To preface, I will be consulting with a lawyer about all of this hopefully next week. I want to throw this out somewhere to see if I can gain any insight because I’m at my wit’s end with all of this. I will try to summarize because it is a very long story.
After a couple of years, my sister and I reconnected with my dad, and he was in terrible shape. Our original plan was to find him a new home/doctor because he and his two brothers owned his previous home. They had planned to sell the property a year or two ago, which is just now coming to fruition. The point is – he does not have a home right now.
He was living in squalor, putting it nicely. His house was disgusting, and so was he. He was filthy. We could barely understand him; he was slurring so bad. He’s always been an alcoholic, so we assumed it was because of that. A couple of times, we went out to eat with him and he got choked and threw up. Again we thought it was because he was drunk.
One of those times was in November, right before Thanksgiving, we had gone out to eat with our family and he had another choking episode and collapsed. He was rushed to the hospital and has been there ever since.
While in the hospital, they checked him for stroke and there was no conclusive evidence of a recent stroke, but severe brain atrophy and a Parkinson’s mimic. He cannot swallow and is on a feeding tube. If he eats or drinks water, he quickly asperates. The other issue is cognitive decline. His short-term memory is shot, and he has serious problems with incontinence.
He’s been eligible for discharge for several weeks but has no place to go, so we’re working with a case manager to determine that. The options are limited because he needs to be placed in a locked unit. He tries to escape quite often. There is only one option in the area, according to our caseworker.
The original plan was to get him into this facility short-term to receive occupational therapy for his swallowing to be placed in assisted living after the visit. His new (very expensive) plan with the ACA says it covers 30 days of therapy…if qualified. Here’s the problem – they won’t approve because he can “walk a certain number of steps”. ??? When we asked to appeal they told us that will “take months and probably not be approved”. I don’t understand how walking plays into this decision.
This is where we are stuck currently. Essentially the only option, according to the caseworker, is to admit him to this facility for long-term care with no kind of rehabilitation and his insurance covers NONE of it. In addition, he is too young for Medicare and has too many assets for Medicaid/Disability. We would have to pay out of pocket for this $2,000/day facility until he has no money in what they are calling “spend down” to qualify for Medicaid.
Do we have any other recourse at this point? This just seems so wrong.
submitted by /u/AntiqueCauliflower84
[link] [comments]To preface, I will be consulting with a lawyer about all of this hopefully next week. I want to throw this out somewhere to see if I can gain any insight because I’m at my wit’s end with all of this. I will try to summarize because it is a very long story. After a couple of years, my sister and I reconnected with my dad, and he was in terrible shape. Our original plan was to find him a new home/doctor because he and his two brothers owned his previous home. They had planned to sell the property a year or two ago, which is just now coming to fruition. The point is – he does not have a home right now. He was living in squalor, putting it nicely. His house was disgusting, and so was he. He was filthy. We could barely understand him; he was slurring so bad. He’s always been an alcoholic, so we assumed it was because of that. A couple of times, we went out to eat with him and he got choked and threw up. Again we thought it was because he was drunk. One of those times was in November, right before Thanksgiving, we had gone out to eat with our family and he had another choking episode and collapsed. He was rushed to the hospital and has been there ever since. While in the hospital, they checked him for stroke and there was no conclusive evidence of a recent stroke, but severe brain atrophy and a Parkinson’s mimic. He cannot swallow and is on a feeding tube. If he eats or drinks water, he quickly asperates. The other issue is cognitive decline. His short-term memory is shot, and he has serious problems with incontinence. He’s been eligible for discharge for several weeks but has no place to go, so we’re working with a case manager to determine that. The options are limited because he needs to be placed in a locked unit. He tries to escape quite often. There is only one option in the area, according to our caseworker. The original plan was to get him into this facility short-term to receive occupational therapy for his swallowing to be placed in assisted living after the visit. His new (very expensive) plan with the ACA says it covers 30 days of therapy…if qualified. Here’s the problem – they won’t approve because he can “walk a certain number of steps”. ??? When we asked to appeal they told us that will “take months and probably not be approved”. I don’t understand how walking plays into this decision. This is where we are stuck currently. Essentially the only option, according to the caseworker, is to admit him to this facility for long-term care with no kind of rehabilitation and his insurance covers NONE of it. In addition, he is too young for Medicare and has too many assets for Medicaid/Disability. We would have to pay out of pocket for this $2,000/day facility until he has no money in what they are calling “spend down” to qualify for Medicaid. Do we have any other recourse at this point? This just seems so wrong. submitted by /u/AntiqueCauliflower84 [link] [comments]Read Morer/HealthInsurance