is talking out their ear. None of you have any clue how coverage for nursing homes work. They can call Evan Almighty, or even God, and the rules aren't going to change.

Ironically, Medicaid is a government run healthcare program that is in part, designed for this situation. The problem is the family doesn't want to be bothered with the paperwork. Universal healthcare doesn't mean that health care providers dig into their own pocket to take care of your relatives, and they can't do the paperwork for you. That's probably why the contempt request was filed against the family, not the patient. Likely they have her power of attorney, so this is their responsibility.

Reading this thread is enough to give a body a headache.

This isn't an insurance issue and it isn't about "elder abuse", either. The nursing home just wants to be sure that they're going to get paid. They have a RIGHT to be paid! The government isn't at this time prividing long term custodial care for the elderly and disabled and if it weren't for the for-profit facilities, there wouldn't be anywhere to go for such care. They deserve to be paid for their servuces. And unless this lady has some pretty exceptional long term care insurance (considering that she's been there for a year already), insurance (including Medicare) isn't going to continue paying for her to be there unless she's receiving actual medical treatment and not just costodial or "maintenance" care. I don't know how it works in PA, but in Illinois an elder has to be indigent for the state to pick-up such charges.

And don't hold your breath for any government provided health care program to pay to keep someone in a nursing home indefinitely either. Any more than Medicare does.

Why not just gather and file the requisite paperwork and get it over with?

My mother has INSURANCE that will cover THERAPY and a prescription for that therapy. This situation is NOT "designed" for medicaid. Medicaid is supposed to be the coverage of last resort for the poor, not for people who have available insurance.

AND FYI -- the contempt charge suggesting jail was FILED AGAINST MY 89 YEAR-OLD MOTHER, not against me.

If we had true, comprehensive, single-payer universal healthcare, there wouldn't BE any paperwork or very little. But people with attitudes like yours are what makes the status quo stay stuck.

On edit: And for those of you who think it is so easy ("why not just gather the paperwork") we have already submitted over 200 pages of documentation and it is not enough to satisfy them. Try doing that sometime over the holidays when your mother is in the hospital and then tell me how easy YOU find it. It has taken days, and the way they have gone over my family's finances I feel like I've been raped. And still they want more information.

Even if you think it's not necessary? The NH does think Medicaid is the payer that your family members qualifies under, and they have a vested interest in understanding the rules. You simply are not listening to them.

Read the following.... this is why Medicare is not going to cover her in the NH except for short periods of time: (you're using the phrase therapy, Medicare uses the term "skilled nursing", and "rehabilitation"). Medicare coverage for NH is very limited, regardless of how many prescriptions your doctor writes at your request for "therapy."

Medicare

Under certain limited conditions, Medicare will pay some nursing home costs for Medicare beneficiaries who require skilled nursing or rehabilitation services. To be covered, you must receive the services from a Medicare certified skilled nursing home after a qualifying hospital stay. A qualifying hospital stay is the amount of time spent in a hospital just prior to entering a nursing home. This is at least three days. To learn more about Medicare payment for skilled nursing home costs, contact your Medicare Fiscal Intermediary or the State Health Insurance Assistance Program (SHIP) in your State. The phone number for the Medicare Fiscal Intermediary or SHIP office in your area can be found in the Helpful Contacts section of this website.

Medicaid

Medicaid is a State and Federal program that will pay most nursing home costs for people with limited income and assets.

is going to cover custodial care. Not going to happen. From the little that you've said and from what was in the article, it sounds as if what your mother has been receiving in the nursing home, at least up until her most recent illness, is maintenance care; therapy and pharmaceuticals that will help to keep her from getting worse, but not active medical care to treat or improve her condition. If there's any question of that, they have to re-certify what her care is with the insurance carrier regularly in order to keep getting paid. Ordinarily, they do that through the doctor who is supervising her care.

But it really doesn't sound as if that's what's going on here. If they're asking you for extensive paperwork and documentation, chances are that they're trying to help you (and her) to get her qualified for Medicaid. And some of that is information they can't get without your cooperation.

Either way, as others have said, the nursing home isn't the Bad Guy here. They're just trying to get paid for the services that they do render to your mother so that they can continue to provide such services to her and others. It really is as simple as that.

What does it cover for the nursing home inpatient charges? There aren't many policies out there that are private insurance that cover indefinite days in a nursing home. (We're just trying to help).

at the nursing home for a year - her medicare ran out in a matter of a few months. Without private insurance that covers it or paying it out of your own pocket, medicaid is all that is left and you MUST apply for it.

emergency room entrances and dropping them off and leaving them when their money runs out. This nation is truly broken.

:nuke:

I'd yank my mother out of a place that treated her so badly... but I also have enough resources to stretch out to take care of her with an at home nurse if I absolutely had to. I know not everyone would be in that position.

It's really frustrating reading stories like this one, and there is often little people can do to make the situation better. Is there anyway you can find another home for your mother to live in rather than keeping her in such a confrontational place that is looking out for their bottom line and not their patient's care?

ADAPT - OUR HOMES NOT NURSING HOMES

We are fighting so people with disabilities can live in the community with real supports instead of being locked away in nursing homes and other institutions.

Support the Community Choice Act
House - H.R. 1621
Senate - S.799

A COMMUNITY-BASED ALTERNATIVE TO NURSING HOMES AND INSTITUTIONS FOR PEOPLE WITH DISABILITIES

--------------------------------------------------------------------------------
For decades, people with disabilities, both old and young, have wanted alternatives to nursing homes and other institutions when they need long term services. Our long term care system has a heavy institutional bias. Every state that receives Medicaid MUST provide nursing home services, but community based services are optional. Sixty five percent of Medicaid long term care dollars pay for institutional services, while the remaining 25% must cover all the community based waivers, optional programs, etc.
Families are in crisis. When support services are needed there are no real choices in the community. Whether a child is born with a disability, an adult has a traumatic injury or a person becomes disabled through the aging process, they overwhelmingly wan t their attendant services provided in their own homes, not nursing homes or other large institutions. People with disabilities and their families will no longer tolerate being forced into selecting institutions. It's time for Real Choice.

The Community Choice Act provides an alternative and will fundamentally change our long term care system and the institutional bias that now exists. Building on the Money Follows the Person concept, the two million Americans currently residing in nursing homes and other institutions would have a choice. In addition, people would not be forced into institutions in order to get out on community services; once they are deemed eligible for the institutional services, people with disabilities and their families will be able to choose where and how they receive services. Instead of making a new entitlement, the Community Choice Act, makes the existing entitlement more flexible.

The Community Choice Act establishes a national program of community-based attendant services and supports for people with disabilities, regardless of age or disability. This bill would allow the dollars to follow the person, and allow eligible individuals, or their representatives, to choose where they would receive services and supports. Any individual who is entitled to nursing home or other institutional services will now be able to choose where and how these services are provided.


COMMUNITY CHOICE ACT NOW!

She wants to come home. And we could probably make that happen with a little help adapting our house and getting care.

The ironic thing is, in our state if she made a few hundred dollars a month less in her pension, she COULD GET home care via Medicaid -- if she needs it. But because she made something of herself and helped the children of our state as a public school teacher and has a little pension, the only option available to her - again if she needs it - is to be warehoused.

In the meantime, again, she wants to come home. Her insurance has not run out, and I will not give up -- am doing everything I can to make it possible for her to get the therapy she was prescribed, and come home.

Hope it's up to date. I don't personally know any of the PA folk but they are strong!!!
Ma=yvbe Cassie or john for a start. They are with ILC's.

Hee's Cassie's ILC - http://libertyresources.org/


PENNSYLVANIA

ADAPT of Erie, PA
contact: Shona & Mike Eakin
814/835-8418 phone
Email Shona in PA
mailto:sactivist@aol.com
-or-
Email Mike in PA
mailto:erieadapter@aol.com


Keystone ADAPT
contact: Linda Anthony
Email Linda in PA
mailto:lanthony@ppainc.org


Philadelphia ADAPT
contact: Jimmi Shrode/Erik von Schmetterling/Nancy Salandra
215/627-7255 v/tty Jimmi & Erik
Email Jimmi in PA
mailto:jimmishrode@verizon.net
-or-
Email Erik in PA
mailto:erikvs@verizon.net

contact: Nancy Salandra
215-627-7255
Email Nancy in PA
mailto:erikvs@verizon.net

contact: Cassie James
215-634-2000 ext 309 days
215-633-0193 eve
Email Cassie in PA
mailto:cassiejames@libertyresources.org


Southwestern PA ADAPT

John Lorence
724/223-5115 days
724/966-2233 eves
724/223-5119 fax
Email John in PA
mailto:jljr@tripil.com

Kathleen Kleinmann
724/223-5115 days
Email Kathleen in PA
mailto:kathleen@tripil.com

every vote for him will take us closer to the goal of sinlepay universal healthcare w/NO insurance companies holdingout a greedy hand.

I am so sorry you & your Mom had to go through this. I was so blessed my Mom & Dad had a wonderful place.....its just not right the way the elderly are treated. :grr:

:hug: best wishes
DR

they lick it up like cream.

It used to be that it would allow a full throttle billing attack where progress is measured in paper-work. My guess is that your mother's insurance is more circumspect and thus more difficult for the paper workers. In the nursing homes, there are specialists that know the right steps to reap the most reward...it's not a measure of patient care, either, and they're familiar with medicare so it is easier for them to go that route.

I wish you and your mother the best. Sometimes one-on-one attention that insures the basic needs of mobility, nutrition, hydration, etc. can do more good than one hour spurts of contrived "intensive therapy". Also a doctor that doesn't leave diagnosis to the nurses.

Anyway, this whole "nursing home care" is screwed-up.

Does she have supplemental insurance and/or long term care, but you can't get them to pay? Is that the problem? And, of course, Medicaid will take any of her assets if she applies for that. Right? Insurance should be paying and if they were, no problem. Is that it?

daily room rate of the nursing home and it isn't paying? Why isn't it paying? They have to give you a reason for refusal.

None of those policies pay indefinitely.

understand how this stuff works or else she understands and refuses to accept it.

I hope you can sue the crap out of them!!

contact them pronto.In a lot of states these offices are even part of the regulatory agency and have the ability to impact the licensure of the facility so once you get them involved you start getting results. The difference in attitude at the assisted living facility where my MIL resides is night and day between before and after getting the ombudsmans office involved.And my MIL is a vert difficult person to deal with.But suddenly theALFisgoing out of their way designing programs and activities specifically for my MIL. This is stuff they shoulda been doing all along but were doing the absolute minimum to save a buck or two.

Good luck to you and your mom.

Pennsylvania Department of Aging
Office of the State Long-Term Care Ombudsman
555 Walnut Street, 5th floor
Harrisburg, Pa. 17101-1919
(717) 783-7247

PA also has local ombudsman programs; a listing by county is at:

http://www.aging.state.pa.us/aging/cwp/view.asp?a=555&q=254082

people and shoot them. What happened to treating older people with respect? Your poor mother. Other posters have good ideas, but it makes me too mad to think straight so I'm coming up dry (unless you want to take strangling insurance executives under consideration). We need single payer, universal healthcare so badly. Hope your mother's doing better soon.

as the NH reiterated when they were approached about it. Nursing homes aren't free, and most family members don't understand the coverage criteria. Most nursing homes have skilled nursing and non-skilled nursing beds. The coverage criteria is different for each. Most primary insurance policies don't pay for both, in which case Medicaid comes into play. Unless you are a insurance coverage specialist or expert it would be a good idea if you cooperated with the NH in getting the proper paperwork completed. Either that or educate yourself. And don't say you are educated. It's clear from your post you are not.

I agree that we have problems in the country with health care, but in this case, the NH is trying to help you get the coverage from Medicaid, and it sounds like you just don't want to go through the hassle. NH are not free. They cost a lot of money to run, and they can't afford to take care of people for free simply because the family doesn't want to complete the required paperwork to get the coverage from the agency designated for that purpose.

P.S. The doctor can order therapy all day long, but that won't take her out of the custodial criteria if she can't do the therapy, or has passed the time frame after the initial diagnosis for which therapy is covered.

mostly outs of this incredibly profit driven system? To threaten to arrest an elder citizen who is in pain is beyond the threshold of decency. It is the nursing home's responsibility to file the appropriate health care forms. Doctors' offices do it; why cannot nursing homes who profit from the ill and the elderly? I know that my children will never allow me to be so treated, but they are a doctor and two lawyers; not everyone has such backing. The poster says she is the only relative left; she is probably overwhelmed.

She isn't supposed to know how, and she wasn't threatened with jail. The NH filed contempt charges against her family, which probably has POA, and is neglecting their legal duties as the POA. And no, it is not the doctor's office or the NH that is required or even allowed to apply for Mediciad on behalf of a patient. That HAS to be done by the patient or their power of attorney designee.

When is the last time your doctor's office filled out your health care insurance application? Never. That is what we are talking about here. The family needs to apply for Medicaid coverage. Once they do that the NH will file the claims. The poster is refusing to complete the Medicaid application process, which only she, a POA, or the beneficiary can do, legally. If the poster is overwhelmed she should ask the court to appoint a guardian, such as a lawyer that takes care of those sorts of things. Yes, it would take a day to complete the proper paperwork, but if she won't do it, the NH cannot get paid, hence the contempt citation.

While their relative is in the hospital or nursing homes.

This doesn't get the press that people get when they die without health insurance. But all the interactions that are required by the health companies of the caregivers of the sick patient, all that time and energy is actually simply drained away from the caregivers so that they have less to give to their sick relative, and less to give to themselves and other family members.

So what are you saying? The NH should just take care of this person for free indefinitely because the family doesn't want to be bothered to fill out the paperwork so the govt funded program, Medicaid, in this case, will cover the bills? The NH cannot legally complete the required paperwork. The OP is neglecting her duties pure and simple. Perhaps she doesn't understand that, though I cannot imagine any NH would not have explained that to her multiple times before filing contempt charges. But contempt charges are appropriate. This patient needs a responsible trustee or guardian in the worst way, and the OP clearly is not.

Like most people, there are things about this you don't realize:

You are only one short quick slip in the shower away from being in a nursing home yourself. Or one car accident. Or one aneurism bursting, etc.

Are you that prepared? Who would fill out your paperwork?

Other countries have figured all this out and there's also the fact that in the brilliance of the other system's set up - no need for paper work.

What part of that don't you get?

Oh, and I should mention that in our system, at least in California, your life will be in the hands of someone who has been in this country all of two weeks, as she or he is the cheapest person the nursing home HR can find.

So too bad for you if there is a mediation mix up. Or too bad for you if your condition leaves you impaired and you can't feed yourself - you can only watch the food tray being placed down half a room across from you. And the staff, all of whom have 14 to 17 other inmates to take are of don't bother to feed you for a couple of meals in a row. And hopefully it iwill be neithr too hot or too cold during your stay - you aren't going to recover very well from the anuerism if the heat is about 103 % inside the facility.

And the nursing home is not the bad guy here. They have to play by the rules just like everyone else. YOUR FAMILY, or a court appointed guardian if you don't have family, has to apply for the Medicaid coverage or the NH will not be paid. What's outrageous here is that the OP is suggesting the elderly relative has been threatened with jail. That is not the case. The family member is not completing the required paperwork so the NH can be paid. And she is in contempt if she is the POA and not fulfilling that obligation.

The rest of your post you spend spouting off about bad Nursing Homes. If this home is so bad, why are they continuing to care for this woman without benefit of being paid for so long? If anything, the NH has been more then generous. According to the news report this has been going on for a year. Do you have any idea how much it costs to take care of someone in a NH for a year? More than most of you make in two years, I can assure you that.

is happening from reading the OP's posts, is her mother's private insurance either doesn't cover nursing home room and board charges or covered them for a "set" period of time. Medicare to begin with then any private insurance, both of which have run out and now she either has to pay out of pocket or qualify for medicaid which the NH is desperately trying to get done for her. That is if her mom's private insurance covered nursing home care at all.

You may need to ask a Medicare or other insurance worker for assistance in filling out the paperwork properly.

It takes a little time, perhaps some tracking people down, some phone calls. But it's something you do for your family.

When that relative dies, the state isn't going to do all of the paper and legwork for you to make funeral arrangements, either.

Nice to know at least one other person responding to this thread gets that.

If it's not her doctor or one in her doctor's practice, find out where her doctor goes. That helps with paperwork and ensures that the home's nurses would be calling the right doctor. Hubby covers a couple of different ones in the area, and he gets calls from them all the time and rounds there at least once a week to get caught up on his patients.

In Michigan, those tactics would qualify as elder abuse and would get a quick audit from the state. One good thing Granholm's done.

Personally, while she's in the hospital, I'd get her into a new home. That kind of behavior makes me wonder what you *don't* know about.

Medicaid is the appropriate agency and the OP refuses to complete the paperwork so the NH can be paid. Contempt charges are entirely appropriate. No one stays in a NH for over a year without Medicaid or private long term care insurance taking over. Clearly the patient does not have the later, and the OP is refusing to complete the paperwork for the former. No doctor, NH, or NH medical director can complete this process. It needs to be done by a family member or a court appointed guardian that holds the patient power of attorney.

There's doing it, and then there's doing it right. Threatening the police is not doing it right. Not getting a resident her glasses to read paperwork you're coercing her to sign is not doing it right. Those are elder abuse.

.... for the family to fulfill their obligations. Are YOU volunteering to pay the bill in the meantime, or just saying they should? How does a NH stay in business if they just let people ignore their basic obligations to fill out the basic required paperwork? The answer is, they don't stay in business. This is an extreme measure for them to take, and reading the article and the original post, I can understand why they took it. The OP has no intention of following the proper procedures so the nursing home can get paid for the care they have been providing. It might be elder abuse, but not on the part of the NH.

They had meetings, offered help with the paperwork, got a social worker to help, and when the patient ran out of money, they got an ambulance to take her to her daughter's house. They had tried to help out, and then they ran out of money for that bed and kicked her out.

Honestly, that seems more honest and fair to me. The patient and her POA had warnings, had offers of help, had a social worker, and they refused. In refusing, the NH had an opening to refuse care.

In this case, the NH is borderline in their behavior at best. Sure, they should get on Medicaid (like most NH residents) if they need it (though their insurance might cover this and is just being stupid about it). Not getting her glasses in order to coerce her to sign something she can't read? Come on, that's just wrong.

Sub-thread removed by moderator. Click here to review the message board rules.

so she couldn't sign. They've been TRYING to get the paperwork done for what looks like a year. My Mom was in a nursing home, things come up missing all the time because people cannot be restrained and they do wander in and out of rooms that are not theirs, and pick up things that are not theirs. It would be impossible for the staff to keep tabs on everything.

Having said that, the entire NH system sucks, there is no doubt, but as long as it's for profit it will be that way.

allowed to keep any social security or pension. You get to keep thirty dollars a month (what it used to be) and the state gets the rest. It sounds like the OP might know this and thinks that she can keep her ss and pension and still have her nursing home paid for, and it doesn't work that way.

I hadn't thought of that, but you might be right.

we are going to have to "FIGHT THE SYSTEM" which will take LOTS of our TIME...to deal with this...Just went through this and am STILL going through this with my Dad who died last year in nursing home. A fit and Healthy 98 year old who broke his hip the year before....

It's a NIGHTMARE dealing with the aftermath...with my brother... I imagine it's worse for others..with more siblings.

sounds like he was truly blessed to live such a long and healthy life up until his broken hip. 98 is amazing.

And who owns the facility?

Apparently someone that is too nice to boot a patient regardless of the fact that her family won't complete the proper paperwork to get nursing home coverage from Medicaid.

You have slandered the original poster and blame the family for all the problems. Typical of your average healthcare "administration". The facility is always right.

:puke:

But I am an expert in Medicare and Medicaid reimbursement regulations. :)

And it's unreasonable for a family to require respect?

It seems that neither was given by this nursing home, and for sure not by the nursing home flying monkeys on this board.

the insurance will cover room and board in a nursing home. She's been there a year and it sounds like with little payment and the NH is trying to get it paid for her. What hasn't the nursing home "given"??

maybe it was because they weren't being paid. The article linked to in the original post states that they have been trying to get the necessary documentation from the family to get financial assistance for this lady for "several months". How do you suppose they can afford to feed and house her and provide even the most basic care for her or any of their other patients if they don't get paid?

Edwards or Obama,. or Hillary sure do have their work cut out for them. We'll never get healthcare reform with attitudes like it's always the patient or family at fault while facilities and insurance are blameless.

What makes you so sure there aren't other problems with the so-called "care" this poor lady may or may not have gotten?

If the OP says there is private insurance available, I'm inclinded to believe her. The daughter says on the video that it started as a billing DISPUTE, not as a refusal to pay. No one would go through all this trouble just to refuse to pay if there weren't other problems, IMHO.

OK, nursing home monkeys... more fodder for you to attack here I am sure.... fly monkeys, fly, fly fly!

I'm going to bed.

But it doesn't sound as if that's the case.

From what the OP has said and the article she linked to, it sounds as if either her mother's coverage had run out or was no longer active madical treatment but only maintenance care and some physical therapy. If that's the case and her insurance benefits haven't been exhausted, they'll probably only pay for the therapy and whatever medications are being given. Insurance is there to pay for treatment, not to pay to feed and house people indefinitely. When that's the case, Medicaid or other state or county programs take over and from everything that the OP has said, that's what the nursing home has been trying to help to arrange for her. And if the paperwork is oppressive, it's be cause that's what whatever program they're trying to get her into requires.

It sounds as if this nursing home has been trying literally for months to help them while not being paid in the meantime. What are they supposed to do? Do you work for free? Does the company you work for give it's goods and/or services away for free? If not, why is it such a terrible thing for others to expect payment for what they do?

NH coverage is provided by MEDICAID, and the OP refuses to file for MEDICAID for her family member. Private insurance does not cover long term NH care - that is why the bill isn't being paid. You can believe that the unicorns fly, but guess what? They don't. In fact, they don't even exist in the real world.

Use your common sense. The average cost for a patient to be cared for in a NH for the rest of her life is $5000 per month. What insurance company is going to write a policy that covers that indefinitely? None. Nada, Zilch. When private insurance runs out Mediciad takes over.

If the OP will not file the paperwork for Medicaid the NH has no means of being paid. None. She is lucky she is getting any care at all thanks to her family. Again, why would the family resist filing the Medicaid paperwork? Because once they do, they no longer get to cash the SS check and keep if for themselves. That is the only concievable reason to not apply for Medicaid coverage for their family member.

By the way, the OP talks about therapy being ordered by the doctor.... this is so transparent. She wants Medicare to pay based on a false claim that the patient is in the NH for rehabilitation. Because then she can keep the SS check. A year in a NH for an 89 year old is NOT rehabilitation. It's where she lives. That's why the Medicare rules are explicit regarding the length of stay before Medicare stops paying and Medicaid takes over.

Legal recourse is a huge pain in the neck for NH, so I highly, highly doubt that the NH hasn't been over this stuff with her ad nauseum.

seems excessive, it's because that's what Medicaid is requiring. It has nothing to do with the nursing home. They're only trying to help her file it all.

A doctor, no doctor, a doctor that thinks all NH should provide care for free does not change the fact that long term NH care is covered by Medicaid and this poster refuses to complete the Medicaid paperwork.

providers that don't get paid, but continue to provide care anyway. So you give me a fucking break. You have NO IDEA what you are talking about. Absolutely none. Helping providers navigate the government regulations around Medicare and Mediciad is what I do for a living. I am not pulling this out of my ass like most of the ridiculous posts to this thread.

You read the article? The patient hasn't paid in a year, yet they continue to care for her. YOU are objectively and factually wrong based on this case, and my observations over 25 years in the field of reimbursment regulations.

It was backed by a furniture company and the family that owned it. She got very good care. Nonetheless, she was a custodial patient - Medicaid - or she would have had to pay $150 dollars a day for her room and board.

I think there are just times that caretakers refuse to accept the rules and regulations of how this stuff works. I learned more about it than I ever wanted to. I had to go to court and have my Mom declared incompetent to even get her IN nursing care, and myself appointed as her guardian. She was on her fourth hospitalization and the last one was 30 days. She couldn't live alone anymore and if I hadn't done it the hospital would have turned her over to the state as a state ward and they then would have placed her anywhere they wanted. She also only had medicare and she earned a very limited amount of money anyway - of which she was allowed to keep thirty dollars a month (as you know).

Long term insurance never pays for long, that is for sure.

I hope this helps. :hug:

I dont know what i can do for help except send vibes of love and peace to you and your mom during this time. :hug:

I am so sorry that you had to expereince that. taking care of a parent or family member with special needs is never easy, and it sounds youve gotten really fucked over. I am sorry.

The one lawyer friend i had is now in iraq - he got called up for duty, so hes not doing any legal work now... i hope you find a good, honest, caring family lawyer.

As i said, i will send you guys good vibes and include you guys in my prayers and daily offerings. :grouphug:

If you just need someone to listen or have a bitchfest, im here, cause i had to deal with a similar situation myself.

Peace!:loveya:

Greed. Pure unadulterated greed on the part of nursing homes, insurance companies, and the like.

http://www.medicareadvocacy.org/Commentary_SNFCEOsWindfall.htm

(SNIP)

Two weeks ago, Manor Care, the largest nursing home chain in the United States, announced that it had agreed to be purchased by the Carlyle Group. Early reports indicate that Manor Care’s CEO Paul Ormond will personally realize between $118 and $186 million when he exercises his stock options at the time of the sale.<1> The Center for Medicare Advocacy wondered how many nurses and nurse aides could be hired for a year at Manor Care’s nursing facilities with that money.

Referring to the Bureau of Labor Statistics’ wage estimates for nursing home workers, (the average nursing home nurse aide earned $22,070 and the average registered nurse, $53,690 in May 2006)<2> and to the 278 facilities operated by Manor Care as of December 1, 2006,<3> the Center did some calculations. Here are the results:

If CEO Paul Ormond got $118,000,000
If all the money went to CNAs - 5346 CNAs
Additional CNAs/Manor Care nursing facility - 19
If all the money went to RNs - 2198 RNs
Additional RNs/Manor Care nursing facility - 7.9
If CEO Paul Ormond got $186,000,000
If all the money went to CNAs - 8427 CNAs
Additional CNAs/Manor Care nursing facility - 30.3
If all the money went to RNs - 3464 RNs
Additional RNs/Manor Care nursing facility - 12.5

Documentation about staffing: The nurse staffing study submitted to Congress by the Centers for Medicare & Medicaid Services in 2001 documented that more than 91% of facilities fail to have sufficient staff to prevent avoidable harm and that 97% of facilities do not have sufficient staff to meet the comprehensive requirements of the Reform Law. CMS, Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes, Phase II Final Report, pages 1-6, 1-7 (Dec. 2001), http://www.cms.hhs.gov/CertificationandComplianc/12_NHs.asp (scroll down to Phase II report).

Solutions: In testimony before the Senate Aging Committee on May 2, 2007 on the 20th anniversary of the federal Nursing Home Reform Law, Professor Charlene Harrington of the University of California, San Francisco, discussed, as one of her key points, the issue of financial accountability for public funds. She described the ability of nursing facilities, under current law, to spend their Medicare reimbursement, once they get it, as they choose, not necessarily as Congress intended. Professor Harrington’s solution is prohibiting nursing facilities from shifting costs across cost centers. Her testimony is at http://aging.senate.gov/events/hr172ch.pdf, pages 9-11.

anywhere. Unfortunately nursing homes are for profit (at least most of them are) and as long as that is the case they can pay their executives whatever they wish. They are a business, period. It should not be so, but until it is changed, it is.

The problem here is that the OP refuses to file for Medicaid, which is how the nursing home gets paid. You may think that all NH should care for all patients for free, but that isn't how it works. All CEOs of corporations get paid too much money. Nothing unique to the nursing home business there. The CEO of McDonald's get's paid too much as well. Does that mean everyone should get burgers for free?

As far as Medicare's numbers? Most times they are full of shit. A consequence of too many republican administrations that place almost no priority on health care.

My 77 year old mother went into a NH a over year and a half ago for rehabilitation (really bad back injury). While she was there, she caught an infection that progressed to pneumonia she couldn't come back all the way from; shortly after, her husband died and after that she pretty much lost all will to work for recovery. Her insurance would only cover two months, so we had to file for Medicaid coverage, filling out all the paper work and giving up mom's (few) assets. None of us are able to care for her physical needs.

It sounds like you have a lot to deal with, and the paperwork is just the start.


:hug:

non profit, I think she got better care, plus she had me and my husband and we were there almost every single day. We used to come at weird times like early in the morning or late at night from time to time so they never knew when we might pop up. We knew all of her nurses by name, I sent flowers to the nursing station and bought lunches for the workers; that helps (they are overworked and underpaid). Plus mom didn't want for anything because we provided laundry and all of her clothes and shoes and glasses and took her out of NH for her doctor's appts and didn't rely on the NH doctors some of which are horrible; plus she came home a lot, every holiday for three or four days when she was well enough. We had expensive bedding and a frig and nice color TV and even painted and wallpapered her room, so it was very homey.

We knew she had to stop coming home the Christmas she almost took a header down the basement steps, she was manic depressive and was wont to wander at night. It got to where I couldn't sleep at all for fear something would happen. But she still came home all day.

I also was armed with all the numbers of where to call and didn't hesitate to raise major holy hell if it was needed; but I was fair and they knew it.

We were lucky, her NH held her bed over the seven day limit several times without charging us. In the end, I was waiting for a transplant and had a compromised immune system and couldn't visit because Mom had MRSA; but my hubby visited and changed her diapers and took her outside on walks. You know you have a keeper in a husband when he will change your Mom's dirty diapers because you can't.

She passed three years ago. Durng her NH time I met so many, many wonderful people who had no families or noone who cared. We provied food (feeding them) clothes, lots of stuff for those that had nothing.

The key to good NH care is VISIBILITY.

to protect people with disabilities from abuse and neglect.

For PA, it's the Disability Rights Network of PA:

Harrisburg Office
1414 N. Cameron St., Suite C
Harrisburg, PA 17103
drnpa-hbg@drnpa.org
1-800-692-7443
1-877-375-7139
(717) 236-8110
(717) 346-0293
(717) 236-0192 ...

Pittsburgh Office
429 4th Avenue, Suite 1901
Pittsburgh, PA 15219-1505
(412) 391-5225
(412) 467-8940
(412) 391-4496
drnpa-pgh@drnpa.org

Staff of a P&A agency have the legal right to go into a nursing home whenever they wish. The home staff can't stop them.