My grandfather suffered a stroke in December, he has lost the ability to use his left and and leg, so he is bed ridden for the time being. At 87 years old we are willing to except that this is the new reality and he may never be independent again. He was placed in a skilled nursing facility after discharge from the hospital. After 20 days his insurance dropped off and we are paying out of pocket $12,000 a month. $12,064 to be exact, not including the extra deductibles for therapy. Obviously this cost is not sustainable, and we are looking at options.

On our search for assisted living facilities we have learned that they all seem to be able to be able to meet his needs for half the cost of the SNF he is at now. HOWEVER, he now has 5 stage 2 & 3 bed sores that are preventing him from moving to assisted living. He did not have sores when he went in to the facility, they have happened in the last 4 weeks he has been there. My question is, what do we do? The SNF staff seems to be doing the best that they can for him, however it's not enough. They have wound care once a week at the SNF he is at, but we are only getting worse, and not better. Do we ask that he gets moved to the hospital? It seems outrageous to be paying what we are paying for him to be in the condition he is in. We don't know what to do, and the social worker at the SNF seems to have the best interest of the facility and not ours.

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He has wound care and he is in SNF. This is where he belongs while this is ongoing. Decubiti are LIFE THREATENING. He is in no condition for any ALF at all. Do seek help for payment for him. This is not sustainable for family and will rob funds you require for savings for your own care. It takes a lifetime to save enough for care in age.

I am so sorry, but right now this isn't about a move. This is about wounds that are no healing and perhaps worsening despite care. You may be looking soon at palliative or hospice care, as this will eventually go to sepsis and a rapid death is there cannot be healing.

Without movement, activity, exercise, circulation, excellent nutrition, being out of bed, it is almost impossible to heal decubiti. You will find much information online.

Please see an attorney. Application for Medicaid must be done so that coverage can happen in SNF setting where he needs to be in this ACUTE condition.
I'm so sorry. Hope you will update us.
Helpful Answer (12)
Reply to AlvaDeer
FlaniganFamily Jan 30, 2024
Hi thanks for your advise, do you think a Hospital is better suited to care for his sores? How long do we let them try to heel him?
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To cover the potential legal side of this, immediately start taking pictures of the bed sores as they are today and retake every few days. Also take pictures of his positioning in bed. Keep track of date and time. Get a copy of the care plan that the facility has set up for him and all of the their care notes to date. Whoever is his POA has the power to obtain those records. You will absolutely need those pictures and records since the bedsores appear to have been caused by neglect secondary to his primary reason for being there - his stroke. You do not need to tell the facility what you are doing or why. POA is just what is says “Power” of “Attorney”. His POA has the power and authority to act in the best interests of the patient as if they were acting as the person’s representative or attorney. Do not pussyfoot around with these facilities. The patient has rights and the POA representative has the legal authority to protect those rights and advocate for the patient. If there is no POA, then his spouse or other primary family member can serve as his advocate for now - but the facility may not recognize them as having any legal standing. That is because they really don’t unless the patient has set them up as POA. I hate to add to your costs, but the bedsore situation and POA situation really require the help of a qualified elder care attorney now - for advice and help. The attorney will want proof of neglect such as photos and statements from family and other knowledgeable people about his skin condition prior to entering the facility. They can also help with POA.
As for financial concerns, please contact Medicare directly to ask about his billing situation. If they won’t speak to you because of lack of POA, then pose your questions as general situations ie “suppose this was the situation” to get them to give you situational information.
I don’t understand why it is costing so much so soon. Typically Medicare pays the full cost for the first 20 days and then about 80% for another period of time. If he has Part B secondary insurance, that usually pays at least some of the cost when Medicare stops paying 100%. Again, call Medicare. Do not pay for his costs out of your own money! Use his $ or if he doesn’t have any consult with Medicaid about applying for benefits. If he is a veteran, begin applying for VA benefits.
Your immediate instinct to send him back to the hospital is what I might do if I felt he was not going to get adequate care for the bedsores. They can progress quickly and make him very sick. if caught soon enough and given proper treatment, they can heal but will always have to be managed carefully since they can easily come back. The neglect that this facility apparently operated under has caused a new issue that may prevent him from ever being accepted at the AL level. AL is not set up to handle wound care. Once a week wound care by this facility for what you describe is ridiculous!

I am sorry you are having to deal with this on top of his stroke. A lawsuit will not restore his skin if this spirals out of control, but it may help recover some $. There are other things you can do. Report this facility to Medicare-Office of Inspector General (OIG). They will want as much detail as you can provide about the neglect. The federal government inspects and rates NH facilities because they receive federal benefits through Medicare.
Helpful Answer (9)
Reply to jemfleming

Flan, I would call 911 and have him transported today, then I would file complaints against this SNF, bedspread are a clear sign of neglect and they can get into big trouble for this situation.

Don't try and deal with them, go to DHHS, Ombudsman and Medicare, their treatment of him is criminal.
Helpful Answer (8)
Reply to Isthisrealyreal
Isthisrealyreal Jan 30, 2024
Grrr, spell check, bedsores not bedspread.
"He did not have sores when he went in to the facility, they have happened in the last 4 weeks he has been there." This means they are not repositioning him often enough or they don't have him on the right kind of mattress or both. This is a sign of neglect. Add on top of that the once a week wound care and wounds only getting worse = get him outta there.
Helpful Answer (7)
Reply to SprirtCare
Isthisrealyreal Jan 30, 2024
Wound care once a week? That seems infrequent for the severity of the wound. Years ago I was a PCA for an elderly woman who developed a bed sore and the nurse came everyday to inspect, rinse, repack and redress the wound. Have you consulted a doctor about this?
Helpful Answer (4)
Reply to SprirtCare

The hospital will treat but another stint in rehab paid by insurance may not be possible. They may send him to another nursing home. Costs at 12k are usual and customary. The wounds take months to heal and care is not in ALs scope of practice.
Stop paying for his care. He should be paying and if he is out of funds why was the facility social worker not helping you to file for Medicaid.
Helpful Answer (4)
Reply to MACinCT

First, I don't understand the insurance dropping off after 20 days. Yes Medicare only pays 100% the first 20 days. 21 to 100 50%. If ur lucky, secondary insurance may pay part or all of it? For a 30 day month thats $400 a day. Are u saying daily charges are $800 a day without insurance?

If the facility will not send Dad to the hospital, then you call and have an ambulance sent to take him. Stage 5 bedsores are serious. Seems this SNF is not caring for them properly. I agree, woundcare once a week is not enough. The SNF may not allow him back, good, u can find another place.

You need to find out what the admitting papers say. If it says there were pressure points noted, redness, then they were very aware that those areas should be looked at regularly for any breakdown. Precautions should have been taken. And, as said, once a week woundcare is not enough. I would put inva complaint with an ombudsman. Maybe even sue.
Helpful Answer (4)
Reply to JoAnn29

Bedsores sound horrible. I do not personally see AL in his future. My mom is in AL and I'm quite sure they could not handle someone without use of a hand and leg and is bedridden.

A friend of a friend got bedsores that got infected and became a bone infection. Very hard to treat and this has been going on for a year or more!

You should NOT be paying for dad to be in a SNF. I hope you are using his money, When his money is gone he will need to go to a facility that accepts Medicaid. If his funds are low, apply now.

Best of luck
Helpful Answer (2)
Reply to againx100

First of all I would ask for a mattress change, they make air flow mattresses and sand mattresses that will help combat pressure. Secondly I would make sure he is eating as best as he can. Proper nutrition will help with healing. Thirdly I would ask the nurse over the unit to implement a reposition schedule. Residents/Patients are to be turned every two hours. I would NOT transport him to a hospital with bedsores. I’ve seen way too many residents leave the facility I work at with no bedsores and come back with bedsores or worsening bedsores. I can tell you that they won’t get proper showering or repositioning at a hospital. If he is getting wound care at the facility he’s at then that’s where he needs to be. Making the changes I mentioned above in tandem with wound care will help heal them up. My MIL is a retired wound care nurse and has healed wounds that tunneled down into a persons back side. DOCUMENT EVERYTHING. If you come to visit and he’s on the left and you feel he needs to be turned DO NOT HESITATE to hit his call light or find his aide or nurse they will not care one bit to help you reposition him
Helpful Answer (2)
Reply to JazzyKat9082

I will say that in response to the observation that ALF is considerably cheaper than SNF- there is a reason for that.

All of the things a SNF (not specifically the one he is in - I agree with others - there are issues there). does for the resident are essentially included in the price. (with the possible exception of medications, and additional therapy). ALF is usually a basic level of care between independent and skill nursing - so the expectation is that they will do LESS for him than the SNF. And many of the things that he may need to "add on" will cost extra.

So if you aren't careful - having a resident who needs Skilled Nursing 24/7 in an ALF, where he is expected to met a lot of his own needs, but have the additional help in an emergency or pay extra for an add on - could end up costing more in the long run.

He needs a skills assessment - to determine what level of care he really needs. If all of his ADLs (activities of daily living) are being provided by the SNF and he needs that and can no longer do those things himself- it's going to be extra cost at ALF to do those things for him.

As to the wound care- my FIL was in what we considered a wonderful SNF and they had an external would care specialist that came in once a week to check any wounds AND they had specially trained would care nurses on site 24/7 who were responsible for his wound care. By virtue of being almost 300 pounds and nearly bedridden- he was very susceptible to bed sores/pressure sores. The wound care team took quite a bit of care to ensure that compromised skin never progressed any further. They made sure that all of the staff - even the ones that didn't have the specialty training - were taught how to relief pressure, they got him an air mattress to shift his weight for him.

He may not be a true candidate for ALF, but there are SNF out there that regularly engage in the care of wounds and ensure that they get the care they need.
Helpful Answer (1)
Reply to BlueEyedGirl94

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