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My husband was hospitalized for Sepsis which weakened his entire body. Upon release he was sent to rehab for PT and OT. He was tested for c-diff just today since he has not been able to eat without food running right through him, literally. The test results haven’t come back yet. Also the PT has said that his heart rate is all over the place and an EKG was ordered just today. Well today, as soon as I get home from visiting him, the social worker called and tells me he’s scheduled to be released in two days. Then she said I have the right to appeal. Are you kidding me? How could he be OK to come home. Is it standard procedure to have to appeal to get continued coverage. He went in rehab on Sunday and today is Wednesday. They want to discharge him Friday. He is 83 years old.

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Maybe he's not well enough for rehab to be effective? Maybe he needs to return to the hospital until his digestive issues and heart rate are resolved.
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I think I'd ask for him to be taken to the ER and re-admitted for his acute cardiac issues.
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Your problem is he is in rehab. Medicare will not pay if, like said, he can't participate. Maybe you can have him transferred to the NH part which means private pay or apply for Medicaid. Explain that you cannot take him home in the condition he is in. I would have him taken to the ER.
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JColl7 Sep 2019
Thanks, I will definitely explain I cannot take him home like that. Seems as though they would tell me if he needs to go back to the hospital, especially since he just came from there. I guess I don’t understand the process.
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So far, I did appeal the “Non Coverage” status. That may take up to 3 days but he is covered during the appeal process. Meanwhile, the SNF informed me he tested positive for C-diff and will be isolated in his room for 10 days while receiving PT & OT in his room. I guess that means insurance will cover it BUT still must wait for official decision. I’ll keep all updated to let you know how it turns out. BTW appeal process was relatively easy on my part...a phone call to an “advocate” who took down all the particulars and explained the process to me.
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Are they saying they "approve" discharge, or is Medicare actually ASKING for discharge? Do they call where he is "rehab"or "skilled nursing facility". By that I mean is he there for rehabilitation through physical therapy and occupational therapy, or specialized wound healings and etc. or is he only in need of more nursing care. Truth is that no one gets to stay in nursing care in hospitals for any amount of time at all anymore, and seems that time in rehab, if they are not actively able to participate and improve they are said to have reached their plateau and to have therefore been discharged from medicare's qualifications list for rehab. I hope against hope this isn't C-diff. It is so hard to cure and it can just be almost literally a killer. If it comes to it research fecal transplants; they are sometimes the only answer, hesitant as MDs are often to even discuss them.
Good luck on the appeal. Some on the forum have done it and won and hope that they are around to walk you through; I am sure there must be key phrases to use like hospitalization key phrase being "unsafe discharge".
Hope you will update us.
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JColl7 Sep 2019
They are saying they will not cover after a certain date. I was given a “Notice of Medicare Non-Coverage”
He is in a skilled nursing facility. He was sent there to build his strength up so that he could return home. They did tell me that if he does indeed have c-diff they would confine him to his room as it is highly contagious and provide the proper treatment. The PT did work with him but wanted to find out why his heart rate was not reacting as she thought. He hasn’t plateau as he hasn’t even completed all the goals they set yet. I will definitely appeal and stress unsafe discharge in addition to the developments that took place while I was there. Thank you for your advice.
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Medicare will not cover rehab when the patient cannot or will not improve.

Based on the issues he has...it sounds like rehab isn't going to work....heart rate all over the place.... Medicare bases their decision on the medical assessment of the facility.
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againx100 Sep 2019
Makes sense. Maybe he needs to be in the hospital instead of rehab?
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What facility is this? My mom wasn't discharged from Nursing home because she had C-Diff. They may do the same for your husband.
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JColl7 Sep 2019
A skilled nursing facility.
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I wouldn't rely on them to make that call. In your shoes, I would call his PCP and ask what her/his opinion is about whether he needs to be readmitted.

Or get hold of the Director of Nursing and ask her directly what she would do if this was HER loved one.
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GardenArtist Sep 2019
Barb, good advice and suggestions.
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Seguing off Alva's response, what WAS the purpose for rehab?   I.e., was it to recover from sepsis, or from C-Diff, or for cardiac issues?  The reason for being there, and whether adequate results have been achieved, drives the discharge decision.

I would talk to the DON tomorrow and find out specifically the purpose for his stay, whether that's been met and/or still exists, whether or not the treating physician at rehab plans to recommend home care (which I think sounds necessary), and why they feel he's ready for discharge.   

If you can't get to the DON, type up the notes (then they know you're serious) and ask the social worker to locate the appropriate people and get answers.

You could also ask her for brochures on home rehab, PT, OT, nurse, aide, etc. and make sure that she arranges for your chosen home rehab company to start either the day of or the day after he returns home.  

I've been through similar situations when I thought my father was being discharged too soon.   I didn't investigate an appeal, b/c at that time I was getting fed up with their lack of interest in his care and didn't feel there would be any benefit to being there any longer.  But I did make sure I got a referral for home care.

I can understand how frustrating this must be for you.   It takes awhile to learn how to play the games of ensuring that you get the care you want. 

And as to appeal, I'm only familiar with appeals from hospital discharges.
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JColl7 Sep 2019
Thank you. I will talk to DON.
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JColl, so glad that got resolved! Glad to hear from you and keep us updated.
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