Question for the medical folks about covid

toolbeltexpert

So my dw was tested on Tuesday Aug 16th with covid but no symptoms, Wednesday she had a fever 99.7, Thursday she was pale and washed out?

When do they start counting the days for her to be released?

Just wanting to be sure I understand how this works. 

Thanks in advance, I haven't called yet for today's update. Waiting on a call from the hospital  administrator the pasrr issue. 

Mint

TBE I do not know the answer to your specific question as that is not my area.

Would suggest though you Google TWIV 924: Clinical Update With Dr. Daniel Griffin if you’re interested in best way of treating Covid.   He is an Infectious disease doctor out of NYC who gives a clinical update every Saturday morning since first of pandemic.  There are two phases to Covid.  The second week is when people who get in trouble with Covid usually end up in hospital.  He explains what should be done and what should not be done each of those two weeks.  Many people, not all, end up with issues second week due to things that were done wrong first week.  There are many people out there who possibly would  not of  ended up in hospital or died if things would had  been done properly first week.  When it first struck a lot was unknown.  There is a lot more evidence now for how to treat it properly.

He is the expert so if interested you can find good information there, will refer you to him for details and stay in my lane. 

Quilting brings calm

I think  what you are asking is how long your wife has to be quarantined after testing positive.  that depends on having  symptoms versus not having symptoms.  I believe the minimum is five days of quarantine and then 5 days of limited contact while wearing a mask.     

That’s a different question that when can your wife be released  while having covid.  That would  depend entirely on her symptoms.  As noted in the comment above mine, symptoms  can worsen on days 7-10. That’s when most people I know  have ended up being hospitalized due to breathing issues.  

There is also the question of whether a facility would  be willing to take her 5 days after a positive covid test.   They may require a longer period and a negative tests. 

M1

Stewart I would be very surprised if any facility would take her without a negative test at this point.

toolbeltexpert

Well I called and dw has no fever color has come back,but and you there was a but. 

She has congestion and cough and the nurse said she didn't want to alarm me but she is a little concerned about this. They have a doctor who was consulted in and the nurse can't tell me anything she may have done. Well I was reminded yesterday that Judy was ready 2 weeks ago according to the sw who is preparing a timeline for the hospital administrator. I may have to pay for some her stay. I haven't heard from the plan a facility but that would be an ICF bed if approved maybe 9k a month, Money I don't have to play with if I have to repay the geripsych. Scare tatics again? 

It's working.

Plan a was the nursing home but understanding the costs of an ICF bed if they even have one. Possible? 9k a month.

Plan b is the low cost respite care which is 3700. 

Plan c is 5200 plus

Plan d home with choices help.

Folks for me it is coming down to going into debt. I need to avoid that, 9 k for me is putting at risk.  If I end up having to repay the geripsych. Even 1 month at the respite place with geripsych could do it. 

So I want to say I have gotten great advice here but if floating the boat means home with the tenn care choices, and saving that money for future cost I have to do what I have to do.

I feel good about whatever happens. I realize that we have to go the best way for each of us, and I know you all will continue with me and dw on the big d road.

I have done a major part of the home prep I tried to attach a picture of the door I framed in to prevent going upstairs. Don't think it took and lucky for me I had copied most of the post cause it disappeared. 

Sorry if I have confused you all more.

M1

Stewart:  it's still not making any sense.  

The covid may become more of a concern here.   I think you should definitely ask to speak to the doctor who is treating her for covid.  I would ask that person what her current status is and what the plan is.  I would tell that person that you have been pushed to have her discharged on Monday and ask what they think.  I would ask whether they think she would be better off being transferred to a medical ward:  that may be a better option anyway, if it gets you to a different social worker/discharge planner.  If they don't think she needs to be transferred, then I would ask how they think the covid should be handled up until discharge, and what would be the criteria for when she should be either transferred to a medical ward or discharged to a facility.

toolbeltexpert

M1 you must be psychic. I did call the md to talk about that. They "may start an iv cause she's not drinking enough because of sore throat and congestion. Md was concerned about her BP it's lower than normal.  She told me that where dw is at they can't get the iv stuff for covid so if it comes to that they would have to discharge her and I would have to bring her there for that. Also if her condition deteriorates they would have to transfer her to a place that has a covid bed. Several sites near home.  Hoping none of this happens. I did not think to ask about what they think the discharge plan would be. I got dw her favorite shake and a card and I peeked when they opened the door.she was upright in the hall. The plan b called they don't think they can do Monday anymore cause of the paperwork delay. I told her home maybe what happens depending on plan "a" cost. They haven't gotten back to me and I am camped outside the hospital administrator door. Waiting for him to show up. It does seem that the sw is adding to the dementia diagnois from the person who got the referal at plan b. Sw is  adding the behaviors that would be secondary to dementia which is her primary dx. Why He can't follow the directions is beyond me. That's why I am gonna camp for a while here.

jmlarue

I think I would take a passive/aggressive tone with the Administrator and remind him/her that she contracted Covid while in their care. I would suggest it is incumbent on them to see her through the treatment for Covid before discharge and adjust the insurance codes accordingly so that her medical insurance will cover the additional hospital stay.

There was a time when MRSA was running rampant through hospitals where Medicare was refusing to pay for additional days to treat something the hospital caused. Consequently, the hospitals were trying to bounce folks back to their home to recover. It took a fight to stop that practice, but eventually the hospitals had to relent to continue in-patient treatment on their own nickel. Seems to me, contracting Covid in the hospital should be handled the same way. They should be obligated to treat, either paid by Medicare or by the hospital - not out of pocket for you.

Jo C.

As with M1, this is not making any sense.  

1.  It sounds as though they do not have the IV drug for COVID, which more than likely is Remdesivir.  

2.  Your wife's COVID condition is worsening in that she now has respiratory symptoms.

M1

Stewart: it’s a Friday. She likely should be transferred. Doing these things on weekends is even more difficult. I would agitate to get her transferred now. You get behind this eightball you won’t get out.

Jo C.

Seems MC1 and I seem to be in the same camp on this - it is not making sense. 

1.   Your wife has COVID and her condition is worsening.  The RN is expressing concern.

2.   She has developed lung congestion and she is coughing.  What does the doctor say her respiratory conditions is like - do they feel she needs a chest x-ray due to the level of congestion if the RN is worried about it?

3.    She has such a severe sore throat and coughing that she is unable to drink the amount of fluids intake she needs which is important for hydration in fighting the virus. She needs hydration - she may end up having to have IV fluids.  She is also not able to eat due to the COVID symptoms.

4.  Her Blood Pressure is dropping and is not in the range they would rather see it.  That too is a potential danger sign.

5.   The most important thing is that she receives adqequate medical care for her condition so not to have it worsening and cause a very bad, to an all the way to a disastrous outcome.  The doctor discussed her condition possibly worsening and if it does, she will have to be transferred to an acute med center where she could receive COVID treatment as they do not have the drug there.  I think the MD may have been speaking of Remdesivir. That transfer would need to be by ambulance, not private auto.

6.  I cannot imagine any long term care facility would be willing to take her into  care when she is physically ill; especially with COVID - that won't happen.  She will need to be improving AND she will, I imagine  need to have a negative COVID test.

7.  Are they trying to "dump" her by sending her home ill with you is a question.  You cannot say or even hint that you can and are willing to do this.  You cannot.  She may even become far more ill and in danger at home.   Often, a person, especially when elderly or who has an immune system not working at fill steam sometimes seems to be getting a bit better - BUT - in the second week they often have a huge downturn and can beome severely ill ending up in an ICU or worse.  You do not have the skills nor stamina to do the required care 24/7; and also she cannot be left in the house alone considering her issues. That means being unable to get out on the tractor, etc. tending to the property for lengths of time.

8.  She contracted COVID while in THEIR care and they cannot dump an ill person into a home setting with a person who is not capable of providing the necessary, safe care the patient requires.  One can stick to that.

9.   Somehow, you have got them thinking that you can and will pay for private pay when the truth is, you cannot.  You just cannot. CANNOT. They cannot force you to do that. If you had adequate finances, then of course you could pay privately, but that is just not so from what you have written.

10.  By federal law, if a patient requires care and even if it is care in a care facility, the hospital CANNOT discharge the patient without having adequate care.  They must find an accepting facility. They CANNOT force the patient into a private pay facility when there is no money to pay for her care once a deposit is made.  However; once a facility with a Medicaid contract is found, even though you do not like or approve of the facility, then you will be on the hook financially.  You can always change the long term care facility to another, later.

11. NOTE:  IF the hospital says to you that your insurance,  Medicare, will no longer cover the patient, they MUST serve you a letter of Notice of Non-Coverage. In this letter, they will explain you have something like two grace days before she has to leave.  You cannot be charged for the grace days and the notice must state the exact date on which you would become financially responsible.  But wait . . . there is more . . . .

12.  BUT:  In this Notice of Non-Coverage letter will be a contact phone number and/or address where you can appeal this decision with Medicare.  Staff must assist you in how to do this.  NOTE:  You cannot and will not be charged for the days waiting for the appeal decision. Most often it takes one to two days for a decision to come through from the Medicare Appeals Department.  NOTE:  In all of my knowledge, you cannot be charged for hospital care IF you have not received such a letter and unless you have failed an appeal. They can only start charging you IF they legally can charge you after the grace days and the appeal days waiting for a result to come in.  You may want ot check with your CELA about that.

13.  In your appeal - The hook to hang your hat on is; the Social Work Department has not found a care facility with a Medicaid contract to accept your wife yet.  You are unable to provide care for your wife as you are elderly, you have physical conditions that compromise your capabiliites and it is not safe for either of you.  You cannot pay privately for facility care as you do not have the funds to do so; your wife is Medicaid Long Term Care pending.

QUESTION:  Have you received a Notice of Non-Coverage for Medicare? 

10.   If you have not received such a later of Non-Coverage, you should still be safe under Medicare. IF Medicare should deny coverage and you never received a notice as described, it will most often be the hospital that takes the financial hit for that as a letter of non-coverage had not been served  that will have grace days and appeal days. CELA will clarify.

11.  You mention the doctor or staff said you will have to take her home and "take her there for that."  What does this mean?   Where is "there?"  And if she needs to be brought to another care facility because she is much more ill with COVID and must be hospitalized, she can be transferred by ambulance; not private auto as sick as she is and as for right now, you do not have COVID and you are elderly with immune system issues and must not expose yourself.

Have to say; if she is in a regular med center and not gero-psych, things will be ever so much better and you will also have different social workers and case managers to work with; but we do hope she does not get more seriously ill.

Stewart:  How old are you - are you in your 70's?  Or 80's?  That would be helpful to know.

J.

jmlarue

God Bless you for your knowledge and willingness to share it with those of us who don't know what we don't know.

Just Bill

Jo C. I am so glad you are here looking out for us. You are very very appreciated.

Ed1937

She is a true gem on this site. We all appreciate her help.

JJAz

toolbeltexpert wrote:

Folks for me it is coming down to going into debt. I need to avoid that, 9 k for me is putting at risk.  If I end up having to repay the geripsych. Even 1 month at the respite place with geripsych could do it. 

 

DO NOT GO INTO DEBT.  Tell the social worker that you need assistance in applying for Medicaid to pay for her care.

[Deleted User]

The user and all related content has been deleted.

Jo C.

When notices of Non-Coverage are given, they are technically a, "HINN," that means:  "Hospital-Issued Notice of Non-Coverage."

The governing entity over that function and in fact, Medicare oversight for each specific geographic area across the United States, will be the QIO; or Quality Improvement  Organization.  Each area has such an entity contracted with Medicare to provide oversight and quality monitoring of such dynamics and they are the ones who will have certain staff members who do a fast track appeal decision made by a patient or family who do not agree with the Notice of Non-Coverage.  Each QIO will have its own name.

There are "errors" of appropriateness made in serving some of the Hospital  Notice of Non-Coverage, there is a list that is in the link I am providing from a QIO - all QIOs all have the same mandates they follow.  Notice the last inappropriate HINN error on the list - it has to do with not having a SNF for a patient to transfer to:

https://bfccqioarea5.com/file/hinn_information_faq.pdf

Just thought those following this may like to see how the oversight agencies deal with this sort of issue.

Stewart; it is true, you really could benefit from a professional to make this all happen in a clear and precise manner keeping everything in line and accomplishing what needs doing. This is certainly not your forte and though working harder than hard, things seem to go backward and get tied up in knots and sliding back to square one and worse the harder you try; all the energy you are putting out there is working against resolution much of the time and it feels as though it may be creating barriers.  Please consider doing what Victoria suggests to call your CELA and request contact information for a professional who can step in and get you set in the right direction and actually bring about results without so much confusion and who can speak and be an advocate for you.  It may well be worth it.

Your wife is acutely ill and is not stable for transfer right now, so transfer has been slowed down.  If there is no care facility with a Medicaid contract to transfer your wife to, the HINN letter cannot be served.  However, if the SW is doing some of the referral calls and a bed IS found at a facility, even though it is not one you like or even if it is quite a distance away, then that is considered as a "found bed," and the HINN letter can be served. One of our Members had her husband placed nearly 100 miles away from home, not by choice; but it was the only facility with a bed willing to take him.

It is hard to feel so helpless in the face of all of this craziness and kerfuffle, but we are at the whims of those in DC who make these decisions.  If we are uber wealthy, then no big deal;but the majority of us are plain wrap middle class folks and do not have millions to burn, so we must accept what the laws are and try to find a way to work with things we have not desired.  If your wife must transfer to a facility that you do not like; as said before, she will be safe and secure and you can continue to have her on a wait list for another facility you like and transfer her later.

One nice positive is that she is on the way with her Medicaid application, that is good.

It will all work out, Stewart. Hang in there; you will find that you will be able to breathe freely again once you are out from under all of this terrible trouble.

So hope your wife will begin to improve soon.  I can imagine they are keeping a close watch on her. 

So; this site ate some of the stuff I had pulled up and cannot locate it again despite a lengthy searc, so I give up and off I go, to soon commune with, Wynken, Blynken and Nod. 

J.

toolbeltexpert

I want to make a statement and I need to,  for everyone's clarification so that it won't be brought up again. 

Gummies, stop about it. I had taken them when dw was home and as a SLEEP AID,. NEVER AT ANY TIME AM I SELF MEDICATING. I appreciate  your concern but that's not an issue. Period. 

I do not drink at all Period.  I have had I glass of wine in 29 years and didn't like it. That was over 20 years ago.

I have used benadryl to sleep this week because I have poison ivy  on both arms. Legs hands,ect I quit that last night and slept pretty good.

I am sorry my post make it seem like I am waffling, this form of communication isn't my Forte. 

I am not veering from placement,  but I am out of options, all of the good advice is accepted. And I am still hopeful something is gonna break.

No she will not be released sick. The consulting doctor did say if she needed the infusion, she would have to be discharged cause they don't have it there.  If needed I will work that out.

Iv fluids were mentioned today, cause of sore throat, she's not drinking enough. They are on top of it but they haven't started any as of this afternoon. 

I have applied to Medicaid that is a process that takes time. 

Jo C I just got my red white and blue card earlier this year. 65  

"The take her there"was in reference to the infusion, What the nurse said and what happens are two different things. 

They maybe trying to dump her? 

Jo I think you had written about the 2 days of grace period or I read it somewhere else. But that hasn't been brought up.

I do know that I am madder than hell that the Hospital administrator yesterday told me he was gonna follow up with the cela and keep me informed and that was pure BS. I have had no contact from him or the patient advocate who has blown me off.

So my plates full I am gonna fight for my dw. 

If I have offended anyone, that has not been my intentions. I really appreciate all the wisdom. 

I am sure I haven't  come close to answering all the questions that were posed. I often print post for a better review of the information which is what I will do with this one. 

Thanks again 

Stewart

toolbeltexpert

Thanks jo C for your last post. More good info. I was writing when you posted it.

toolbeltexpert

Thanks Jmlarue  I agree. Thanks for that perspective. I do remember  the mersa, spelling is wrong outbreak it was everywhere. That maybe what they are doing

Jo C.

BIG hunks and chunks of my Post have completely disappeared . . . they were there when I hit the Post button, but now gone . . . . tried to put in some stuff, but not the same -  looks like the electronic imps came and chewed on it.  Sigh.  Can't find some of the things that got cut out that should be there.   Mumble, mumble.

J.

dayn2nite2

The most important question here is has the hospital given you a Notice of Non-Coverage?  If they have, when did they give it to you?

If not, please re-read Jo’s posts to you in this thread.

Fairyland

TBE I can’t help with advice about the situation- I just want to tell you that the kindness and concern for others really shines through in your posts- you need lots of the same for yourself right now - maybe the only one who can provide that right now is you and your faith. But you have clearly helped many others, don’t be afraid to ask for MORE help from your friends and colleagues- they would be honoured to be able to assist all they can,  I am sure.

Remember to put on your own oxygen mask before helping others, including DW, as they say to passengers on a plane!!

Jo C.

A new day; am hoping your wife is doing alright and her condition has not worsened.  Do let us know.

It is me again with that repeat question:  Have you or have you not been served with a Notice of Non-Coverage?   If so; what was the date they stated you would not be insurance covered any longer? 

If served with a Notice of Non-Coverage; they will need to rescind it considering your wife's present condition as there is no ability to transfer her to a care facility at this time.  If there was such a Notice served to you and it is now rescinded, ask for that in writing for your records.

If your wife needs care at an acute hospital, then it appears a transfer may possibly be to a different acute med center because they state they do not have the COVID med where she is.

Stewart:  Our M1 can let us know if the following appears appropriate under the circumstances and/or if anything needs to be changed or added.  Our M is an MD with far more knowledge than I have, and I am not an MD.  (If you have had a close relationship with your primary doctor, you can also inform him of the COVID situation.)

A.)  Ask for the drug name of what  they say they do not have. You can always double check with the hospital pharmacist to see if they have it OR if they can get it to ensure accuracy of that statement. 

B.)  Ask how your wife's blood pressure and fluid intake are doing.  

C.)  If she is still problematic, if they have not yet done so, also ask them to put her on a monitoring of her fluid intake and output if she is still not drinking and is still ill as well as blood pressure checks at least each shift or more often as appropriate, since the BP had been declining and dehydration can cause that or make it worse. 

D.)  If she is still not drinking fluids, and they have not started an IV; then discussing that with the supervising RN and contacting the doctor may possibly be necessary.  GeroPsych usually does not do such care on that Unit; the patient is usually transferred out onto a medical floor for acute medical needs . . . however; since this is an active COVID situation, they may not want to transfer out onto a medical floor.  SO . . . one will have to keep on top of it to ensure adequate medical care and oversight is being rendered for the condition.  

E.)  Also good to ask if your wife will be seen by a medical doctor each day to monitor her medical condition if she is still exhibiting symptoms as she has been; especially if she appears more ill.

One wants to try and prevent worsening of the condition; especially trying to forestall ARDS if it is at all possible - Adult Respiratory Distress Syndrome which can be terribly serious requiring ICU and even a ventilator. This is the condition that can cause fatal COVID outcomes.   So; one will want the nursing and medical staff to stay on their toes on high alert and very careful monitoring.

So hope she is a bit better today.

J.