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Old 03-02-2014, 06:25 PM
 
Location: Wartrace,TN
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My father is dying of cancer. He is a veteran and is entitled to VA health benefits. He assumed he would be covered by the VA for medications so he did not purchase medicare part D insurance. The nursing home informed my Mother that all medications HAVE TO come from the nursing home pharmacy and he can not use the medication he can get for free from the VA. My Mother said the nursing home demands the pills be packaged individually in pill packs (like cold medicine is) instead of bottles.

Can the nursing home do this?

Another issue she mentioned in medicare will not pay anything for the 10,000 dollar per month nursing home fee. If he were receiving "rehabilitation" medicare would cover the nursing home. Since he is terminal and can not participate in "rehab" he has to pay out of pocket for the home. My great Aunt was recently in a nursing home but was able to participate in rehab. Medicare paid her nursing home fees even though she was terminal as well.

I wonder why medicare will pay for one individual but not for others? It doesn't seem right. This man worked for 50 years and paid into medicare his entire working life.
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Old 03-02-2014, 06:39 PM
 
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Most Hospital are same way .They have responsibility; so use pills as described. They certainly have right to make rules in their nursing home. Medicare does not pay for anything but limited rehab nursing home. with limit. He would have to go on Medicaid. Some nursing home have hospice centers and some don't for terminally ill. Really sound like your patient isn't on hospice care to me. You could contact VA to see about care they have if in fact is terminally ill or needs hospice.Talk to a social worker in your area.
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Old 03-02-2014, 08:43 PM
 
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The first issue is that Nursing Homes can and many require meds in pillow packs. That is because they consider it safer in avoiding mistakes and it easier to store, dispense an inventory for refill. Also, the major institutional pharmacies that they work with have systems in place with MARS (Medical Application Record System) that simplifies the whole process of medications administration and refills.

If your father is dying. He should be certified for Hospice Care. At that time, Medicare takes over all the care from your medical insurance and is at no charge. The big requirement is that the patient cannot receive any more treatment or meds for recovering or treatment. The meds are only for amelioration of pain until death and that is at no cost.

There are other hospice issue. If you receive hospice at an institution, hospital, nursing home, you are still responsible for board as in the monthly rental cost, even if an outside hospice company comes in to co ordinate care. Obviously these nursing love that arrangement as they continually get paid.

The way around that problem is to have your father admitted to a hospice only facility and then there are no more rental cost for board. All costs, all medications and all care is covered by Medicare.

I had this issue with my mother and put her in a hospice facility even though there were those hospice care companies who wanted to care for her at a nursing home.

The same issue applies if you receive hospice at home, you are still responsible for your home cost.

Some people want to die at the facility where they spend there last time with some friends around or prefer to die at home. However, many at that stage of illness loose awareness and are heavily sedated for the pain of dying.

The issue of Rehabilitation Care is called Skilled Nursing Facility (SNF) care under Medicare and is for a limited duration, where all costs including meds are covered. You can go in and of SNF designation to Long Term Care (LTC) where you pay all the costs, even if you are in the same bed. It is a complicated but essentially you have to meet levels of improvement and can loose SNF designation even if you have not reached the time limit of care under Medicare.

Also SNF does not mean your are receiving skilled nursing care, it is designation of rehabilitation after a certified hospital stay. You may be receiving skilled nursing in LTC but may not be considered under SNF. SNF is pronounced "snif" by the medical industry.

Livecontent

Last edited by livecontent; 03-02-2014 at 09:17 PM..
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Old 03-04-2014, 03:46 AM
 
Location: Florida
19,844 posts, read 19,943,516 times
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Quote:
Originally Posted by livecontent View Post
. The big requirement is that the patient cannot receive any more treatment or meds for recovering or treatment. The meds are only for amelioration of pain until death and that is at no cost.


Livecontent
This is not totally correct.
No measures are taken for the purpose of 'cure' but treatment and/or meds for many conditions other than pain may be given.
For instance, my husband just developed a UTI and he was given everything needed to clear it up(including antibiotics)
Hospice provides the maintenance drugs for his COPD, acid reflux, among others since they improve the quality of whatever life he does have left.
Hospice does not just mean you're on your death bed. Some do, in fact, improve enough to no longer qualify for the program.
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Old 03-04-2014, 10:04 AM
 
Location: Prescott AZ
6,131 posts, read 9,101,023 times
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Yes, my mom, also in hospice in an assisted living facility, continued with meds for urinary tract infection and also her gouty arthritis. We did not use the facility meds. I got them from Walgreens using her Medicare card and supplied the facility when they needed them to dispense. You don't have to be terminal for hospice; you just have to not be getting better and gaining skills.
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Old 03-04-2014, 10:41 AM
 
Location: The Triad (NC)
28,548 posts, read 62,302,713 times
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Quote:
Originally Posted by Wartrace View Post
Can the nursing home do this?
Of course they can. Dad is their patient.
They have responsibility about the "quality chain".

Quote:
It doesn't seem right.
Then move Dad to a VA facility and he can have VA supplied Rx's

Odds are though that even there they'll prescribe and dispense the meds
they prefer to work with (for various reasons).
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Old 03-04-2014, 11:35 AM
 
Location: Denver, CO
9,311 posts, read 5,505,186 times
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It isn't about responsibility of any healthcare facility. It's about the money they make. That's why some hospitals will charge six dollars for a single aspirin, claiming they are covering the cost of scheduling the bedside delivery of the product by a licensed nurse even if a family member is sitting there with full knowledge of when and how to give an aspirin.

Since our nation makes health care a profit enterprise, it's all about maximizing profit for the health care facility and absolutely no concern with the health of the individual. People come out of hospitals sometimes physically better, but with tremendous monetary stress that frequently leads to further deterioration of physical health.

Our entire system of health care is just a gigantic Catch-22.
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Old 03-07-2014, 06:06 PM
 
5,090 posts, read 13,558,822 times
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Quote:
Originally Posted by old_cold View Post
This is not totally correct.
No measures are taken for the purpose of 'cure' but treatment and/or meds for many conditions other than pain may be given.
For instance, my husband just developed a UTI and he was given everything needed to clear it up(including antibiotics)
Hospice provides the maintenance drugs for his COPD, acid reflux, among others since they improve the quality of whatever life he does have left.
Hospice does not just mean you're on your death bed. Some do, in fact, improve enough to no longer qualify for the program.
You have many misunderstandings of Hospice Care. To make it clear, I am giving the citations from the Federal Statutes that governs these regulations:

Meds are not given to cure the conditions that is leading to death but meds are given to amelioration conditions to make the patient comfortable as in palliative care:

"Only drugs as defined in section 1861(t) of the Act and which are used primarily for the relief of pain and symptom control related to the individual's terminal illness are covered."

Palliative care means patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and to facilitate patient autonomy, access to information, and choice.

That would include conditions to treat gout, arthritis etc. and any all conditions that cause pain and suffering.

However, the patient is on their death bed because in the US, per medicare rules, the patient has to certified by a physician that:

"The certification must specify that the individual's prognosis is for a life expectancy of 6 months or less if the terminal illness runs its normal course."

Yes, some people live longer than 6 months and some people recover from their terminal illness but that does not mean that they were not in the condition of dying. Patients can also go in and out of hospice defintions as the their condition changes.

Terminally ill means that the individual has a medical prognosis that his or her life expectancy is 6 months or less if the illness runs its normal course.

You can use all the euphemisms you want but if one is in Hospice it means that one has a terminal illness and one is dying. Harsh that may be to many, but that is Hospice Care, in the US.

Treating an infection is not to prolong the patients life but to provide protection to patient, family and caregivers during the period of hospice care, so an infection does not spread and cause more disease. Obviously you would have to treat the patient, the source of the infection:

"418.60 Condition of participation: Infection control.

The hospice must maintain and document an effective infection control program that protects patients, families, visitors, and hospice personnel by preventing and controlling infections and communicable diseases."


Italic references are to 42 CFR Part 418 Hospice Care

These issues are complicated and cannot be totally explained in this post. All that is in the Federal Statutes and there are interpretive rulings by CMS(Center for Medicare Services) and the Secretary of Health and Human Services. So, if you really need to know the full issues, you must go to the regulations that govern hospice care.


Livecontent

Last edited by livecontent; 03-07-2014 at 06:42 PM..
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Old 03-07-2014, 06:29 PM
 
5,090 posts, read 13,558,822 times
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Quote:
Originally Posted by PhxBarb View Post
Yes, my mom, also in hospice in an assisted living facility, continued with meds for urinary tract infection and also her gouty arthritis. We did not use the facility meds. I got them from Walgreens using her Medicare card and supplied the facility when they needed them to dispense. You don't have to be terminal for hospice; you just have to not be getting better and gaining skills.
Absolutely wrong; read my previous post ^^^^

In addition your are confusing Hospice with skilled nursing facility,, SNF, rehabilitative care under Medicare. If one does not improve under SNF then one is move more likely to LTC,, long term care, but one can be move to Hospice care designation from SNF, which means you are terminally ill.

Livecontent

Last edited by livecontent; 03-07-2014 at 07:49 PM..
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Old 03-08-2014, 03:12 AM
 
Location: Florida
19,844 posts, read 19,943,516 times
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Livecontent
You can post and interpret what you post all you want.
My husband is with Hospice so, if it's OK with you, we'll go with the reality.

As to why infections are treated....your reasoning is a bit silly. All infections are not spreadable.
What you posted is saying that a program must be in effect that controls communicable diseases /infections .
IOW, just because they are not a hospital doesn't mean they can ignore following the same type of sanitary procedures.

Your bolded statement ""in Hospice it means that one has a terminal illness and one is dying."" left off something in the quoted portion that is important......"life expectancy is 6 months or less if the illness runs its normal course."
It's standard procedure that after the first 90day period and then every 60 days thereafter, one must be recertified .
That alone highly suggests that there is no dependably definable "normal course".
And, BTW, all of the rules governing Hospice pertain only to the qualifying condition. All other events or illnesses are handled the same as with anybody else.
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