Rehab after rejection of Medicaid

[daughter213]

Hi Everyone,
I'm looking for some direction here.  My 61 year old father had a stroke 1 month ago.  He is still in the hospital awaiting approval of medicaid to cover his costs for intensive rehab at a local facility.  Today the social worker indicated that she felt his medicaid was going to be rejected.  My father can not use his left side, can not sit up and can not walk.  He lives alone.  What are his options?  He certainly can not be released to live on his own.  Even if he came to live with my brother or myself, we can not lift him.  He's currently using a bed pan and has a catheter because the nursing staff can not move him.  I'm at a loss as far as researching options for him. Any help or ideas would be greatly appreciated.

[vega1318]

you cannot take him home and you should be firm about that.     don't feel like you've failed him.   he would certainly benefit from rehab but most importantly, he needs a skilled nursing facility -- at least for time being until he becomes more independent.    the other alternative would be to hire a private nurse to take care of him as well as get a private physical therapist.   all of these are quite expensive options.    the most viable option, then, is to be firm - medicaid can sometimes turn around if social work is persistent enough - and to start looking for a long-term facility for him.    you may then consult a private physiatrist and ask what types of exercises you should do while there.   it won't be acute rehab but it's better than nothing.

[daughter213]

There's no money for any of the expensive options.  What do they do when someone lives alone, can not walk or take care of themselves, and has no money?  They're talking about releasing him, but how can they when there's no where for him to go?  How can I find somewhere for him to go?  Should I consult legal aid?  

[caregiver222]

Today, write them a written registered letter, return receipt requested to the hospital administer by name (copy to legal department) stating that you understand they are recieving federal funds and request him to be treated under the Hill-Burton Act. DO NOT AGREE TO TAKE HIM HOME. Then write the same letter to the rehab facility director by name.

[daughter213]

caregiver and vega,

Thank you so much for your input.  I'll be spending the next couple of days trying to get my father settled.  While it's all very scary, I want to make sure that you both know that I'm grateful for your advice and will be exploring your recommendations.

[vega1318]

This is a terrible situation.   IF you feel that they're pushing you out and not considering the type of care that he will be receiving while at home -- get a lawyer right away.   A patient cannot be pushed out of the hospital without minimal provisions for skilled care while at home.   I hope things work out for you.

[daughter213]

** Update **

I went in this weekend to get answers from the social worker and doctor (my father is in a hospital 3 hours away from my home).  The social worker stated that originally all looked favorable for Dad to get Medicaid, but my father is an independent contractor who did not file his taxes last year.  He told them his income, but could not produce tax documents to prove his income and show his expenses.  The business that contracted him can produce a document of what they paid out to him, but it doesn't take into account his expenses.  Therefore, it is expected that medicaid is going to be rejected based on the difference in income.  His contract has been terminated at this point and there is no income.  The doctor states that he still needs acute rehab, but rehabs are a business and there's nothing they can do other than release him from the hospital.  He still can not walk or move his left arm, and requires a catheter.  After pressing the Social Worker for an answer, she told me that if there is no place for my father to go and no one to care for him (they acknowledge that he needs full time care), the hospital takes over guardianship and puts him in a nursing home.  For a 61 year old man who has lived his life outdoors, this is horrible to him.  My feeling is that I should continue to pursue Medicaid with an attorney.  I would appreciate anyone's input.  thanks.

[vega1318]

You should continue to pursue Medicaid with an attorney.   While that is going on, they cannot discharge your father anywhere as they would have to assume guardianship to do so and they cannot do that while you're his legal guardian.   It is tricky but I would talk to an attorney as soon as possible.   In the end, however, a nursing home where they can take care of his medical needs is much better than the hospital where he could only get sick from other patients and where, with all likelihood, his needs will now be ignored as he's no longer actively sick.   And it is much better than taking him home where you cannot take care of him.    It is a bad situation but a nursing home is not such a terrible alternative.   In the meantime, you should talk to a lawyer asap.