My wife is coming home tommorrow after six weeks in critical & intensive care. Vanderbilt says no home care can be provided and the only other option is an assisted living facility. She has had four surgeries on her inner ear & brain to remove an infection and can not walk. She has a PICC tube and a PEG feeding tube. I will be giving her medications thru the PICC tube & PEG feeding tube. Also I must start physical therapy. What options are available thru Medicare? She also will be going back to the hospital in a few weeks to replace the skull area in two places that was removed.

Not much help, but my mom went through something similar two years ago. My folks can easily afford a nurse coming over once or twice a week to administer the antibiotics in her PICC line, change the dressing, etc. But the hospital said Medicare would deny all claims related to the procedure if she went home, even if she paid for the nurse out of pocket. She was looking at well north of $200k of bills if Medicare didn't cover things. So she stayed in the hospital for what would have cost her $180ish per week. Imagine what Medicare paid for that hospital stay. After five knew replacements due to a very resistant staph infection, she was miraculously cured and released when her Medicare hospital days ran out.

The hospital should have an office there that can give you the options available in your area.
This is hard for us to know and give accurate answers without knowing all aspects of the situation.
When I’ve had relatives leaving they usually came to the room to talk to us in that situation a day or two before discharge.

The problem seems to be Medicare. Medicare will pay for assisted living for a specified number of days. Then you are on your own. Private duty nursing on your dime is likely the only option for you. There are many things not covered by Medicare. Vanderbilt should have a list of qualified private duty nurses.
BTW Medicare will pay for PT that it deems medically necessary. PT is not cheap.

The social worker at the hospital should be able to help you arrange things. They can often move mountains.

The refusal to pay for rehabilitation or home care after discharge can be a drawback when one chooses a Medicaid Advantage plan. I would find out from the hospital social worker exactly why your wife is not eligible for these services. The SW might be able to appeal etc.

You'd think Medicaid would jump at the chance to pay for the comparatively inexpensive Home Health Care option rather than Assisted Living.

Ask about an LTAC. Long term assisted care. They can rehab her there.

quote:

Originally posted by whanson_wi:
You'd think Medicaid would jump at the chance to pay for the comparatively inexpensive Home Health Care option rather than Assisted Living.

I don’t know if it’s regular Medicare A&B or Medicare Advantage, which is a private plan with different benefits. Also a supplement like a part G plan might help but you can’t change in a situation like this if that’s the issue.

Just went through a similar situation with my dad. The hospital had a case management person to help explore the options. It can get pretty complicated based on the specific things the patient can and can't do for themselves

quote:

Originally posted by MelissaDallas:
The social worker at the hospital should be able to help you arrange things. They can often move mountains.

^^^This, Social Workers are in virtually all Hospitals and this is one of their duties, proper patient discharge^^^

quote:

Originally posted by 220-9er:
I don’t know if it’s regular Medicare A&B or Medicare Advantage, which is a private plan with different benefits. Also a supplement like a part G plan might help but you can’t change in a situation like this if that’s the issue.

Not an expert, but I do have a Plan G. Once Medicare decides what they will pay, then Medicare pays 80% of the amount Medicare approves. Plan G then pays the remaining 20% of what Medicare approved.

If no Medicare payment, then no Plan G payment.

My wife has regular Medicare A&B with a Plan G Supplement. The head of Neurosurgery & also head of the Neuro inpatient at Vanderbilt called me yesterday evening. He had just found out about the discharge and was against it. He said that the case manager had not consulted with him and he was going to take care of insuring my wife was not discharged until a proper skilled facility was found.

quote:

Originally posted by Anush:
My wife has regular Medicare A&B with a Plan G Supplement. The head of Neurosurgery... said that the case manager had not consulted with him and he was going to take care of insuring my wife was not discharged until a proper skilled facility was found.

Going through this with my mom as we speak, but having a much easier time of it than you seem to be. I'm not a doctor, but from experience I would definitely expect her next stop in the process to be a Skilled Nursing Facility (SNF). Medicare and your Part G insurance should pick this up at no cost to you. Her stay in a SNF will be a maximum of 100 days and should include various forms of Physical, Occupational and Speech therapy six days/week.

Her length of stay at the SNF will be based on how well she is progressing in PT. When she begins to plateau they "should" notify you with 2 weeks notice that she will be disenrolled from the SNF. But often the time frame is much less so be prepared to look for her next stop (your home, Assisted Living, or Nursing Facility) with little notice.

Based on her situation, after the SNF visit she might be eligible for "Home Health" which is another round of PT three days/week and other available health services such as a weekly visit from a nurse. This is the step that we are at with my mom. With a broken hip AND broken shoulder my mom is going to use up all of her 100 days in the SNF and immediately go into the Home Health program for some length of time. Medicare is also going to pay for some durable medical equipment (DME) such as a new hospital bed and wheelchair. The social worker at the SNF is coordinating all of this for us and is happily doing so without me having to ask or coerce her.

The only issue I foresee is how your wife's return to the hospital in a few weeks for another surgery will be handled by Medicare. Medicare has a 100 day limit to the SNF visit per "event", so you need to ensure she can return to the SNF after the surgery and hospital stay to complete her rehab as part of the original event. Keep in mind the Medicare 100 day SNF limit which I mentioned above. After that, if she needs another SNF visit, 60 days must pass before Medicare will pay for another SNF visit under a new event.

Any hospital care coordinator or social worker should know all this and be able to brief you further and help coordinate it. After six weeks in critical and intensive care it's bullshit they were trying to send her directly home before going to a SNF.

If you'd like to discuss the journey ahead of you further feel free to contact me - my email is in my profile. Take care and good luck!

quote:

Originally posted by Anush:
My wife has regular Medicare A&B with a Plan G Supplement. The head of Neurosurgery & also head of the Neuro inpatient at Vanderbilt called me yesterday evening. He had just found out about the discharge and was against it. He said that the case manager had not consulted with him and he was going to take care of insuring my wife was not discharged until a proper skilled facility was found.

Medicare may cover up to 100 days of custodial skilled nursing care or rehab if the patient is discharged from the hospital straight to the nursing home/rehab center.

I had a month and a half stay in a live-in rehab center, post-surgery. It was completely covered, down to the last penny, by Medicare and Medicare Supplement. I had (still have) Plan J, no longer available for new Medicare customers, but grandfathered so I can keep it.