By Jack Halpern, CEO, My Elder

My Elder shares a rude awakening for those who have Medicare HMO.

Absolutely. Last year during the health care reform fight in Congress, Republicans and members of Tea Party were very vocal about the government using “death panels” to decide which elders will live and which will die. Of course the new health care reform act had no such provision, but the phrases “death panels” and “killing granny” really struck a chord with elders on Medicare.

The following story should be a rude awakening to millions of our elderly in the US, who have Medicare HMO Policies.

Linda Todd spent three weeks in a New York Hospital with a blood disorder, and suffered from complications resulting from obesity (she weighs 390 pounds). In the hospital she began to lose weight and get some rehabilitation. She required a lot of specialized care, which the hospital did not want to continue. The discharge planners began to pressure Linda’s husband to place her in a nursing home for rehabilitation and continued care.

There are very few nursing homes in New York that can handle residents like Linda. Residents and patients weighing 350 to 750 pounds pose special challenges that most facilities are unequipped to manage. Providing appropriate nursing home care to residents who have obesity requires environmental modifications, specialized equipment, and staff training. Effective nursing home care of residents who have obesity is interdisciplinary and requires special nursing, medical, nutritional, psychosocial, and rehabilitation considerations.

Most of the facilities that provide these programs receive a high reimbursement while they don’t provide any care close to meeting the above criteria. They are hellholes for all residents, let alone for those requiring specialized care.

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Ms. Todd’s discharge planner sent her paperwork to ABC Rehabilitation Hospital in New York. ABC Rehabilitation Center is one of the leading centers for rehabilitation in the country, and they also have a rehab program for obese individuals. Linda was accepted at ABC. Her HMO (in this case, not a Medicare HMO) approved admission to ABC Rehab.

Unfortunately for Linda and her family, the hospital discharge planner also sent paperwork to XYZ Nursing Home (one of the worst nursing homes in the country). This nursing home’s program for obese people is sub-standard and does not meet any of the criteria above. There is no interdisciplinary approach to care, no specially trained nurses or physicians, no specialized rehabilitation or psychosocial services. NO SPECIALIZED DIETARY SERVICES! Yet this nursing home claimed that it could handle Linda’s specialized needs.

Linda’s HMO was informed that Linda was accepted at XYZ Nursing Home (at a much lower cost) and withdrew permission for her to go to ABC Rehabilitation Hospital.

Despite appeals (with strong warnings from My Elder concerning the unsuitability of XYZ Nursing Home) from all concerned (even the hospital), the HMO would not allow Linda’s admission to the place she needed the most.

DEATH PANEL!

There is a happy ending –– this time. My Elder was able to convince XYZ Nursing Home (very forcefully) that they could not really handle Linda and it was not in their interest to accept her. The facility refused to accept her, opening the way for her admission to ABC Rehabilitation Hospital.

So if you are in the hospital and it is determined that you need rehabilitation and you are told that you have to go to an inferior facility because your Medicare HMO is not contracted with the best, your life is in danger. You need My Elder immediately.

My Elder provides elder advocacy services to families. Talk to us about long-term planning, finding the right home for your loved ones, preventing crisis and abuse, and ensuring they receive the best care possible.

If you have one of these terrible policies call MEA and we will advise you as what to do.
More on Medicare HMOs in future posts.