Non Coverage Medicare Appeal position:

·       Mom was doing well in rehab before she got pneumonia, which took me 5 days of bringing it to the SNF attention to get any action. Sure, they did x-rays which came back “clear” but there was clearly something still wrong with her respiration. Then on 12/25 we came into see her after taking 2 days off and noticed she had another stroke, none of the staff even noticed. They called the on call doctor and he said call 911 and off we went to the hospital.  Additionally, there was a massive infection in her mouth, which no one was attending to. The hospital nurse had to pry gobs of green gunk off of the roof of her mouth.

·       She recovered from the pneumonia after continuing IV antibiotics in the SNF after the 7 day hospital stay where they threw away her dentures.

·       So from 12/29 to 1/29 (30 days) she had no teeth.  She had very little appetite before and was on an appetite stimulant (Meghase) off and on over that period.  She was not eating and no one was taking a very big interest in the fact.

·       I asked the SNF for a “ready set go” meeting 2 weeks after her return (1/2/2013) to the SNF.  At that meeting they revealed that she was not doing very well. REALLY, you waited 2 weeks to tell me and what are you doing about it? I am busy going through all of her belongings and trying to liquidate her apartment. I don’t have time to continue to police your staff. We had that talk before I brought her back her: I do not want to police the staff. They are the ones who did not notice the stroke and could not see the pneumonia and the massive infection in her mouth. I need the SNF to do their job; to monitor her health and bring it to the professional’s attention to manage it.

·       Then, yesterday (2/14) in an impromptu meeting at the SNF, Anne the assistant director of nursing remarked how much more alert and stronger mom was. What? Then why the no progress report?

·       The ombudsman says SNFs pull this all the time. How is it to their advantage to rob my mom of her rehab?

·       So the bottom line is that you don’t eat you get weak. If you are a two time stroke victim you cannot tell someone how you feel and what is going on, you need the pros to recognize and manage this. Since her intake has been so little and she has lost so much strength and muscle mass then she was not able to perform and get better. These are directly related to Palomar’s negligence in the act of throwing away her dentures. They robbed her of a month’s worth of rehab.

·       Mom’s condition currently is that she is now able to wear her teeth 60-90 minutes 3-4 times a day. The dentist put her on a puree diet on 2/13 to see if it will not strengthen her and give her some more stamina. I am preparing smoothies with high quality protein in them and delivering them every other day to the staff. The staff will need to pour some of it into a glass for her every day and provide a straw, as often as she will drink it.

·       She received her teeth on 1/29 and was allowed to wear them for as long as she wanted. That should not have been allowed. It is like new shoes you cannot wear them and walk in them for 24 hours straight. After day 2 she had major sores in her mouth and was not able to put the teeth back in. I called the dentist and he prescribed hydrogen peroxide treatments and adjusted the teeth to make sure they fit.

·       When she is physically able she will begin to improve again. She wants to be independent. I see it often when she struggles to sit up in bed. She wants to be able to get up on her own and she would be doing that by now if she hadn’t been sabotaged.