Arghhhhhh
I just keep hitting road blocks, the area agency on aging called, dw is medically approved, her pae was accepted. So she can get tn care choices. I called the sw about sending referrals to the 2 nursing homes that I have checked out, he won't send them because she doesn't qualify on a passr.
Qualifying means she has to have some deficit, incontinence, not ambulatory. Ect
Whatever, I am so frustrated it's looking it is gonna have to be respite care. Nothing makes any sense to me. So I can search for all the medicaid places but unless they will take a wandering woman in al which has been a major road block so far. I really am almost ready to quit and bring dw home. Not by choice. It's the fancy place or nothing.
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Understood.....nothing goes 1-10. It goes 1-4-8-2-5-9-7-6-3-10.0
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Stewart, I’m so sorry you are having to go through all of this. You shouldn’t have to jump through so many hoops. I was going to send you an article by private message, but my inbox isn’t working for some reason.0
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You realize that the obstacle course to getting services is not a bug its a feature of certain stats that want people to leave rather than provide care .
Tennessee was ranked 44th out of 50 states in elderly health care (2016)
https://www.caring.com/senior-living/tennessee
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Florida is even worse, ranks lower on most scales. I’m not so sure they want you to leave per se, but they sure don’t want to provide services. God help anyone who comes here thinking otherwise. There’s data showing many if not most newcomers and primary voters (who elect the people who decide to provide) actually do not need those services.
But so many people don’t understand the distance between “qualifying” for help, and actually being able to “get” that help. As in, you may qualify for Medicaid housing, but that doesn’t mean you will find available rooms/facilities.
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toolbeltexpert wrote:
Qualifying means she has to have some deficit, incontinence, not ambulatory. Ect
Does this mean it's a criteria from the facilities that must be met? If so, there might be others who have relaxed criteria. I'm sorry things have to be so complicated for you. When people need help, they need help. Not another maze to work through.
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RED ALERT: At least after a bit of research, I think so. This PASSR criteria makes no sense or logic out of what you have been told and what exists in re to your wife's dementia. The Social Worker you have working with you may not be well informed or accurate at all and not skilled at NH, ALF, MC transfers.
Dementia does not fall under the PASSR criteria unless the person has an actual primary profound/severe mental illness. Here is a link regarding the PASSR qualfications AND as you can clearly see, the PASSR is only for Mental Illness or significant developmental disabilities. It distinctly states that is is "NOT FOR A PRIMARY DIAGNOSIS OF DEMENTIA INCLUDING ALZHEIMER'S . . . " See attachment - keep scrolling down and you will see the two page questionnaire re the PASSR criteria. I think that SW is way off base using severe mental health impairment rather than dementia of Alzheimer's as the primary diagnosis. The PASSR was to help keep the severely mentally ill from being inappropriately warehoused.
https://files.medi-cal.ca.gov/pubsdoco/publications/masters-mtp/part2/preadmis.pdf
The PASSR info details what mental illness is; and it is not dementia. Nowhere could I find that a person with dementia must fulfill a PASSR in Tennessee to enter a care facility under Medicaid; in fact in what I read, it is always stated that that the diagnoses requiring PASSR criteria to be met does NOT include dementia.
Here is a guide booklet to Long Term Care In Tennessee:
https://www.thca.org/files/2019/06/guide-to-long-term-care.pdf
Here is Tennessee's exemption from PASSR for Dementia:
(d) Exemptions from Level II Review
An individual who has a diagnosis of mental illness or mental retardation will be exempt from the PASRR process if they meet any of the following criteria:
1. Dementia - This must be a primary diagnosis based on criteria in the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition; or it may be the secondary diagnosis (including Alzheimer's disease and related disorders) as long as the primary diagnosis is not a major mental illness. The primary or secondary diagnosis of dementia (including Alzheimer's disease and related disorders) must be based on a neurological examination. Dementia is not allowed as an exemption if the individual has, or is suspected of having, a diagnosis of mental retardation.That comes from this link:
You are going to have to be best served to raise this issue AND it would be helpful for you to clearly and succinctly address this with perhaps different Social Worker perhaps at the Dept. of Aging, or other entity and you can also speak to the most desired care facility staff such as the DON or the supervisor of admitting. I am willing to bet that the PASSR is nothing you have to be concerned with since her primary diagnosis is Alzheimer's Dementia.
Your wife cannot perform all her needs that must be met; she is a wanderer; she is unable to use logic and reasoning for her own self; she is no longer competent to format her own plan of care; she has had increased functional limitations within the last six months; she is unable to concentrate or have persistence for her own care needs, she has fears, her interpersonal abilities are no longer as they have been; she needs 24 hour care for her own safety; she gets agitated . . . and so on.
Okay; here is the other thing. To be successful you MUST not speak as though can and are willing to take her home. How old are you? How healthy are you and how are you able to deal with 24 hour care needs? This placement is NOT a temporary respite for the caregiver; the caregiver husband CANNOT care for her any longer as the care needs are too high an acuity. You will need to be clear about this and let them know that you are unable to care for her. Any slight intimation that you can take her home is going to scuttle your goals.
Okay. It is a good start to get some input from someone who knows better and far more than the social worker you have been working with. It is also okay to let him know that you have received information re the PASSR and now understand that dementia is clearly NOT required to pass PASSR and this is clearly written in the PASSR laws/rules.
Good luck and always, always check and double check when you are told something so off the cuff. Perhaps I have been reading with a blindfold on, but I do not think so. I specifically used Tennessee and PASSR together, so it is state specific.
Good luck,
J.
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Stewart, it is a concern that the SW may be feeling that you are asking him to do too much as family is expected to do a lot of the heavy lifting for the screening and calling. That may not be so, but it is a thought and I have seen that happen to others within my profession. I would hate to think he is avoiding you and hopefully he is not, he is the only SW for the entire psych unit. If you find out the following information is true, I would report the SW once your wife is safely placed in a care facility after discharge. This has caused significant problems for you and affected you personally including your health through the stress levels, and if it has happened with you, it is probably happening with other families too. It would be best to eventually have it addressed so the SW can be adequately educated.
It is true that many if not most MCs are licensed under ALF licensing. That is why they sometimes will not take significant wanderers, etc. if they do not have fully secure units. Many will not take persons who cannot get to the dining room to eat and will not do incontinent changes; others will, some will take the non-ambulatory, others will not. It does however beg the question about lacking secure units as you have encountered, as nearly all the MCs are indeed secure with locked or otherwise secured doors.
How are you presenting your wife; if you are presenting her as a large problem issue, it may be inadvertantly creating a bit of difficulty for admission acceptance. If she is a normal walking about wandering sort of person with dementia, that is expected in most circumstances which is why the MCs are pretty much all secure. In fact, I personally, and professionally have never seen one that is not.
So hope you are not eliminating places that are workable as they are not your primary private pay preference. I can understand how hard that must be. The four bed room was not a plus; that is not good for persons with dementia considering behaviors and need for routine and structure. A two bed room can work if the persons are reasonably compatible together. A private room is a huge plus but not as available in many facilities. You will need to make an accommodation soonest for what you are willing to work with. If you are not happy with the accepting facility she will at least be safe and secure until a bed opens at a facility you are more comfortable with.
Other than that, it is home with all the emotional and behavioral triggers and you to provide all 24 hour care as well as full time oversight so she remains safe. It will mean some modification of home for security and the ability for it to be sustainable and that can be done. The operant word, sustainable; if this is your choice it may work with some willingness to adjust and adapt as needs be. Best wishes with any way you choose to go; may it all work out better than you have anticipated for the both of you.
J.
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Just another brilliant and invaluable post by Jo. Thanks so much for being so helpful!!0
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Jo is spot on Stewart. You need to ask to have a different SW involved if this is the same one that youve been dealing with all along. Clearly not competent. And again: she's right on the other point too, you CANNOT care for her at home and you need to quit intimating that you can.
CHOICES will Not be adequate for her, I can tell you that right now.
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Stewart just letting you know I'm thinking of you. You've been through a lot. I was trying to send you a message through my connections, but like ImMaggieMae my inbox isn't working either. Just stay strong my friend.0
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Wow I could have used that 2 weeks ago Jo Thank you. I did call the SW with 2 places that would swap to Medicaid, No he said , so I called the AAA d and the nurse who got DW approved called him, then the SW called me back telling me he might get her a facility on lcf at 9000 a month he asked me about my spend down I told him 9k is more than my spend down. He still hasn't sent my choices any referrals. I gave the SW and assisted living memory care one I had researched they do not transfer to Medicaid but they are working to get it.I was only a mile away so I stopped in to tell them that when and if they get approved to do Medicaid I want on the list now. So the nurse that does the admissions told what they had right now in respite, I do know it doesn't transfer, she listened to my Dw case and how it's gone, she could not believe what was going on, I guess something struck a cord with her and she wants to make me a deal on the respite room 3675 per month all inclusive for 2 months, also shes gonna help my Dw get into a place with Medicaid. I was blown away. So she got a referral from the SW and she will review it first thing tomorrow morning. I think I am going with it. that will finish my spend down. This is not my first choice but right now it's my best one if I am not bring DW home. The only facility the sw did get that transfer to Medicaid is the one where there were several folks wander the unit looking for their rooms, and all the cna"s were outside smoking with no staff on the floor. Sorry that's is a setup for predation, abuse and neglect.
I don't know how to thank you all especially Jo C. I am almost afraid to say anything to the SW! The good news is, I got 2. 17 page letters tonight from Tenncare asking for more information on our TN care app. seems they sent the letter before the pae was approved so now she is denied till they get that pae, the one they approved. and they want more info on unearned income. Must be something to do with bank interest? AAAD here I come.
I have heard many folks say you know when it's right this feels right.
I am studying on Transfer Trama which happens when you move a pwd and how to minimize the decline with very simple strategies. I also learned that was happened to me when DW left the house I got sick for 8 days, well worth the read. I post a link at the bottom. I am also writing Judy's bio for when she changes. all the stories fun times, crafts, food ministry, Judy and I started a food ministry that is still going today. "I' had to quit doing it, that was my of help DW back out, I had to leave completely or she would have tried again. She couldn't make a couple food boxes in 1 hour, I hated that so much. She had a passion for the elderly and just took to older folks that were older than DW. We did that more than 10 years every Friday evening and Saturday morning there by 6 am.
Tonight I do not feel as stressed.
worth the read
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I’m not sure, but is there a communication issue with this social worker and you? I absolutely cannot tell what kind of placement you are looking for for her from your posts, and you are describing the SW only looking for AL and you are insisting on MC. Meanwhile, you are pursuing TennCare, which is TN’s version of Medicaid, so that is part of the mix too.
Now, you are saying it’ll have to be respite. I don’t understand any of this. There should be a patient advocate at the hospital. Please ask the nursing staff for this office and ask them to get a different social worker for you, to find 2 or 3 facilities that will accept her on TennCare for permanent placement from the hospital so you can choose. It may not be one of these facilities you have been talking about before.
As Jo said PASSR does not apply here.
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Stewart, what is a,"pae," and what is an, "AAAd" and "lcf" - the abbreviation definitions are eluding me.
Something in all of this feels not right and seems skewed and "off base,:" Stewart. I so wish you had a private Geriatric Care Manager or private Advocate working with you, but that can be expensive and I do not know if such a private professional is even available in your area.
Something in all of this is just not computing so to speak.
As another Member has mentioned, it may be a good idea to contact the Hospital Admin. Office and ask how to reach their Patient Advocate. This person can be of assistance and you can even ask for a different Social Worker to assist re the transfer and see if that is a possibility. However; most of the placement outreach will be expected to come from the family. Do you have a close family member nearby who may possibly be able to assist you?
Here is a concise explanation of a Patient Advocate, and it outlines the job of such a person in hospitals:
https://www.tricare-west.com/content/hnfs/home/tw/bene/res/hospital-stay/patient_advocates.html
I have another question Stewart, and it is honestly asked with all respect and caring. Do you have a health condition or perhaps have medication or other supportive product that may be affecting ease of thinking and processing? Do you feel sometimes that you are in a situation that cannot be processed except with the greatest of difficulty and attention and striving to understand and move forward? Is it difficult to stay on path? I also respectfully ask if you are you using more of the gummies of a,"substance," than you had been doing in order to deal with the stress?
I ask because the logic of a lot of what I read seems to be puzzling and I have concern for you regarding the situation and how it is playing out. Sometimes it feels like a ball of tangled yarn. I understand how hard you have been working at all of this and trying to make it come together; yet there seems to be a sort of discordant dissonance within the dynamics. That may just be me, though - perhaps I am quite off base.
Stress and lack of knowledge can certainly contribute to this, but it all seems so much more convoluted than it needs to be. I so wish you had another strong person to assist you in all that is transpiring and am sorry for all that has been happening.
I so hope you do not take offense at my query, it is not meant to do so and I do understand how deeply and significantly stressful this must be for you in so many ways and as many here who are communicating with you; we truly do care.
As for the care facility setting you saw with a patient looking for their room and not seeing staff and feeling upset that an aide was outside with residents - that was a one time snapshot and could perhaps not be the usual in that facility. Why not return to make a second visit? You can even make an appointment with the Director to be taken on a tour and have their care and programs explained. By the way, Stewart; did you actually see the aide smoking a cigarette outside? And if so, could that aide have been on a break? So many questions. I do feel for you in that you have so many negatives about every facility except for the fancier one that is only private pay which is not sustainable financially for you.
Stewart, when a facility applies to get on a Medicaid program, that can take nigh unto nearly forever to get completed. One cannot think it will happen in a few months. And if one applies for a LO to become a resident in such a facility, hoping that Medicaid will be approved as a program for that facility which at that point does not have such a program, it does not mean the facility will always be successful, so once again, "pie in the sky," may be an issue. In such a situation, if you are expecting to pin all of your hopes on this, you would be best served to make an appointment to speak to the facility Administrator and ask him/her what stage the Medicaid facility application is in. If they are almost complete, that is one thing. However, anything else leaves much up in the air for your long term needs, so actual, factual knowledge in this situation is really important. You cannot expect the words of a different "line" staff member to be accurate information.
We cannot do much from afar, but we can listen and we absolutely do care.
J.
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Thanks Jo c and d2n I am glad that you are where I am confused, cause I have been trying to get DW placed in a Medicaid facility GOT IT! The two referrals I asked the SW to send were both Medicaid with personal pay to start! the SW says she doesn't qualify on the PASSR. Like I said I had the lady from the AAA d called him, he still doesn't get it. The area agency on aging and disability is the AAAD. LCF was a type of bed in a skilled nursing home, why he thinks she could go there is beyond me. IF you are confused I get it so are all the other people I talk to. So why respite, cause she is coming out next Monday one way or another and I can't get her in a facility that takes Medicaid. Jo the place I talked about is 90 miles from home, the ones I asked to get referrals sent to are 34 and 40 miles and have a bed. So unless I can get the SW to do what I need, I can't do anything else. She is not coming home.I have been fighting this for a month, Jo c I have called and asked those questions you gave me I keep my mouth shut unless ask. I feel sad for my wife and now covid, yep I am wore out. but I pick my feet up every day and try. I may have to try the hospital admin? I am trying to be extra nice to the SW, kill em with kindness. Some of which I got from the lady who offered her help with respite she can she how desperate I am getting ,she used to be a SW she's got 30 years into this and wants to work in a place where she can make a difference, I really prefer to stay on point. Thanks Jo c I will be addressing this somehow today. what would you do is what Jesus asks. I need solutions.0
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Stewart: I'm with day2nite, what you are saying IS in fact very confusing. Maybe you're just rambling here because it's a safe place, but you're not making a lot of sense. For example: "she's coming out Monday one way or the other"--that's nonsense. She may still be symptomatic with covid next Monday. Or still testing positive. So i can't tell if you are imposing these things on yourself, or if the SW is feeding you a line.0
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Go to the hospital today ( you will not be visiting) and ask for a Patient Advocate at the information desk. Stay there until they come and get you. Tell the Patient Advocate you need another SW now, the current one has wasted time and you need to determine where DW is going by 5pm tomorrow. Keep repeating this.0
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Jo C. wrote:I think the AAA-D might be Area Agency for Aging and Disability ?
Stewart, what is a,"pae," and what is an, "AAAd" and "lcf" - the abbreviation definitions are eluding me.
Something in all of this feels not right and seems skewed and "off base,:" Stewart. I so wish you had a private Geriatric Care Manager or private Advocate working with you, but that can be expensive and I do not know if such a private professional is even available in your area.
Something in all of this is just not computing so to speak.
As another Member has mentioned, it may be a good idea to contact the Hospital Admin. Office and ask how to reach their Patient Advocate. This person can be of assistance and you can even ask for a different Social Worker to assist re the transfer and see if that is a possibility. However; most of the placement outreach will be expected to come from the family. Do you have a close family member nearby who may possibly be able to assist you?
Here is a concise explanation of a Patient Advocate, and it outlines the job of such a person in hospitals:
https://www.tricare-west.com/content/hnfs/home/tw/bene/res/hospital-stay/patient_advocates.html
I have another question Stewart, and it is honestly asked with all respect and caring. Do you have a health condition or perhaps have medication or other supportive product that may be affecting ease of thinking and processing? Do you feel sometimes that you are in a situation that cannot be processed except with the greatest of difficulty and attention and striving to understand and move forward? Is it difficult to stay on path? I also respectfully ask if you are you using more of the gummies of a,"substance," than you had been doing in order to deal with the stress?
I ask because the logic of a lot of what I read seems to be puzzling and I have concern for you regarding the situation and how it is playing out. Sometimes it feels like a ball of tangled yarn. I understand how hard you have been working at all of this and trying to make it come together; yet there seems to be a sort of discordant dissonance within the dynamics. That may just be me, though - perhaps I am quite off base.
Stress and lack of knowledge can certainly contribute to this, but it all seems so much more convoluted than it needs to be. I so wish you had another strong person to assist you in all that is transpiring and am sorry for all that has been happening.
I so hope you do not take offense at my query, it is not meant to do so and I do understand how deeply and significantly stressful this must be for you in so many ways and as many here who are communicating with you; we truly do care.
As for the care facility setting you saw with a patient looking for their room and not seeing staff and feeling upset that an aide was outside with residents - that was a one time snapshot and could perhaps not be the usual in that facility. Why not return to make a second visit? You can even make an appointment with the Director to be taken on a tour and have their care and programs explained. By the way, Stewart; did you actually see the aide smoking a cigarette outside? And if so, could that aide have been on a break? So many questions. I do feel for you in that you have so many negatives about every facility except for the fancier one that is only private pay which is not sustainable financially for you.
Stewart, when a facility applies to get on a Medicaid program, that can take nigh unto nearly forever to get completed. One cannot think it will happen in a few months. And if one applies for a LO to become a resident in such a facility, hoping that Medicaid will be approved as a program for that facility which at that point does not have such a program, it does not mean the facility will always be successful, so once again, "pie in the sky," may be an issue. In such a situation, if you are expecting to pin all of your hopes on this, you would be best served to make an appointment to speak to the facility Administrator and ask him/her what stage the Medicaid facility application is in. If they are almost complete, that is one thing. However, anything else leaves much up in the air for your long term needs, so actual, factual knowledge in this situation is really important. You cannot expect the words of a different "line" staff member to be accurate information.
We cannot do much from afar, but we can listen and we absolutely do care.
J.
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M1 your right about her being discharged. Maybe I am putting the pressure on my self but the SW has made it clear Monday, he even asked one of the assisted memory care places he sent a referral that doesn't have a Medicaid transfer if they could do it on Sunday They told me that! they said no. Rambling maybe?I am going to the area agency on aging and disabilities and the lawyer then to the Hospital admin if need be. But when all is said and done she will be in a facility when she is released period.... I would prefer it to be a nursing facility just 10 miles from my home but SW says she doesn't qualify today that's gonna change one way or another. They have an opening and have said just send the referral. I really don't know if anyone out here gets how frustrated I am, and some comments have not been very helpful to me while others are pure joy. I take it all with a grain of sand. I have been doing as much of the heavy lifting for the SW cause I want what's best for DW he just won't move. Just left a message with the CELA who is an expert in all these matters.
Maybe I should just stay off here till I have some JOY in this.
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I can see that some comments would not be helpful TBE. You are doing a great job, and it will all be sorted out eventually. One day at a time…0
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I think what might be considered "unhelpful" are merely clarifying questions trying to figure out where the disconnect is occurring, because TBE is on 1 page, the SW is on another.
If anything I said is regarded as "unhelpful" you can be assured I decided after my last response that I would not reply further, as if I, with lots of experience in the flow of a hospital stay and discharge, cannot figure out where the issue is, then I simply am missing the key to help me understand what is happening here.0 -
I had fallen asleep on top of the guest room bed, reading a book earlier in the evening and abruptly woke up in the wee hours. I was awake and not going back to sleep at that point. My Post was written at 3:45 a.m. Somehow, my conscious self was still a bit addled because I did not notice that the first line I had typed in my Post was no longer there. Having a line or an entire paragraph disappear sometimes happens here.
Anyway; my first line that should have still been there, is that for the particular Post being written, I was takng off my Peer Volunteer hat and speaking as a Member only.
You must be exhausted to the core, Stewart. Good to hear that you are getting to people who are in a position to make a difference for assistance. Your attorney, if beneficent, can even make contact for you, often done in writing, and put the fear of YIKES! into the staff involved in the situation.
I do wonder; you mention three different facilities that asked to be sent a referral for your wife and, "the SW did not do it." Can you not make that referral yourself? The care facility can call the SW themselves and do an initial screening as they wish, and the transferring patient always comes to them with a detailed written set of information on patient abilities and issues/needs, and a listing of medications as well as any discharging physician orders. That is mandated.
You can still make the referrals and explain the SW has been lax re sending the referrals and ask the care facility licensed staff if they can make the call to the SW in order to facilitate the information they need.
So hoping for the very best. If there is an Advocate in the medical center your wife is in that you can speak with, be sure to explain the significant erroneous PASSR error the SW has made which has been the cause of delays and errors in appropriate planning. In my professional experience, I have even seen angry, frustrated family in the Administrative suite demanding to speak to the hospital Administrator/CEO.
Let us know how all is moving along, (or not), and it may not be Monday due to the positive COVID test. When you can, sure would like to think that you will make an appt. with your own doctor for yourself as your stress has been over the moon and it is best to be checked out so that you will be in good stead.
J.
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Day2 I do appreciate all comments. I just talked with the cela she says he is wrong and is gonna tell him to send referrals to the one right near home. Sorry I do not communicate as clearly as I would like and I don't blame any body for not understanding. I hope you continue to offer your expertise, as well as all the others. Jo c I have downloaded the TN annotated code and found those sections you referred to and I have them with me today.0
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Stewart, I am sorry to hear about all the trouble you are having with the SW.
You haven’t mentioned how your wife is doing. I know you’re only allowed to visit a few times per week, but are you seeing changes since they’ve been adjusting her medications?
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So here is the reply I got to my email to the sw to send referrals.
The layer is supposed to call him.
Good Morning Stewart,
Per our conversation yesterday I'd like to review a few points. Woodbury and Smith County Rehab are both Skilled Nursing Facilities and Judy is not appropriate for skilled services at a nursing home. She is eligible for an ICF (intermediate care facility) bed which nursing homes do have. However, without Tenncare/Medicaid her insurance will not pay for this and you will be responsible for payment. Another consideration is that Judy does not have an approved PASRR (pre-admission and resident review) assessment that is needed for all patients who reside or apply for nursing home placement. During her stay here, a PASRR was submitted and denied. I have submitted another PASRR and will attempt again. In the event that it is approved I'd like clarification that you are aware that if she goes to a nursing home you will be responsible for the cost. I have spoken to Woodbury Health and Rehab and they informed me that this is accurate. I have received calls from both Victorian Square and the Pavillion in Carthage who asked if you are still interested in placement at either facility. Please let me know so that I can inform them of your decision. Provided there are no issues, we are planning on a discharge on Monday 8/22/22 and need for you to decide on where we will discharge to.
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AAAD in TN has already said she qualifies medically, right? Because she has a degenerative neurological illness.
PASRR is for someone who has serious mental illness, intellectual, and/or developmental disabilities. It says so right on the form. This is not your wife!
Please contact the Patient Advocate at the hospital now and tell them you want a different social worker. This SW is wasting time.0 -
It is in all probabilty true that your wife does not fit Medicare Criteria for Skilled Care Rehab, that appears out as an option. Criteria is strict and needs to be met; that is a mandate by law, and from what you have written, your dear wife does not appear to meet such criteria.
I am still curious as for the PASSR - have you communicated with the SW as to what primary diagnosis he is using for making a transfer? Is he aware that the diagnosis of Alzheimer's Disease is NOT required to have a PASSR and is exempt? That is clearly stated right on PSSRs form. It would be best to clear the air on this matter asap.
Could it be that in Tennessee every single person being discharged from a mental health setting for any reason no matter the diagosis is required to have a PASSR? In that case, one could submit it with the appropriate diagnosis for Alzheimer's Dementia and listing that as primary diagnosis to ensure a PASSR is not required to meet specified criteria for such a diagnosis and can state so? Need to get that clarified as in the first thing to pay attention to for all else.
NOTE: You would benefit from speaking with your attorney or a case worker from Tennessee Medicaid or to a SW at AAAD to ask the question about return of money paid privately for Long Term Care IF your wife is approvedfor Tennessee's Medicaid; TennCare . In many of the states, Medicaid will reimburse up to three months of private pay for care IF the patient is approved for Medicaid for Long Term Care. This is usually figured from the date the application was received. You can check on this to see if Tennessee also honors this. If this is so, if your wife is approved for Medicaid, then the money paid will be returned for those months. If not approved, it stays out of pocket.
Just a bit more to be done, but do ask about the exemption from the PASSR rules. And of course, a choice must be made; but choices can be changed over time to something else.
J.
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I agree with your assessment about the skilled nursing, both these facilities I asked for referral can handle dementia patients. An the I was at the Smith rehab yesterday and toured it again, I asked about the high turnover rate75% and she blamed it on covid. I saw the room and met the other lady in the room. I did see the outside court and the admin lady was standing next to a deck board that had split and was curled up 2 inches, I warned her to watch her step, oh that needs to be fixed she said, when we went to go back in she had to knock on the door. I saw something that looked like a pin cushion just above the door frame, it was a next of hornets. I am allergic to stings. I have a severe reaction of hives, all over and need an eppy pen. Anyway I will still go there if I have to. I tried to speak to a patient advocate at the geripych they tried to send the sw as the patient advocate I said no. They sent the head nurse and she seemed to think dw needed a pasrr even after I showed her the code and exemption. Then I got a number to call and talked to a patient advocate who has passed me off to someone else. That's where I am at right now. Doesn't sound good. I just left a meeting with the hospital administrator and the sw. He made his case I pointed out the exemption of dementia and asked if my wife had been diagnosed with dementia, yes she is, the sw worker tried to add her other behaviors and I pointed out the main diagnosis is dementia the other behaviors are not a factor, the sw didn't agree. It's gonna come down to the cela calling the hospital admin and clarifying this for me. He did send the referral right after I asked about seeing a patient advocate, I think he was tipped off? I really hope I can get her in that place. They are gonna create a time line on when Judy should have left. I can see it now. I am gonna be double broke soon.0
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Toolbelt, I am so sorry you are going thru this. I remember having to place my LO when I was physically at the end of my rope, and I did not have to deal with Medicaid at the time.
This process has seemed so confusing that I got curious about TennCare and scanned through the TennCare Pre Admission Evaluation (PAE) Manual. Good Grief! For those as confused as I was (and still am) here are some definitions.
AAAD- Area Agency on Aging and Disability- This agency is an access point to TennCare. They can do applicant assessments, fill out applications and provide information.
Pre Admission Evaluation- PAE--The information on this form determines medical eligibility for TennCare long term care and the level of care.
Level of Care- LOC- the way TennCare uses this term is not what you might think, they divide care into Group 1--inside nursing facility, Group 2--Home and Community Based (HCBS) (which includes assisted living), Group 3--a lesser amount of care, at home usually, limited to persons receiving Supplemental Security Income.
Nursing Facility care requires a doctors order, HCBS does not. but, what is needed to be medically eligible is almost exactly the same for both. To some extent the choice seems to be up to the applicant, at least in theory.
The medical provider or social worker who fills out the PAE has to provide documentation to back up the information they put down. TennCare reviews this documentation and may not accept the conclusions of the person who filled out the form. This process is fairly standard I think, but TennCare does seem to be quite picky.
PASRR-Pre Admission Screening Reside ? -- This is a federal form, used only with nursing homes I believe. It screens for Serious Mental Illness and Intellectual Disability. For various reasons people with these conditions do not reside in nursing homes except for short stays, respite, rehab, hospice,etc or unless they also have dementia as a primary overriding diagnosis, as Jo C said.
This whole process, as well as the financial aspect, takes anywhere from 45 to 90 days, according to their website.
Toolbelt, has your PAE been reviewed by TennCare and was it accepted without revision? Have they given you any guidance as to your level of care?
I hope AAAD and your lawyer can help and that you find a facility that will accept your LO, even if it is not one you are perfectly happy with.
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Towee thanks for your thoughts and all the work you've done. First dw has an approved pae per the agency on Aging. It is a high enough score for nursing home care, or memory care. I hate the terms that are loosely used. Now the funny part I got 2. 17 page letter from tenn care the day after dw pae was approved. One was addressed to me as a person assisting someone in the household, dw.the second one is for Dw. They were both saying the same thing. 1 need more info on financial stuff, second was a denial because they didn't have an approved pae,at the time of the letter. They again have approved her pae. Just timing but now I have to make sure that it is put in her case file. The person I spoke with at tenn care, said it's almost done. Funny he could all my financial stuff why couldn't he just put it in the file?
I hope I am going to hear from the hospital that the pasrr thing is a done deal and that it will help them going forward.
I hate using a phone. I have to go back and remove errors like double spaces.
Well I am optimistic today things will get turned around. I have plan a,b,c. D is really not an option.
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Stewart, that's the best news I've heard from you for a while, and I'm glad things are looking better for you. I've been following your posts, but didn't have much to add because I know little about how that works for you.0
Commonly Used Abbreviations
DH = Dear Husband
DW= Dear Wife, Darling Wife
LO = Loved One
ES = Early Stage
EO = Early Onset
FTD = Frontotemporal Dementia
VD = Vascular Dementia
MC = Memory Care
AL = Assisted Living
POA = Power of Attorney
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