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I have had several negative experiences with discharge planning from case managers in the hospital. What if the source of it: insurance companies, DRGs, risk of senior catching infection or sense of institutionalism if left in the hospital longer, etc. To me, it appears they want the senior out as soon as possible.



Issues I came across:
1) One documented I agreed on the short-term facility. I never agreed on that facility.
2) One told me the health care proxy was responsible for signing all admission paperwork. Believing her I did these tasks only to find out later from my elder attorney, I was not responsible for signing all these papers.
3) One told me there were no short-term rehab facilities open except for one. I called around and found others who had open spots. The discharge planner/case manager became furious I did this and double checked her work.
4) A doctor documented he spoke to me (the HCP) for 30 minutes as well as did education. He never spoke to me. (I filed a complaint with the Patient Advocate).
5) One told me the official discharge date was Friday. Because there appeared to be so much misinformation occurring, I filed a complaint with Kepro who did an investigation. The told me there was never an official discharge date written in the chart; thus, my parent was not due to be discharged that friday afterall.
6) Two let another family who was not a HCP decide the facility,



A really good social worker told me all they want is a signature.....

The doctor doing what he did is fraud. If the patient is Medicare call them. If just Insurance, call them. A friend of mine was unconscious from surgery. He was billed by a doctor he had never seen. He checked it out and found this doctor had not even been consulted. Seems he walked into friends room and claimed they had talked. This is fraud.

As Healtcare Proxy not sure if you pick the facility. If Rehab, yes Medicare will pay 100% for 20 days but after that only 50%. So that means either supplimental insurance picks up the 50% or the patient pays it. At that point the Financial POA has the choice because they need to guarentee that the patient has the money.

The responsibility of a HCP is limited. You carry out Lzos wishes. If a medical decision needs to be made not covered by the proxy, you make it based on "what would LO want". You talk to Doctors and staff. But anything to do with finances, like who is going to be responsible for the bills, is the Financial POA. Because thats the person who knows how much money the principle has.
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Geaton777 Jul 8, 2024
Many years ago when my 96-yr Grandma was hospitalized, a psychiatrist stuck her head into her room and asked my Grandma, unconcious and not an English-speaker anyway, "How are you doing today?" Then she billed Medicare for that (my Mom was in the room at the time). Total Medicare fraud, or at a minimum "opportunism".
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The hospital may have a partnership of some kind with the short-term care facility. I'm not a fan of these types of partnerships and they may even be borderline kickback schemes in some instances. They shouldn't lie-by-omission about it by telling a patient or HCP that there is nowhere else the hospital can find a spot for them. We don't know if that is what happened to you and your loved one, but it is possible.
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SummerHope Jul 9, 2024
I have questioned this. I asked a geriatric case manager in the area if this occurs--she said no but if they get kudos for honestly referring a patient for example describing their condition well. I appreciate your feedback and will ask them in the future if there is a partnership.
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Are you your LO's PoA? If so, is the PoA active? From what you describe it seems there is confusion over who is the decision-maker. I always take the PoA paperwork with me, plus the letter of diagnosis in case there's any doubt. I never make an assumption about who knows what info accurately, or if they are communicating with each other. I get that it is frustrating and exhausting. People are poorly trained or don't have common sense or any problem-solving skills, no less "customer service" attitude.

Hospitals run based on a financial business model. They don't want to keep people in who don't have enough (or any) insurance, especially if they are taking up staff "resources" (time and materials). Hospital ERs are chaotic places, with patients often staying longer than most staff shifts.

My son's ex GF is now a nurse. She is as dumb as a box of rocks. It puts shivers down my spine to think she's working in a hospital. Especially my Mom, an RN with 40 yrs of experience who has nothing good to say about most modern-day nurses and hospitals.
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JoAnn29 Jul 8, 2024
My boss was 65 when she retired in 2006. She had a BS degree in nursing. One of our RNs picked up a second job at a NH. She had to do medvpasses. She complained about it and Boss asked her if she did them in Nursing school, answer was no. My DD started out as an LPN working into RN. She says RNs are not trained to work hands on with patients. The are usually Administrators. They now have CNAs and LPNs to do the dirty work.
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