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Answers to your questions




Subject: Alzheimer's and Medicare Eligibility

My mother has Alzheimer's and was placed in a skilled nursing facility after she suffered a stroke. She qualified for Medicare payments due to her hospital stay, etc. In the nursing home she initially received speech therapy. While she continued to receive therapy she received Medicare payments. When the home determined that she was no longer advancing in her therapy due to her dementia, her Medicare eligibility status changed. She is paralyzed on one side, is unable to speak, incontinent, unable to perform her daily hygienic functions without assistance, unable to dress herself, and unable to make any decisions about her care. She pockets her food and her once perfect teeth are rotting away. At what point in time, if ever and under what conditions, might she become eligible for Medicare payments for a skilled nursing facility. I. F.

Dear I. F., Unfortunately, Alzheimer's disease does not automatically qualify an individual for Medicare coverage. The individual must require a qualified medical service under Medicare guidelines to receive Medicare payment. From the description you provided, it looks like the nursing home has determined your mother no longer meets Medicare guidelines. Please refer to my Medicare page for further information regarding Medicare. If your mother's condition should decline further, she may have new medical needs that require skilled care. If this were to happen, she would need to have a new three day hospital stay to receive Medicare coverage. If she goes 60 days without being in a skilled nursing bed or hospital bed, she would be able to start over with a new 100 day Medicare benefit period.

Subject: Medicare Benefits Termination By Nursing Home

Hi, Great site! I am looking for some additional information regarding Medicare. My father-in-law has just been placed in a nursing home after suffering from a stroke. He is also in N-stage renal failure and needs dialysis 3 times a week. Now that he has been in the Medicare section of the home, the social worker is telling us that he has to make a "major improvement" in the next week or so or " he will have to go to the private pay section of the home. The stroke and the subsequent hospital stay has made him weak. My question is "Is there an actual Medicare guideline that needs to be followed for progress in physical therapy." We know that only 100 days of hospital/nursing home is allowed and he has about 50 days left for this illness. I have checked all over and can't seem to find a definitive answer. Any suggestions/information would be greatly appreciated! Thanks Steve

Dear Steve, Medicare regulations do state that a patient must be showing progress and benefit from the therapy program. If he has reached his maximum potential based on his condition, therapy must end. Also if a patient misses or refuses to go to therapy sessions, therapy must end. I would trust the decision they have made, because they also want to keep him in therapy if possible. They would make way more from therapy then what they will make from the change in payment source to private pay. Medicare does allow you to challenge the centers decision. You can ask to file a demand bill and for him to stay in a Medicare certified room and continue to receive therapy. But A big warning if you do...... If Medicare agrees with the centers decision you will have to pay the center all charges for Medicare room, supplies, drugs, and therapy after the date the center first told you he was no longer eligible for Medicare coverage. Hope this helps, Gary


Subject: How many days does Medicaid pay to hold a bed?

Hi, my name is Laura. I have worked in nursing homes for the past 10 years. I have been Activity Director, Social Worker, Admission Director and presently bill Medicare from my home computer. Your information is excellent and very accurate. I have a question about Medicaid paying for a seven day bed hold during a hospital stay. Does that vary from state to state because I am almost sure they do not pay in North Carolina unless something has change since I have been working from the facility. Thanks for the information. Laura

Dear Laura. Medicaid bedhold days varies from state to state. In Tennessee Medicaid pays for 10 days per year during a patient's hospital stay. In some states Medicaid does not pay to hold a bed. I suggest you contact your state Ombudsman for your states policy. Their phone number can be found on my Ombudsman page. Gary


Subject: Do We Have To Purchase Medication From Center? Why Not A Store?


Dear Joseph. Your problem is very common. You are caught in a bind. Let me try to explain. Nursing homes, by law, are to allow the patient to obtain their medications from any source they choose. The problem is, the law requires the medications and patient's condition to be evaluated by a pharmacist on a regular basis (I can not remember the exact time frame). The nursing home can also require the medications be packaged in individual dosage units. You will not be able to get the pharmacist from the store you purchased the medication from to come to the nursing home and look at the chart and evaluate patient's condition. You will not be able to get the store to package medications in individual unit dosages. See the situation. Your stuck purchasing all medications (drugs, medicated creams, etc.) from the nursing home. Basically nursing homes operate the same way hospitals do when it comes to medications. The main reason they cost more is due to the overhead expenses. In the nursing home you have a small number of "consumers" purchasing from one nursing home controlled pharmacy. The nursing home must pay pharmacist salary, space costs, packaging of individual units, distribution system, outdated medications that are destroyed, etc. I hope this explanation has made sense and been helpful in understanding your current situation. If I can be of further assistance, please let me know. Gary.


Subject: What about the use and dispensing of liquor in nursing homes?

My wife just started working in a nursing home recently and is concerned about several things. This one seem to bother her the most. In the med room there is Hard liquor and beer in the fridge kept with meds. She was told it was for patients and she would have to serve it. What kind of liability or danger to her license does this pose. She told me she is going to refuse to serve liquor to patients and that she has the right to do so. Please respond as soon as possible. Thank You, Mike

Mike, Most facilities treat liquor of all types as a drug. They require doctor's orders for dispersing to protect patient from drug / liquor complications and also to protect the nurses. Example of order: One can of beer, of patient's choice, BID. This order is to be terminated and will be considered for renewal by MD anytime patient has a change in medications. Hope this helped. Gary


Subject: How can families show their appreciation to staff member?

GREAT site; this is my first happening upon it so will accept the invitation to ask a question; please feel free to post it and your answer for others to see. Here's my question: My mother's been in a nursing home for close to a year. My father and I have been exceedingly pleased with consistently respectful and kind care she's received by the entire staff, from nursing to kitchen to cleaning staffs, etc. We'd like to demonstrate our appreciation for the fine care she's received (which has certainly lessened our stresses and strains) but have no idea what kind of gift could be enjoyed by the entire staff. We thought of flowers or a gift certificate large enough to buy pizza for three shifts but also thought that we can't be the first family that has ever wanted to express its gratitude in a tangible way. We would prefer not to make a charitable contribution in the name of the facility. Thanks. Barb

Dear Barb, As I'm sure you know, staff members are not allowed to accept gifts from patients or family members on an individual basis. I would suggest putting a candy dish at each nurses station with your family name on it and each time a family member visits you could fill it up. I know the staff will enjoy that. Pizza party is a good idea too, but candy dish is something that is ongoing. Gary


Subject: What are family rights to information about a loved one in a nursing home ?

What are family rights to information about a loved one in a nursing home? This concerns a daughter requesting information about a mother with Alzheimer's Disease. The information that is being requested concerns what the primary care Drs. comments or observations are when he sees the patient. What are the Daughters rights to talk to Dr. when new problems and concerns arise and the nursing home does not report new problems to Drs?. Bill

Dear Bill. Confidentiality laws set by the Federal and State Government protect access to patient records/information. The only way you can legally access the records is be to appointed as Power of Attorney or go thru the courts and be appointed conservator. Depending on how advanced the Alzheimer's Disease is, you could also get the patient's permission verbally in front of medical staff to access all records. If this is done, make sure it is documented in medical chart as verbal approval for access to records at any time. If patient has the ability to understand at all, I would get patient to sign a P.O.A. If patient is totally confused, you might want to obtain conservatorship. This can cost several hundreds of dollars. As far as the doctor, you can call the doctor anytime to report your concerns. Don't be surprised if you don't actually talk to him, most of the time you end up talking to the doctor's nurse. This is normal. Depending on the doctor, they may or may not release information to you. They are also suppose to protect patient information, but many times will tell you what you want to know. Hope this has helped, Gary


Subject: What Can You Do If A Nursing Home Does Not Want To Admit Someone?

Where do you go if a nursing facility chooses not to accept someone, and the facility that he is currently at, which is a rehabilitation center, is discharging this individual as well. Where can you turn? Monica

Dear Monica, Nursing facilities are like any business, they can choose who if anyone they want to admit. There are times patients are forced to obtain nursing home placement many miles from where they live, because no facility closer wants to admit them. I always encourage families to apply at several facilities for this reason. Gary

Subject: Why Is The Nursing Home Asking So Many Financial Questions And Not Admitting Based On Answers?

I'm looking for a nice place to send my Grandmother. We have recently buried my Grandfather her husband for 57 years. She has been hospitalized for about a month and every day he would come and see her. His sudden death left the family with a lot of financial questions. But, right now the hospital is giving us three days until my grandmother will be sent home. Here's the catch, she is in failing health and needs constant oxygen. The nursing homes we have talked to say we have to give them a complete inventory of everything my grandfather worked his entire life to have. Why? Are they going to confiscate this stuff? Medicaid said at first that they would pay for her, then two days ago they called back and basically said "your family has the money, you can pay for it." My grandfather left a small sum of money after we paid for his funeral and bought the arrangements for my grandmothers burial, there isn't much left. So, I ask you, why is Medicaid trying to take what little else my grandmother has? Please reply immediately. Thank You, Stephanie

Dear Stephanie. I would ask that your Grandmother be admitted to a nursing home under Medicare.  You can DEMAND a nursing home bill your grandmother's charges to Medicare. It is called a demand bill. Be warned that if Medicare determines that your grandmothers condition does not meet Medicare guidelines your grandmother will owe charges since admission.  Under Medicaid, an accounting of all of your grandparents assets is required to determine eligibility. That is what the nursing homes are asking. They are trying to determine if your grandmother has funds to pay privately or will need Medicaid. Nursing homes will not admit a patient without a clear payment source. Hope this has helped, Gary.


Subject: Use Of Medicated Powder On The Elderly.

I am a registered nurse working in a long term care facility. I have a question. Somewhere in my education I remember hearing that we should not use powder on the elderly or on babies. The reason being, it can cause URI's, bronchitis, etc. My facility uses powder constantly, whenever a resident is bathed and changed. I feel it is bad for them, as I can feel it in my lungs after working a shift. Could you possibly give me any insight on this subject? I would really like to get this changed, and start using the promise wipes on all residents. These contain lanolin. They are soft, require no drying time and could eliminate the need for powder. I realize they are expensive, but really how much more when you look at the big picture. Thank you very much for your time. R. B.

Dear R. B., Many facilities do not use powder at her facility, but for other reasons than mentioned in the question. The reason they do not use it is because it can cause a skin irritation problem, especially to some residents who may be allergic to the powder. I would recommend that you check for skin irritation that might be caused from the powder and then discuss the situation with the Director Of Nursing at your facility. The use of powder you are seeing is much higher than that of the typical nursing home.  It is always important to determine which product works the best for each individual patient.  Hope this helps, Gary


Subject: Finding a nursing homes complaint history

How do you find out the complaint/licensure/problem history of a facility. M.T. Lanoka Harbor, NJ

Dear M. T., All nursing homes are required to post their most recent state survey in the facility. Ask an employee where it is located if you can not find it. It is to be in a location that the public has access to. You can also go to the government's Nursing Home Ratings website.  Check out my Ombudsman page for addresses and phone numbers for Ombudsman in every state for this and other information.

Subject: What can be done if a patient is not receiving proper care?

I am writing in regards in finding some answers to some questions. I have a loved one in this nursing home, while I was visiting one evening, her roommate put on her call light, she waited for 35 minutes before anyone answered it. 8 people walked by the room, including two nurses, none of them even stopped to see what they needed. The same night, another patient put on her call light at approximately 2:00am, she waited 1/2 hour for someone to take her to the bathroom, an aide walked by, the patient called out her name, with no answer, finally at 2:30 they answered her light. The patient had told me she should of just wet the bed. She is 87 years old of sound mind and body, granted she can't walk so she does need help to the bathroom. I understand she isn't the only person in the home, but I do feel that with more staffing these needs of the all the patients could be better attended. Where do we go from here???? They cover state minimum hours, which include the nurses, nurses provide care, they pass out meds, they help when they want, some better then others. The aides are the heart of a nursing home, without them, there would be nothing. In counting hours, if the nurses hours weren't counted there would be 4-6 more aides on days, 2 on afternoons, and 2 more on midnights. This would benefit the patients needs much better. In ending this letter I thank you in advance for any input you may be able to give me. Sincerely Michelle

Dear Michelle, What you are reporting is a frequent problem in many nursing homes. Let me first say I agree with all the points you make. But the facts make it very difficult to change. Let me explain. Homes are, as I'm sure you are aware, required not only to have a certain number of CNA's, but also LPN/RN hours. So it is not simply a matter of replacing nurses with CNA's. CNA's are also some of the lowest paid workers in America and have one of the highest turnover rates of any job. Most homes have 100% to 200% turnover each year. And to make matters worse, it is very difficult to hire CNA's due to wages and job requirements. It takes a special person to do some of the things they have to do for the patients. Why would anyone want to be a CNA then? They truly love the elderly, they are desperate for work, they do not have enough education or skills for any other job, no other job available, etc.. So the homes first problem is the type of individuals they hire on the most part. I realize there are exceptions. The second problem is lack of income. Most homes admit Medicaid patients and I have yet to hear of a state that pays enough to offset the costs of the patient's needs. Some states expect the home to provide all needed services, drugs, supplies, for as little as $100 to $120 per day. You can't even get a good hotel for that price and let alone have all meals provided, laundry done, drugs purchased, maid service, activity program, etc. With that low of daily reimbursement it is no wonder CNA's and other nursing home employees are under paid for what they do. I am also aware that many nursing homes are for profit. Some people take objection to for profit nursing home companies, but I don't and I'll explain why. Overall the cost of staying in a for profit home owned or managed by a company does not cost any more than that a non-profit home. The reason why is because they can buy in bulk to negotiate lower prices on almost every item used in the home. That is where they make most of their profit. Also the larger companies are usually the leaders in innovative treatment, services, and quality assurance for patients. I often hear the statement that no one should make a profit on caring for the elderly. But we live in a country where anyone has the right to start a business. No one complains about other businesses making money on the elderly. Adaptive equipment suppliers, drug companies, security companies, hospitals, insurance companies, etc.. The fact is if it were not for the for profit nursing home companies most of the nursing homes now open would not exist. It takes someone with money to open a home and most who do expect to make money because they are taking a financial risk in doing so. I did not mean this to come across PRO nursing homes. I just felt I needed to present the nursing homes point of view and the situation they face in funding and staffing. I do believe many nursing homes could improve their operation and provide better care with the staff they have. Better supervision, training, quality assurance programs, family involvement, etc. would help. I suggest the following plan of action to be followed until corrective action is taken. Keep a written journal of all contacts and action you have taken: 1. Talk with the Administrator and D.O.N. together. Allow them an opportunity to correct problems. After all, they will be the ones to have to fix the problem regardless who else you talk to. 2. Ask when the next family council meeting is and ask to be on the agenda. Present your findings to other families and together take the next steps if needed. 3. Talk with the owner or President of the nursing home. Even if it is a large corporation, talk to the president, demand it, he works for your loved one. 4. Call your state representative. Get their involvement. 5. Talk with state Ombudsman. Their number is found here on my web site. 6. Contact state survey agency. The Ombudsman or any other nursing home can give you the phone number. 7. Don't give up. Keep contacting the above. I hope this has helped. Your Friend, Gary


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