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1516809 tn?1345082764

No Proper Parkinsons Treatment & Medicare

My father is 90 years old with Parkinsons Disease. I am aware it is a degenerative disease over time. Within the last month, because of his rigidity and recently developed habit of picking and scratching his skin, his Neurologist changed his meds. Upped his Sinemet ER from 25/100 to 50/200 to help him with his morning stiffness, and had him titrate Lamictal XR to 50 Mg daily for the skin. This past Monday, as we left the house, he suddenly complained that he could no longer walk and move his legs. As a result, I called the Ambulance to take him to the Emergency Room. The attending ER doctors called his Neurologist who trivialized the incident stating that he suffers from extremity weakness not bothering to question or comment on her change in his meds. I then called his Primary about this response who agreed with me that this was not a satisfactory answer so we both agreed that another Neurologist needs to be consulted. In the meantime, she would admit him to the hospital. Today is Wednesday, and I was informed today. that the hopital could not justify a third day to keep him because they are not acutely treating him. As a result, he was admitted under the category of Observation not Acute Treatment. Moreover, I was told that there was a Neurology consult by another doctor who stated that it was just the progression of the disease.  His Primary doctor strongly feels that the solution to my father's current problem is sub-acute Rehab at a Nursing Home which could also monitor him for the meds. However, because the hospital made its decision to discharge him, there was nothing that she could do, so tomorrow he is coming home without resolution to the ambulation problem. I spoke to the case Manager for his floor, and to her boss as well, and they both quote the change in the Medicare guidelines which establishes that the hospital will not get paid for the third day under his category of admission Observation.

When I took my father to the ER, I was not thinking of categories of Admission nor do I think that I should be. Secondly, if the doctor supposedly admits him, I would not think to question the doctor's motive. Bottom line, there was a change in Meds which could have a bearing on his sudden difficulty ambulating. The hospital tells me that the Doctor could monitor the meds. I said the doctor cannot be in the house 24/7. They replied that a visiting Nurse could do this. I replied that she too, cannot be in the house 24/7. Then the hospital told me that some home P/T could help him. As it now stands, I have had a Therapist come to the house but she obviously cannot provide 5 days of intense therapy like a Nursing Home At best, one hour a day twice a week. So because everybody is afraid of a Medicare Audit and the possible accusation that a fraud is being committed, my father will come home with no resolution to his immediate problem. I am not asking for long term care, nor a cure for his Parkinsons. Moreover, my father is not rich so we cannot afford like the hospital suggested to pay privately for a Nurse and P/T and Aide to be there 5 days a week 24/7.

So my father will come home without resolution to the immediate problem. What caused the sudden stiffness, meds? And what can we do to help him? Sub-acute therapy? Denied, cannot justify three days of treatment. I am not a doctor. I do not know every test and treatment that could have been done to keep him the three days or change the category of admission. Now we will never know for fear of the Medicare Audit. If the hospital cannot justify three days because they would not get paid, then he never should have been allowed into the hospital at all. I feel they should have turned him away. And if you tell me that they are obligated to treat him, then they are contradicting themselves because there is no way to justify the treatment under these new guidelines.

My father is 90 years old. He will come home, and he may not be able to walk properly. I am not a nurse, nor an Aide. The aides and P/T come in for only a few hours and days ago. More was not justified. This arrangement cannot be a substitute for short term care at a Nursing Home. There is a solution but the hospital's criteria under the Medicare guidelines prevents it. Something is wrong with this situation, and it is at the expense of my father's health. I have filed a Medicare appeal but I fear it will go nowhere because of the category he was admitted: Observation.

Any suggestions? Can anyone help me?
9 Responses
Avatar universal
The physician should be able to change his status to full admit and then Medicare should cover after the change.  He should be able stay until he is seen by this second Neuorlogist.  I think his Primary is the key to your problem.  

Have you talked to anyone from administration about this problem?  
1516809 tn?1345082764
The second neurologist has concluded that it is the disease that is my father's problem, as if I did not already know, and has upped his Aricept from 5 to 10Mg to improve cognition. Today, when I visited my father, I observed that my father experienced some type of seizure as they were taking him for an MRI. I think this new neurologist is missing the boat, and I need to bring in another. The primary is hoping that the MRI will find something which in turn can change his admittance status. In the meantime, the primary reiterated again today that it was the hospital that changed the admittance status of my father. When I originally spoke to Patient Relations, they kept quoting Medicare Guidelines.  I need to escalate this further.
585414 tn?1288941302
  Parkinson's when it becomes difficult to respond to treatment might need a further specialist. I know people with Parkinson's who have benefited from a consult with a movement disorders specialist. There are some hospitals that specialize in this area. Perhaps he could be referred to one and they could provide  appropriate recommendations as to treatment. There can also be concerns about medication side effects and interactions (and of course other medication options) but a specifically trained movement disorders specialist would be the best person to speak to.
1516809 tn?1345082764
Agreed but the next most pressing problem for me is knowing that a Hospital can override how you are admitted by a Doctor precluding you from certain treatments if you are a Medicare recipient. Since when in history did one ever have to question the category by which a doctor admits you to determine whether the hospital will be paid at the expense of life-saving minutes?  When your in an ER, you should not have to think about this at all because you are putting full trust in the doctor's admission criteria. There is a bad precedent being established.
Avatar universal
Well, has your father gotten the MRI yet?  Is he still in the hospital?    

I am kinda confused.  Has the hospital's social worker/case manager done anything for you?  
1516809 tn?1345082764
The MRI results are negative. My father is still in the hospital. The Primary is ordering more tests because of the seizure, also hoping that this would make the hospital change the status. If so, he is Nursing Home eligible.

On the other hand, I spoke to one of the Hospital Administrators. He told me that everyhthing is driven by what meets Medicare criteria.

In the meantime, the Home Care that I had previously arranged for him told me that if they evaluate him for reinstatement and find he is unsafe and/or unstable, they cannot admit him. I informed the Primary and the Hospital Administrator about this. The Primary tells me do not worry, the Administrator tells me to Private Pay or seek charity care. I told both the number one concern is the health of my father.
Avatar universal
Hopefully, this status will be changed.  Geez, you are having a time with all of this.  

Does your father only receive Medicare?  

Have you talked with anyone from Medicare yourself?  Something does not sound correct.  

In my opinion, he was nursing eligible before he even went into the hopsital.  I tell you Medicare changes their regulations and rules so often.  

As an American, I can say this is appalling.  

Avatar universal
This hospital didn't give you any other resources that may be able to help?

Have you called around to different facilities on your own that may be able to take him?  
1516809 tn?1345082764
As of today, I was informed by the PCP that in a X-Ray, they detected some pneumonia in a lung. Being that this is an acute condition, treated with IV antibiotic, this should more than likely change the admittance classification to acute after three days, making him Nursing Home eligible. However, the hospital has to do their classification check with Medicare.

I met the Medical Coordinator from his floor today by accident who is working behind the scenes with Medicare in regard to this problem. No one revealed her existence to me but it give me a chance to voice my concerns, and what I would like to see at least. She came across that the hospital is really trying to help but the PCP's constant harping on the hospitals refusal to classify the admittance as acute painted the hospital in a negative light.

My father besides Medicare, has a secondary, and tertiary insurance however they only pick up after Medicare. It boils down to the category of admittance. I have now been told that some hospitals now turn patients away at the ER level from admittance because the patient does not qualify for acute treatment according to Medicare guidelines. They have procedures in place for this purpose but this hospital does not have such as system in place yet, so we face this dilemma.

Everything is predicated on Medicare guidelines according to every facility I called so far.

What is needed is some type of Ombudsman for people in my situation. Some doctor who is willing to consult, and/or intercede on the family's behalf with other doctors, at the family's request to help with diagnosis, and treatment. Not a hospital advocate but a family advocate.

I find myself acting more like the doctor's should, and I am not a doctor.

By the way, there is no one that you can talk with at Medicare when the classification is Observation. When it is Acute, you have the right to appeal the discharge if you choose. If you do call Medicare, you wind up talking to a clerk who reads from the Medicare manual.
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