LTC - virtual assessment today - pitfalls to watch out for?

LovingAwareness

The LTC company set up a zoom call with a nurse from their subcontractor and we need to take the call on a cell phone in Dad's room at memory care.

The MC director of nursing is irritated that they won't just accept her care plan and forego the assessment. She is tied up with a COVID outbreak in the facility. (Yes, the rest of the world moves on and unmasks, so I can understand why she would be irritated this week.)

For anyone who has done this LTC assessment before, Dad's policy states he needs at least 2 out of 6 ADLs, and as I understand it, the help needs to be hands-on, not just cueing. To the LTC co., I think cueing equals just a reminder. So even though Dad won't eat his food unless somebody says, eat your food - otherwise he'll just get involved in folding his napkin and not eat - the LTC co. doesn't care - they want to see that somebody is actually picking up a fork and putting the food in his mouth. And I don't think the MC is doing that. So he won't qualify on eating. 

So he has hands-on for dressing, bathing and continence. It should be a no-brainer. But I fully expect the assessment company to help the LTC co. keep Dad's money if they can. Is there any way to head this off at the pass during the call? Should we insist that they give us feedback as to where we stand during the assessment and record it on our end? 

I don't think we can rely on "severe cognitive impairment" due to dementia - even though that should also be covered per the terms of his policy and he scored 8/30 on his latest MMSE - I just see that as a giant gray area that they will gloss over if they can. I feel like we need to rely on getting 2 or 3 of the 6 ADLs, and WE know the truth that he is hands-on for them. How to make it undeniably clear on the assessment call though? They'll ask him, 'do you need help in the shower?' and he'll say no. Anosognosia. And then I'll say, "oh no, I squat down and get covered in water while I wash his feet, and I put shampoo in his hands and then guide his hands to his head and start his hands massaging the scalp because otherwise he doesn't know what the shampoo is for." At that point, are we good?

Did you coach your LO prior to the assessment - urge them that they're not trying to "pass" the test, it's okay to admit that they need help, or even ask them to please not bring their A-game?

I'm so nervous about this, even though I know we're right and he should qualify.

SusanB-dil

We had no way of 'coaching', as she had no idea what would be going on, anyway.

It sounds like you should be ok, but do keep in mind that even if they do 'deny' you at the moment, you can refute the finding, and also get his doctors involved.  If necessary, even lawyer.

Please post that all went well... !  (fingers crossed and we hope so)

LovingAwareness

Thanks, SusanB-dil, it went fine. It was just the MMSE, and he got, at most, 4 points, so I would think that would about do it. Then a lot of questions for us about his history and his ADLs; and then he had to demonstrate walking to his bathroom, at which point he had a dizzy spell and almost fell down, so the nurse cut the physical activities part a bit short and just had him take off and put on a shoe and sock and put on a jacket, which he did by himself, but mind-bogglingly slowly. Then a final series of questions for us about his delusions, orientation to family and friends, social behaviors, etc. Then he told us he believed Dad does need assistance and is where he should be and he'll send the report to the LTC company by early next week. 

It's a big relief to have it over. I hope that he met the cognitive impairment aspect so obviously that the proof of ADLs was just a formality. He only needs one or the other - severe cognitive impairment or 2 ADLs. If 4/30 on the MMSA indicates severe cognitive (I think it's less than 10 is considered severe), then it seems like it should be a pretty open and shut case. But that's just my opinion and I don't know their policies or if they deny everything initially just to see who will go away. I guess we'll find out soon if it's approved or denied. 

Anyway, my fears that he would bring his A-game were unfounded. I don't think he has his A-game any longer.

ButterflyWings

LA - so glad it sounds like things went well, but it really is such a topsy-turvy world we caregivers live in, where good news can also make you want to cry, right? I mean, I understand that sinking feeling when you see your LO fail dismally and realize...that actually was his "A" game.

I'm reminded of when "we" were filling out a lengthy form soon after diagnosis. I tried to just sit next to DH while he took the lead on things like name, address, and lots of other basics that required no judgment, just memory for the most part.  You know like the intake forms at a new Dr's office. And your appointment can't commence until you finish filling it out, lol.

I had to gently prompt and remind at several points about the most truly basic facts that he used to know in his sleep...and back then I was still feeling my way as to how to provide this kind of support without him bristling indignantly, or feeling less than (followed by hours of "cold shoulder" afterward). That simple application task was so hard for him and it was such an eye-opener for me. But after taking forever to get to the end of the full page of questions, he breathed a sigh of relief - proof of how hard this highly educated man had been working just to fill out a basic form. Imagine the anxiety he'd been experiencing. It was clear he felt accomplished and super relieved to get through the task. 

Then, we turned it over and saw there was another entire page to complete. His shoulders physically slumped and he sighed again, but with a totally defeated sound. I could literally have cried for him right there on the spot. Instead I fake cheerfully scooped it up with a "great job, my turn now, we're almost done, you did the most important part, etc., etc." but that was pre-anosognosia so I don't know if it made him feel better or not.

It sounds like you got feedback during the assessment, that your LO "passed", and LTD funds will be released. Sad, but also good if so. Thanks for the update. Fingers crossed for you all.