My mom is in a SNF and after two weeks they terminated her Medicare coverage saying she did not progress in physical therapy and in their eyes is clinically stable. Her doctor that treated her during her hospital stay disagrees, and even think she deserves to be in a higher care facility as she has an unpredictable, delicate, and complex neuromuscular disorder requiring her to be on two external ventilator devices.
I read a lot of information online in Medicare pamphlets and the Elder Law website that state that Medicare covers patients that need this care to prevent deterioration and keep them stable. We have two instances where she was immediately hospitalized post a drop in care level to illustrate how delicate her condition is.
However the SNF says the internet information is incorrect and that I shouldn't believe everything I read. I don't, and I did a lot of research. Please tell me if this is true or not? I don't trust the SNF one bit, they are rude, and greedy, one of their employees
told us that my mom wouldn't be able to stay long because they lose profit on her for having to rent her devices and they cost $1000 a month.
What is the criteria for continuing on Medicare at a SNF if in their eyes physical therapy has "plateaued"? The info I found said requiring a skilled level of care which she does need, but they claim it's custodial and it doesn't count even though it supposedly does. I'm very confused and really need some facts. The ombudsman sent a volunteer out and she was very biased and rude to me for no reason.
Does Medicare continue SNF coverage for a patient that's in a gray area, her case is not black and white so everything keeps getting overlooked. Is coverage based on physical therapy alone and is plateauing actually a legal excuse even if literature on the web suggests not?
Her doctor says she needs a respiratory therapist to survive and her day and night ventilator and someone to operate it. Supposedly the SNF said that there is some legalese that their RT's can not provide that care, so they have trained the nurses to do it, but because nurses are doing it and not RT that disqualifies her for Medicare. I find this very confusing how that can be a legal loophole?
Please help, I really appreciate any information you can provide. Thank you so very much!