I have a question for the group. I am on a SCU in a hospital, we have a resident, 49 years old who has been here for 29 days today. Here for rehab. History is chronic back pain from mva in past, pain drug addiction, severe neuropathy, dm, severely obese >450 lbs. Prior level of function was bedbound (really sofa bound) being cared for by wife who also was in the mva, and pain drug addiction. She was in drug rehab and now out. He has been participating in rehab, is now independent, to supervision with adl's. Ambulates with walker > 200 feet. Uses toilet, but unable to cleans self due to old shoulder injury.He has lost weight since here and in our minds much better than prior level of function. Both resident and spouse are now homeless due to being evicted. Resident has POA and guardian due to his past impaired ability (drug addiction).He continue to need pain meds but much less than prior to hospitization. Together resident and wife get disability but medication expenses are high. They are saying they have no where to go, yet are not looking, They know how to work the system if you know what I mean. Talking of separating so he can get Medicaid, etc. We have told him, wife, POA and guardian that we are planning on discharge on DEC. 3. We picked this date as both him and his wife get their checks on DEC. 1. (they had stated they had no money to go anywhere.) Now they are still complaining that she cannot take care of him.Wife is staying at her mothers. He is not welcome there. We have given lists of low income housing, homeless shelters, agencies to assist them. But they are making no efforts. They say they make to much money for low income housing, but due to their m edication expense they can't afford regular housing.
I have never had to issue a denial letter before and want to make sure we do it right. Can anyone coach me through this? Are we right in our determination that he no longer needs our services? And that Medicare should pay for him to live here. If he refuses to leave what do we do, do I continue to do MDS's and submit and get refused payment? What complicates this situation is we are a non-profit religious hospital and meet lots of resistance. That is how we ended up with him in the first place, he was in acute care, finished his DRG and no other facility would take him due to his size. They could not provide care. So rather than loose money upstairs, he came here. sorry its so lenghty. KAREN ____________________________________________________________ Get advanced SPAM filtering on Webmail or POP Mail ... Get Lycos Mail! http://login.mail.lycos.com/r/referral?aid=27005 /---------------------------------------------------------- The Case Mix Discussion Group is a free service of the American Association of Nurse Assessment Coordinators "Committed to the Assessment Professional" Be sure to visit the AANAC website. Accurate answers to your questions posted to NAC News and FAQs. For more info visit us at http://www.aanac.org -----------------------------------------------------------/
