I'm not sure if this is the correct place to ask this, but I don't know where else to get help or advice.

Long story short, my father turned 65 this year in April so now has Medicare. Also supplements that with Blue Cross/Blue Shield.

Started symptoms July 17th, went into hospital July 20th when symptoms got worse, was intubated and in ICU July 23rd.

Was in an induced comma from the 23rd to September 1st when he was transferred from Killeen to Dallas to a Ventilator Rehab facility in Deep Ellum. He lost over 60 pounds of muscle during this time. Once he was weaned from the Vent and his trach was removed, he was transferred to Encompass Rehab for PT/OT. He has been there for almost a month. When he arrived there, he could do absolutely nothing. Could not raise his arm, move his leg, could hardly talk.

He took 6 steps this week for the first time, on the parallel bars with some assistance, but is slowly getting better and gaining his strength back.

This facility lets one visitor a day be there from 8am-8pm. My mom has moved in with my wife and I in Carrollton so she can visit each day. When she has to go back home to Central Texas, I go visit.

Everyone at Encompass is great, he likes working with them and has built relationships with them.

2 weeks ago Medicare tried to remove him from that facility to another one. This new facility gives you one visitor for 20 minutes a day and you have to have a negative COVID test every 3 days. We appealed that and won so he has remained for the last two weeks. They are now doing the same thing and trying to move him. We have appealed again, but they are saying if it is denied, then we have to pay out of pocket for the days he is there which is about $2000/day.

Does anyone work for Medicare or know someone that can give us some insight on why they would do this? I know it has to come down to money somehow. Why would they take him from a facility where he has progressed and move him to a place where no one knows him or his story or how much better he has gotten?

It was terrible enough from June-September thinking he was going to die each day, but now the financial impact is starting to take a toll.

Any advice or help in the regards to dealing with Medicare would be greatly appreciated if you have the time.

Sorry if that was a long story long instead of short!

Medicare will not pay for rehab for very long. Not COVID related but my mom was sent home following surgery after just 9 days in rehab. She just received a bill for $900 for "staying" one extra day even though originally it was ok'd for 10.

Sorry you have to go thru this. Royally sucks. Hoping it works out.

I'm so sorry for everything your family is going through. Does Encompass have a case manager on staff? My dad was in a rehab facility, and we relied heavily on his case manager to explain Medicare rules/coverage. She also met with us to set up all his continuing care after he was released.

As others have said, if he has to move, the facility is your choice and the case manager should have a list of approved facilities and some recommendations. Also, Medicare.gov has a Nursing Home Compare that provides ratings by category for skilled nursing facilities (search by zip code).

After my dad was released, we used Encompass for his home health care (nurses, therapists), and some of his therapists had patients they would visit in facilities as well. They were all very good and covered by Medicare.

I hope the rehab director and case manager can advocate further for your dad during your appeal.

Does he have traditional MCR? If he does, the "move to another facility" is likely due to him completing his length of stay and no longer being "appropriate" for IPR status. The payment is on a CMG which means that the reimbursement is fixed based upon his functional abilities and his diagnoses/comorbidities. Encompass is likely the one pushing it based upon MCR guidelines and not MCR specifically. The proper process is like what the first reply is 2-4 wks at IRF level and then SNF. I know that being up north, you are in a hot bed of COVID and I would be very hesitant to send any loved one to a SNF if at all possible but that is not always possible. Have they offered a HINN letter to you or anyone regarding his care? If it is at all possible, you could easily hire out a good solid provider service to and take him home and pay out of pocket if his medical complications are squared away.

I am a rehab director at a smaller community based hospital with an IRF and have a pretty solid grasp on the process. Feel free to PM me if you have any questions in particular.

Thank you everyone for the replies and information. Really is appreciated.

I'm going to forward these answers/questions to my mom and will hopefully have some more clarity in the morning.

I'm late to this but speaking from experience, go see and smell the potential facility and don't just rely on the ratings you read. You, or someone needs to be an advocate lookin out for your dad's interests and some of the ratings are false and facilities are third world - even some that hospital case managers recommend based on their relying too much on the ratings rather than periodically walking through and observing. Go in unannounced and check out the staff and care. Best of luck to you and yours. Caregiving is a very difficult situation.

This is why I fear covid. The expense if you survive for many of us who are old will wipe out any hope to stay financially secure or life independently. So sorry for the bad case your dad has. This is not just the flu but so many think it is. I know of others with the same situation, including a dear friend from high school with her husband.

Have you checked on home health care? With dad and his stroke, we were able to bring him home from the intensive therapy level rehab floor with speech, physical, and occupational therapy at the house, a bath lady as he called her three times a week, and an RN checking weekly...and a monitor for vitals three times a day. And all of that was covered by medicare for another month. By then I could handle him but he did not want me bathing him. We were able to private pay the same bath lady to keep coming.

I'm sorry you are having to move him. If it is necessary for him to go to a facility first vs. home, I hope you will have some time to tour and choose. We asked a lot of questions and were very watchful during our tours and immediately knew which ones felt right. The reviews and case worker recommendations just helped us narrow down which ones to visit.

My dad was very weak and had cognitive issues, but we ultimately decided to give home care a try instead. This was just prior to Covid hitting, so we were very fortunate. He had several visits per week from an RN and physical, occupational and speech therapists. The evaluation by the nurse will determine the initial number of visits, and then they will re-evaluate after a period of time and continue as necessary... all covered by Medicare. We actually went through this process twice as my dad was hospitalized and went to rehab twice within 6 months. Our first home health company was not great, and that's when we switched to Encompass for his second round of home therapy,

We had grab bars installed, pull-up bars for his bed and chair, modified the layout of the bathroom, furniture, etc. to accommodate him. The occupational therapist will help with recommendations.

My dad has a separate long-term care policy he bought from State Farm years ago, so we used that to pay for a caregiver several hours a day. I was unaware he had this until I was going through their paperwork, so be sure to check.

I truly sympathize with you and know how life-altering this is for the entire family. I hope your dad recovers soon.

Something I forgot to add is that if you do give home health a shot, you do have 30 days from date of discharge from and acute facility (which IPR is) to admit to SNF level. Assuming he is truly traditional MCR, that process should be pretty easy and straight forward, the only issue would be if he is still testing positive and they require a COVID test to get him in or the options of facilities you would want to send him to was limited due to his OCVID status