Any background on medicare and medicaide so I can help mom?

Discussion in 'The Watercooler' started by exhausted, Mar 17, 2012.

  1. exhausted

    exhausted Active Member

    My mom had a stroke 15 years ago-partial paralysis on whole right side. She has been on SSI since. She is going down hill. Could barely walk with cane (refuses walker), and now her right knee is completely blown. When she falls as she did Thursday, she requires the fire department to get her up as she is big and my brother can't do it alone. Luckily she has a Lifeline button. She has only 12 hours of in home nursing.

    She is not able to get out of bed at all-can't walk. Is black an blue all over from 5 falls this week-2 emergency room visits. The little home nurse loves her so is going over 4x a day to change diapers and feed (even though this far out does her hours). My brother called in distress because he is male and doesn't know what to do. He is a private contractor and business is tough now-but he has some jobs and he needs the money of course. I know my mom is just beside herself as she is such a proud women and diapers...

    Why in the heck did they not admit her? She is 72-has no working legs and can't get out of bed into a chair or onto a toilet? Isn't this neglect? I read that admitts with medicare a big deal and emergency room docs. struggle with this but???

    I will call care center to send in a re-evaluation but they told my bro it could take weeks to come through to get her more hours. She sees the orthepedic surgeon next week but she may not even be a candidate for surgery to replace her knee.( Can he do anything to expedite stuff?) Isn't it medical neglect to send her home with only 12 hours nursing? How can they expect my brother to stop everything and care for her? ( I know this comes off selfish but we all have to eat) We are all going to rally to try to pay the home nurse for extra hours this week but none of us can do it for much longer.

    any ideas?
  2. keista

    keista New Member

    Here is the sad scary reality. As long as you brother manages to help her, and continues managing, they will not admit her or get her more nurse hours. Does your brother live with her? Whose house is it? No one will "place" her in a nursing home unless it's absolutely critical - if, say your brother had an accident of his own and was laid up for a few weeks, or took a job out of town and there was NO ONE to take care of your mom. What you should be doing is finding a nursing home placement for her and get her on the waiting list sooner rather than later.

    I am so not proud of this, but my mother in law got on the fast track waiting list for assisted living because each time she called an ambulance to our house they couldn't get the gurney to her. The house has a strange layout, but I also am a hoarder and have lots of clutter everywhere (no, nothing like on the TV shows) So, she finally complained and the got her out of my house sooner rather than later.

    There is no "medical neglect" when the hospital treats her and sends her home. It's not their responsibility to make sure she is being cared for at home. One resource you can look to for more resources and/or assistance is adult protective services (a branch of children's protective services)

    Good luck to all of you. Elderly issues can be just as difficult, complicated and exasperating as difficult child issues.
  3. susiestar

    susiestar Roll With It

    I am so very sorry. I know it hurts you to know that this is the situation that your mother and brother are in. Kiesta is right that as long as your bro takes her home, as long as he is living with her, there isn't much that will be offered to help.

    MANY states have elder care/elder abuse programs. If you google elder abuse you will find warning signs, resources in your state, etc... Sadly, if your mom is laying or sitting around in dirty diapers for very long then it is possible for your brother to be charged with elder abuse. MOST areas are understanding of the problems and would NOT charge a relative as long as the situation changes for the better. I would NOT worry about your brother being charged, not at all. Instead I would have bro start with medicaid/medicare and keep telling them that he just can't care for her, needs help, etc....

    This is HARD for families. It will be super hard on your brother to go and tell people that he can't care for your mom and can't have her living at home unless she can get full time caregivers. It will be super hard for your mom to hear and to accept also. None of us want to be in that position but that is the reality for many many people. Your mother or brother also needs to contact social security to see if they can do anything to help. I don't know if there is anything they can do, but it doesn't hurt to ask.

    What does the doctor recommend? Do they have any ideas to expedite things? It sounds like your mother needs a nursing home and there are some really good ones. As you go into the search for a nursing home it is important to know the warning signs of elder abuse/neglect and to know what to ask. Googling elder abuse will give you info on this and will help you make sure that you all know what is/isn't acceptable.

    I wish I could add more to help. It may be that your bro needs to tell the hospital that he can't care for mom and can't take her home because he can't care for her. This will be so hard, but it is probably better than taking her home and having her continue to get injured and continue to have things stay the way they are. I am so terribly sorry, this is such an impossible situation for anyone to be in. Please be sure that your brother has some outlets and support as he goes through all of this. He can't do it alone and probably feels tremendous guilt and pain over everything.
  4. DammitJanet

    DammitJanet Well-Known Member


    She really probably doesnt need nursing home care but like rest home care but I dont care if she cannot walk and is falling she cannot be discharged from a hospital and MUST be at least sent to a rehab hospital. If from there they feel she cannot go back to her home safely then she is sent to a nursing home that offers several levels of nursing care from intermediate to full nursing care.

    When I had my meningitis and lost all use of my arms and my legs you can bet your bottom dollar I didnt want to go to rehab. I wanted to go HOME. They refused to let me. If I hadnt been able to learn to use my legs and hands well enough feed myself, dress myself, toilet, make a simple meal, walk up and down 4 steps and get in and out of a car...there is no way in this world I would be at home today. Either I would still be in that rehab or I would have gone to a nursing home.

    They do have some services called CAP which is to keep people in their homes instead of going into nursing homes but they provide basically live in services that cover 12 to 18 days if the person has a person who is actually there at night with the patient.

    This is all covered by medicare and medicaid. In order to get my mom in her nursing home I had to take her to the ER and tell them that I simply couldnt care for her by myself anymore. If your mother is falling this much and to this degree, neither can you. Just take her in, say you cant do it anymore. Check out the local nursing homes that you would like her placed at and talk to the social worker at the hospital and ask that she be placed at one of your top three.
  5. Marcie Mac

    Marcie Mac Just Plain Ole Tired

    This is something we now deal with since SO's mom moved in with us last July - she is 79 - both knees are pretty well shot - no operations available due to her age and heart problems. The doctor has been our biggest lifesaver when it comes to as many services she can qualify for. Right now she just got out of the hospital, and is in rehab again-not for long as she only has about 21 days left as coverage-she has to wait a full 60 days without any hospitalization for coverage to kick in again. Any time she goes to ER, doctor admits her and its automatically rehab afterwards. We have nurses come in few times a week to check her and give her a shower.

    I don't know what we will do when the time comes that she is no longer able to walk. Right now she can take a few steps, and that is enough to get her on the toilet or into her wheelchair. If she falls, there is no way either SO or I could pick her up - she is well over 200 pounds. Last time she was in rehab, the doctor was able to get braces for her knees which is a big help. Everytime she is released from rehab, the social worker calls with a suggestion that we place her in a retirement home and gives us a list, but she has absolutely no money, and we would be hard pressed to afford to do 150 to 200.00 a day for her to go live there.

    I feel for your bro - I take care of mom as I work from home, but we didn't realize how difficult it was going to be. Our life pretty much went from whenever the mood strikes us to go out and eat, shop, movie, whatever to one highly structured. She has diabetes 2, has lost pretty much control of her bladder, is deaf in one ear and the other one is almost gone. We managed to get her a hospital bed and are awaiting another one that tilts so she will not develop bedsores since she doesn't move a muscle once she is in bed.

    I would talk to her doctor and see what he can come up with as far as more services. If we need more nursing hours, we just call him and he arranges it, it doesn't take weeks to get that done. Plus I can qualify for money from the state as I am her caretaker-supposedly they prefer to do that since it costs them less money for a nursing home, but I haven't taken advantage of that.

    Good luck. I am telling you that I am pretty freaked out about my pending old age after going thru this with my mom and SO's mom. I have already told my boys that if I ever get really bad where I have lost my quality of life, I am just going to be checking out LOL

  6. sjexpress

    sjexpress Guest

    The next time Mom falls or has medical issues your brother can not handle, call an ambulance and have her taken to the ER. Once there, you need to explain to the ER docs what is going on, medication. history, etc...and she can no longer be cared for at home because the only caretaker in the house must now work long hours and can't me there ( LIE if you must but it is for a good cause!) . You must then ask to speak to a social worker...they are the ones who get the ball rolling from the hospital. Tell them it is not safe for your Mom to come home again and you will not leave the hospital without the help of the social worker. She basically needs nursing home care at this point since she can not walk or take care of herself in any real capacity. Assisted living facilities are for those people who can do somethings by themselves. If she has not been walking for years already, a rehab. facility would not do much to change this now, only if it was a new problem, maybe. I work in health care and believe me, your Mom needs to be evaluated my a team of doctors, physical therapists, occupational therapists, etc... to find out the best place for her to be safe and well cared for. Medicare if you have it will cover it ( depending on Mom's age) if not, medicaid will. You may only have a limited choice of facilities if you are not private pay or personal insurance does not cover long term care, but again, at least you know your Mom will be cared for by professionals and you and your brother will have relief of stress and worries. Good luck!! I hope things change soon for you.

  7. exhausted

    exhausted Active Member

    Thank you everyone-she did go to the ER and this doctor. actually released her even though my brother had to call a transport service to get her into a chair and home into bed. He has his friend who is a nirses aide there this week along with the 12 hours of nursing she already gets. I am getting on the phone today to her doctor. She will be stinking mad but oh well. My little brother and she cannot continue this way it is dangerous. She is not sitting in dirty diapers because my brother and I would never allow it-but my brother needs to work and we have to get this settled.

    I heard some stuff from you all that will be helpful-I hate being so far away from there but it is what it is.