As an Elder Law Attorney, I experience first hand the same pain, anguish, struggle and frustration a family goes through while taking care of their loved one. Our health care system is so broken and complicated that it has simply forgotten the notion it was created on. Every one is treated as one fit size all regardless of individual necessities and requirements.
This week I received an email from one of my loyal radio show listener, who herself is a psychiatric nurse practitioner for last 30 years & taking care of her elderly mother. Her mother is right now at a rehab facility and she has Group Health Insurance. Rehab facility and Group Health managed care wants to discharge her mother even though she cannot transfer by herself and may even have torn her shoulder rotator cuff in the fall which had not even been addressed yet.
Daughter thinks Group Health is not meeting their fiduciary duty & wants to discharge her mom, even when it is not safe for her mom to be discharged…..Daughter is struggling & fighting with the system, simply to maintain the quality, safety and dignity of her mom's life.
Under the law, Group Health can only discharge mom if it is safe for her to be discharged. I suggested the daughter to hire the services of a care mangers (social workers) to interface with the medical community and try and work with them in developing the discharge plan. If they are given a hard time then I will write a letter as an attorney requesting their cooperation and informing them that their planned discharge will place mom in physical jeopardy for which they may have liability. If they still insist in discharging then they have to give a written notice to mom and mom will have the right to request review. While the review is pending, Group Health must pay for the care of mom. However, if the review is unfavorable to mom then mom would have to pay for the days out of her own pocket.
I also suggested daughter to have a backup plan that is to work on Medicaid and or VA benefits while trying to push the Medicare days. The ideal way to deal with this situation will be to have care managers meet the Group Health folks and get an idea of what needs to be done to ensure the safety & quality of life for mom before discharging her and simultaneously review mom's estate for VA and Medicaid benefits……