patrick.net

Your mother should be able to go to a snf and pay the daily private rate - whatever that is - and supplies only. If she has a wound vac, that could be expensive (and perhaps not necessary), and all this might be confusing for your mother since she has been in/out of facilities and moved around in the recent past. Are there smaller group homes (2-3 residents) that can provide a higher level of care and be supplemented by a home health nurse under Medicare hhc benefit?

Marianne, it seems to me that you need some help - actual consultation with someone to develop a plan of care for your mother. Have you heard of private case managers who can help you figure this out? There's a fairly new field called Geriatric Care Management, where you hire someone to guide you in making decisions for your mother.

Here are a couple in your area I pulled off the interwebs:

http://www.seniorcaremanagement.com/
This one employs Social Workers, which is my personal bias. I believe that SW's are more well-rounded than RN's when it comes to these issues. Once again - my personal bias. I'm sure these other agencies can help just as well:

http://www.innovativehc.com/about.html
http://www.jfssd.org/site/PageServer

All are based in San Diego. You'll want to call them asap. The hospital will rush you because your mother doesn't have an acute need and she's racking up thousands of dollars per day in billed charges for which they'll never get paid.

I should have mentioned GCM's sooner - didn't think about it. Let me know how it goes - and tell 'em about my book. :)

Thank you Ellie Mae!

My Mom just had to switch insurance plans this year due to her former employer switching from Calpers to save money on costs. She had a choice between Kaiser Senior Advantage or Anthem Blue Cross Senior Secure HMO. I chose the latter for her.

It is a very large group plan, which medicare is secondary. I believe it is a managed plan.

All very confusing, but overall a very good plan. She is in UCSD hospital now, however I changed her group to Sharp due to personal reasons (Dr's stopped her Aricept without my consent; she moved from ER to one floor to a different floor and I did give them the med list, but somehow they decided to stop it or got mixed up.)

Anyways, tomorrow is my day off, I will call up a few of these Geriatric Managers.

Her Residential Care Home really is not set up for wound care, and has become mediocre over this past year, high caregiver turnover...

I have contacted a service to look to see what is out there for my Mom to move from that place.

Thanks again!

marianne says

It is a very large group plan, which medicare is secondary. I believe it is a managed plan.

If your mother has a Part C Advantage Plan, their rules are different. She must go to a contracted provider SNF in order to receive any covered services. Their pharmacy rules might be different too - most nursing homes order meds from a commercial pharmacy and it's only after you get slammed with a huge bill that you find out they're not contracted providers for your insurance plan. I'd have to know a bit more - but if she's managed care the rules change a bit. I'm sure the Care Manager you choose can help you understand all this - and she might be able to help you locate a new place for your mom.

It's crazy - all the ins & outs of the insurance and nursing home biz. Even tho it's my job security, it's so complicated that even professionals don't completely understand it. I wish you luck.

Is part C Advantage Medicare? She has A and B only.

I think her Anthem is a managed care plan.

Her coverage for ambulance is 0 copay.

Her coverage for Er/Hospital is $50.00 admit/$50.00 discharge.

So, essentially, she could stay there a few more days while I figure things out, she has a wound so they cannot just discharge her.
They are turning her for wound care too,anf giving her antibiotics for the UTI for follow up treatment.

I am her Health POA, but I did not sign for her either.

Thanks to you, Ellie Mae!

marianne says

Is part C Advantage Medicare? She has A and B only.
I think her Anthem is a managed care plan.
Her coverage for ambulance is 0 copay.
Her coverage for Er/Hospital is $50.00 admit/$50.00 discharge.

She has A&B - but her medical benefits have been assigned to a Med C advantage plan. She pays a monthly premium (or doesn't depending upon the plan she's on) and her part D drug plan is bundled in there. The part A/B copays for ER is higher than the amount you listed, which verifies she's managed care and her choices are severely limited. You've got an insurance case manager who will be forcing you to move her, or the wrath of the plan shall fall upon you.

Time is of the essence. They'll move her with, or without your permission.

Yes, they actually can just discharge her to a lower level of care, part of the managed care agreement she signed onto. Her needs aren't acute, they're sub-acute and can be managed in a snf or at home with home health assistance. Even the antibiotics (abx) can be administered in a snf or acute rehab if it's IV abx.

Good luck.