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How can I get my dad transported to his home state?

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    #16
    We believe, unfortunately, that there is some hesitation because of age. His age does not reflect his determination or his mental stamina. Before the accident he had high blood pressure, which of course is no longer an issue. Otherwise he has been in great health and has kept a healthy lifestyle. We were always amazed that my dad never got sick.

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      #17
      Tell hi. To keep his head up and things will fall in place! He should not give up as you shouldn't either. Keep fighting for what is best for him.
      T6 Incomplete due to a Spinal cord infarction July 2009

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        #18
        There is considerable age discrimination by many rehabilitation programs for older people with SCI. It is sad, but common, and no one seems to be advocating for this population. We see it often in Veterans who are referred to us only after being turned down by regular private sector rehabilitation programs. I would also recommend contacting the help line at the Christopher & Dana Reeve Paralysis Foundation: www.paralysis.org as they may be able to help advocate for your dad.

        Unfortunately I don't share SmashMS's optimizum that "everything will fall into place on this". Our LTACs (long term acute care hospitals) which often serve as "vent farms" are full of people like your Dad who could not get access to appropriate rehabilitation services due to age. I do agree that you should not give up though. hlh had given you some excellent advice about refusing to allow him to be moved to an LTAC/SNF facility. Keep pushing!!!

        (KLD)
        The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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          #19
          I understand your desire to move your Dad to Georgia because it is his home state. Have you also asked the Case Manager to refer him to other SCI Rehabs to see if he would be offered a bed elsewhere? I know this seems counter-intuitive but it would be interesting to see if any other acute rehab will offer a bed. They might not want to bother with this, so I would present them with a list and contact information for some other centers. It does not matter that the hospital wants LTAC, their goal is to transfer ASAP. I see the point of digging your heels in to try to get him placed and moved to Shepherd. When Medicare determines that he is medically stable and can be transferred to the local LTAC, they will issue denial of coverage and back you to the wall. You can appeal the discharge however in this case it will be tough to beat. Still I do not blame your family for your choices. I would review the PT notes in his chart. Are they supportive and favorable for acute rehabilitation? You would need him to be motivated and eager to participate in PT at the hospital and for this to be documented in strong language. It is rough because the healthcare world is quality and outcomes driven, and mostly ignorant when it comes to understanding what a motivated person with paralysis can do. If there is a social worker at the hospital, ask for some support.

          I wish you the best as you go through this process,

          Mary
          1FineSpineRN

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            #20
            Originally posted by Elegrier View Post
            We believe, unfortunately, that there is some hesitation because of age. His age does not reflect his determination or his mental stamina. Before the accident he had high blood pressure, which of course is no longer an issue. Otherwise he has been in great health and has kept a healthy lifestyle. We were always amazed that my dad never got sick.
            We also had some difficulty with getting the appropriate treatments and assessments because of my father's age. And in the ICU with a million tubes coming out of him, he looked even older...

            You actually need to keep reminding the case managers, doctors, administrators at Shephard how healthy he was before the accident. He was extremely healthy for his age, with no major medical problems. If he could walk a mile, say that. If he was still volunteering or working part time, say that. It is important for people to start looking at him as a person.... and not just an elderly patient with a SCI.

            I would have someone from your family start calling Shephard directly. Keep pushing and calling every day. Find the people in charge of these decisions, and keep talking to them. Do not wait. No miracles will happen on their own with this one. Ask the physical and occupational and speech therapists working with him now to assist you in indicating his rehab needs and potential. If any of them seem at all helpful or kind or motivated, ask them to help you with the referral process. And make Shephard answer your questions.... Have they ever had high injuries like your father before accepted to rehab before? Yes? So why not him? Have they ever had patients his age accepted before? Yes? So why not him? When will the next bed be available?

            This is the time to fight.

            Great idea to call the Christopher Reeve Foundation and see if anyone can give you advice on how to advocate. I'm sure they have seen cases like your Dad's before.

            Hang in there.

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              #21
              We have pretty much given up on Shepherd. We tried all week to get them to admit him. When we pushed for specifics we were told that he is twice the age of the average person they see. When we asked if this was the reason for denial, we were told that they look at other factors as well. Our head hurts from hitting that brick wall.
              We are looking at other Centers in Georgia ( around the Atlanta area).

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                #22
                Basically they told you it was because of his age then. But told you the roundabout way. Sorry to say at his age it will be a miracle if any acute care rehab facility accepts him. You may be better off looking at long term care places in atlanta.
                T6 Incomplete due to a Spinal cord infarction July 2009

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                  #23
                  You also need to have a second option in Georgia ready to give the Social Worker if Shepherd won't accept him. After looking at the total picture and his health status, they may prefer that he go to a long term acute rehabilitation first.
                  CWO
                  The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                  Comment


                    #24
                    I would still keep calling Shepherd. Have you gone as high as you can?

                    I guess the way I look at it is .... this is not the time to be nice. This is not the time to accept no for an answer. Tell them that just because their average age of admitted patient is low (of course..... most traumatic SCI happen to young men), this is not a reason to deny care. Tell them you know they have accepted other patients with his level of injury, with similar medical history (he only has hypertension!) and similar current health in the past. Remember, the people you are pushing now are not the people who actually would treat your Dad. They are mostly administrators who don't even see patients, and are just thinking about numbers/money.

                    I'm assuming he is medically doing ok now, outside of the spinal cord injury?

                    Nurses, are they allowed to deny entry for someone with this level of injury based on age?

                    Honestly, part of me thinks that it is against Medicare guidelines to refuse to treat someone due to age.... if he is similar to others in his current deficits/abilities who have been accepted in the past. They are probably being careful not to say it is based on age alone, but it is hard for me to believe this is allowed.

                    Is he regaining any movement/sensation at all? There may be changes over time, so keep looking/asking. Has Shepherd said if they would reconsider if he improves at all? Have they recommended other local subacute rehab facilities for you to check with?

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                      #25
                      Shephard Center is CARF accredited as a Spinal Cord System of Care (SCSC). I don't believe that CARF would consider refusal based only on age a legitimate reason. You could call CARF to find out (www.CARF.org).

                      Have you contacted the Christopher Reeve Foundation Help Line? www.paralysis.org

                      (KLD)
                      The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                      Comment


                        #26
                        Thank you all so much for your on point responses. They have been a tremendous help to myself, my mom, and my siblings...and ultimately to my dad. My dad was accepted at an LTAC in Georgia only to have Medicare refuse to pay stating that this was an "inappropriate level of care." I have reached out to various advocacy groups in Connecticut that focus on health disparities. We are appealing this decision.
                        We have not given up on Shepherd. The hospital physiatrist is checking with his contacts to see if we can get our feet further in the door. We continue to be blessed with my dad's presence...his smile, his sometimes successful attempts to communicate his own thoughts by mouthing words. His first sentence - "I want food."

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                          #27
                          Elegrier-

                          Here's information about how to appeal an adverse Medicare decision. Keep pushing.

                          http://www.medicare.gov/claims-and-a...e-appeals.html

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                            #28
                            The LTAC wants him to go to SNF? or what? Not sure why they would say that. You need to find one with a ventilator and rehabilitation program. Acute rehabilitation like Shepherd requires 3 hours of therapy-total- a day. Medicare requires this also. They do have a special vent program but they have a waiting list and prioritize admissions. They look at many factors and age and average length of life. I have never known them to take an 80 year old.
                            But don't give up hope- just keep looking and you will find a good place close to his home.
                            CWO
                            The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                            Comment


                              #29
                              Good for you.

                              Wow - Medicare even said he shouldn't be in LTAC!?!? This is more evidence he needs to be in acute rehab like Shephard.

                              How great you are reaching out to groups that can help you advocate. Call everyone/anyone... Did you try calling the Christopher Reeve foundation? I like the Nurse KLDs reference for CARF. Call them. Shephard does not want its accreditation to be stained by refusing a patient like your Dad. And then you let Shephard know that you have talked with these places.... or even better... see if they can call Shephard or advocate in any way.

                              It is so wonderful your father still has good spirits. Thank you for doing what you are to support him.

                              While you are in this transition period, remember that your father's enemies will be the early "complications" of spinal cord injury that affect many of us who cannot move/advocate for ourselves.

                              It is most critical that he is being turned regularly so that he doesn't get pressure sores (should be at least every 4 hours, turned from side to side and propped up with pillows), and that his skin (especially sacral area above the butt) is checked multiple times a day. It is hard to get assistance from the nurses/nurse's aids to do this, so sometimes it is helpful for you guys to remind them and assist (carefully). He also should have special boots on his feet to protect his heels and ankles from developing pressure sores... I cannot emphasize enough how important this is.

                              Also, he is at risk for developing a blood clot (especially in the legs), so ask how they are trying to prevent this..... which is tricky because he had a bleed that caused his injury. At a minimum he should have boots on his legs that pump air in and out that help his circulation. Once they are less worried that he will bleed again, he may be put on a low dose of a blood thinner to prevent blood clots. Ask about this.

                              He is at high risk for infections, as hospitals are dirty places... Make sure everyone (especially all hospital providers) wash their hands before they touch him. He is at high risk for urinary tract infections from the catheter, and pneumonias. Ask the respiratory therapists what advice they can give to prevent pneumonias. If he can ever get to sit up, this will help a lot.

                              How great you have a physiatrist now helping you. Learn from this doctor these spinal cord injury complications that you should be watching for, and get his/her advice if they seem knowledgeable about SCI. Look at the links at the top of this forum (stickies) - especially those from the Paralyzed Veterans from America and the Christopher Reeve Foundation.

                              Keep pushing....

                              Comment


                                #30
                                The initial denial likely came from the Medicare Administrative Contractor, (A.K.A "The MAC" ) with jurisdiction over your geographic area. Claims reviewers at this level have varying degrees of medical qualification and do not necessarily have to be specialists in the type of injury affecting your Dad. The percentage of claims denied at this level is high.

                                Insist that your appeal get reviewed by a QUALIFIED medical specialist with direct knowledge of high level SCI patients.

                                Here's a table of how the "game" is played. Knowledge is power. Best of luck to you. This Monday is a holiday so you will have to wait until Tuesday to call.


                                MEDICARE APPEALS PROCESS
                                Level of Appeal
                                Decision Maker
                                Individuals or Entities
                                Authorized to Appeal
                                Timeframe to Request
                                Format of Request
                                Timeframe for Decision
                                Level One—Redetermination A/BMAC A provider, supplier, beneficiary, other party, or a representative of the above Within 120 calendar days from date of notice of initial or revised determination CMS Form 20027 Within (w/n) 60 calendar days, with 14-day extension if additional information is submitted
                                Level Two—Reconsideration QIC A provider, supplier, beneficiary, other party, or a representative of the above Within 180 calendar days from date of notice of redetermination decision CMS Form 20033 W/n 60 calendars days; if QIC fails to make its decision timely, provider may request escalation, which may occur if QIC fails to make their decision w/n 5 days of request
                                Level Three—Administrative Law Judge (ALJ) Hearing ALJ A provider, supplier, beneficiary, other party, or a representative of the above, so long as amount in controversy threshold is met ($140), and CMS Within 60 calendar days from date of notice of reconsideration decision; provider must notify all parties to the QIC reconsideration of the hearing request CMS Form 20034 W/n 90 calendar days; if ALJ fails to make their decision timely, provider may request escalation, which will occur if ALJ fails to make its decision w/n five days of request
                                Fourth Level—Appeals Council Review Appeals Council Any party not satisfied with ALJ’s decision, including CMS Within 60 days of notice of ALJ’s decision DAB Form 101 W/n 90 calendar days; if AC fails to make its decision timely, provider may request escalation, which will occur if AC fails to make its decision w/n five days of request
                                Fifth Level—Judicial (Federal District Court) Review Federal District Court Any party, if amount in controversy ($1430) is met Within 60 days of notice of AC decision Request must follow Federal and local rules for federal district court Court follows Federal Rules of Civil Procedure and local rules for federal district court

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