Know the ins and outs of the billing and the system
By James Ward
James Ward
If you or a loved one is in the hospital, the natural thing is to want to go home. That’s clear. But what if you’re in the nursing home? Same thing. Residents want to go home, and their families want them home. But what if there’s nobody to care for the ill person? What then? Think carefully before you take someone home. Can they be left alone? Can they take care of their daily living activities? Will they be safe?
I had a case last year with a severely disabled man who was being discharged from the hospital. His second wife could no longer care for him, so she wanted him placed in a nursing home.
The man’s daughter from his first marriage, along with one of his sisters, decided to take matters into their own hands and kidnap the disabled man from the hospital. After two nights at the daughter’s house, they realized that they could not care for the man, so they took him back to the hospital emergency and just dropped him off and left him there. Yes, absolutely crazy, but it happened.
The hospital finally discharged the gentleman to a nursing home, and now Medi-Cal is paying for his care and he has 24-hour nursing care available to him. Everything finally worked out well once the family stopped fighting and finally followed my instructions — but it took a court case and the judge’s order for the daughter and sister to back off. Unnecessary expense and stress for the family.
A couple of weeks ago I had a similar situation where the disabled man had been living with his caregiver for several years, but then fell and banged his head and had to go to the hospital emergency room. The doctor said he could no longer go home, but the discharge nurse at the hospital was demanding the man go back to live with his caregiver, despite the doctor’s statement that he should not go back there. The disabled man had been fighting with his caregiver for years, but the main reason he could not go back there was because the caregiver was his 94-year-old father! Yes, it was clear that the 94-year-old father could no longer care for his severely disabled son, and that for the health of both of them, the son had to be placed in a skilled nursing facility.
Another family came to me for help with their mother. She needs the care of a nursing home, but the social services person at the nursing home is telling her husband that he should take her home and she’ll be much better off at home on hospice.
Really? The husband is 91 and already has significant dementia. The adult children know that he’s unable to care for their mother, but the nursing home staff is trying to convince him to just take her home.
Why would they do such a thing? Because the nursing home can make more money by getting her out and using her bed for someone who comes directly from the hospital on Medicare (not Medi-Cal) and the nursing home has a much higher profit on the Medicare patients. It’s not about the care — it’s about the nursing home profitability. And unless you know the ins and outs of the billing and the system, you’ll be at a disadvantage when working with hospital and nursing home staff who are trying to bamboozle you for their own benefit.
Know your rights. Be informed. Work with an experienced elder law professional to guide you.
James Ward lives in Morgan Hill. He went to law school in New England and earned a post-graduate law degree in Estate Planning at the University of Miami. Jim worked as an Estate Planning and Elder Law attorney in Florida, and then returned to open his law firm focusing on Estate Planning and Elder Law. He has offices in South Valley and Willow Glen.
