In elder caring, things move quickly. More quickly than you would expect.
Client is in the nursing home, and the nursing home is saying he is “plateauing:” they need to stop therapy and make the family private pay. Medicare will no longer pay.
Forget for the moment that “plateauing” is not the standard. The notice says “Call your QIO at: {insert QIO name and toll-free number of QIO} to appeal….” No name or number of the QIO! (QIO is Quality Improvement Organization.) The notice is given after the termination, not two days before as required.
So we appeal. Indiana’s QIO acts quickly and upholds our appeal within 24 hours. The nursing home issues another notice: this time they insert the QIO’s name and number, but still try to backdate the notice. We appeal again. The QIO acts quickly again.
They uphold our appeal again. (Turns out the nursing home had no records to show the condition of our client!)
So I call my client’s spouse to give the good news and it turns out that the client is now becoming belligerent around the nursing home staff and they want to send the client to a psychiatric hospital. This sounds too convenient to me, but after investigation, it seems true. So off to the hospital. All in the space of Friday to Monday.
The point is that things change quickly and we need to respond as quickly. The point is also there are many good people out there who can help make things right. The point is also that sometimes paperwork does not prove what the providers say it will prove, so it is good to follow your instincts when something does not seem right. The point is also that the person in a nursing home needs an advocate and most often that advocate is their spouse or their child: you. And you can call in help.
:- Doug.
