Can I have someone else evaluate Mom for rehab?

1 answer | Last updated: Oct 10, 2016
Eb2 asked...

My mother fell and broke her hip last July. She was diagnosed with anesthesia induced dementia and placed on Aricept, which showed no improvement. Her rehab was stopped because she had "plateaued" and she was placed on private pay. At some point her rehab was instituted under Medicare Part B. I received a phone call yesterday that her rehab was being discontinued due to her showing no improvement. I appealed this and received word today that due to her doctor's comments the appeal was denied. I am planning to appeal again, but, is there any way to have an independent caregiver evaluate her condition.
To be honest I don't trust the nursing home as she is worth more to them in a bed consuming no services than she is if she is improving.

Expert Answers

Kay Paggi, GCM, LPC, CGC, MA, is in private practice as a geriatric care manager and is on the advisory board for the Emeritus Program at Richland College. She has worked with seniors for nearly 20 years as a licensed professional counselor, certified gerontological counselor, and certified geriatric care manager.

I have had the opportunity of working with some of the physicians at a medical center well known for its research into Alzheimer's. One of these doctors told me that some patients are diagnosed with dementia following a car accident, surgery, or other physical crisis, and blame the crisis for causing the dementia, as in your mother's case. He explained that in most cases, what happens is that the crisis reveals a dementia that was already present.

He explained that all of us have a 'mental reserve' that we use during times of crisis or extreme stress. What has probably happened to your mother is that she had early dementia before her surgery but was using her mental reserves to cope and keep it hidden. The trauma of her injury and subsequent treatment used up that reserve. Alzheimer's patients are unable to renew mental capacity, so what you are seeing now is probably a true Alzheimer's.

What I am telling you is that your mother is unlikely to recover.

Medicare pays for rehab, both with Part A and Part B. Medicare will not continue to pay for rehab once the patient is no longer making progress. People with dementia have great difficulty learning new material, so they do not do well in rehab. It is time to stop looking for improvement using Medicare dollars.

Since nursing homes make profit from having resident use Medicare services, they will keep a patient on Medicare for as long as possible. But since the facility provides the service first, and is reimbursed by Medicare later, they run the risk of being denied payment by Medicare for providing services that were not needed. The facilities actually have less profit from patients who are no longer on Medicare.

You may request some private pay maintenance therapy, some nursing homes offer 15-30 minute sessions with therapists to help maintain the current level of functioning.

I hope you will begin to cope with this new crisis by finding out as much as you can about dementia. I highly recommend Jolene Brackey's book,Creating Moments of Joy,