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Margaret McKen is right -- make him demonstrate his proclaimed abilities to the assessor. These are done in-person, correct?

My mother could showtime. I honestly think that when her doctor saw that I the daughter took her to appointments, that I would make sure all was well. Even when I was ordered by my mother not to go into the examining room anymore with her, I think the dr. still made that assumption.

When she was hospitalized for 17 days and the OT and PT would say things like, "We're going to get you home!" I was very concerned. My friend's H (an MD) told me that when they gave discharge instructions, that I insist that I wasn't going to be there (my mother would have a permanent gallbladder drain), and that my mother must demonstrate how to change the drainage bag (and other activities). I'm sure that otherwise they would just give ME the instructions and assume I would be there. That is exactly what they did when the drain was inserted. Although I said several times that I didn't live with her and didn't need to know how to change the bag or what to do if it was leaking, I was asked, "Well, you are going to have to know if your mother calls you in the middle of the night." They also tried to show me how to attach a bag to her leg so she could walk more easily. Of course, during all of this my mother said nothing, as she was beyond comprehending what any of it meant.

I complained to the hospitalist that people were acting like she would be going home, and she told me that they weren't looking very deeply at her cognition, and that she would not be going home. Whew! She went to a rehab center, then transitioned to LTC at the same place (NH).
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AliceLS Sep 2022
Wow. I get it. I’m glad you had a good outcome.

I grew up in a medical family with one and nurses all around. I have caught on to the system as you describe. I’m non medical yet often spoken to as a nurse. I’ve started playing dumb.
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Pcp is helping by ordering assessments to try to get Medicare paid.

Medicare paid, what? Medicare paid, hospice? Is that for Medicare paid hospice services? Sounds like dad is not eligible.
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Alice, I’m not surprised that you were shocked! What did you do about it? Have you sent to the Hospice Assessment manager the same summary you gave us? That’s the first approach. If they won’t budge, try a different Hospice service. Is the assessment limited to Hospice – which is usually looking for prospects of death within 6 months, not ADLs.

If necessary, you may need to give a demonstration. Leave Dad in bed, with his clothes to change on the end of the bed. Breakfast things on a small table out of reach of the bed. His expired driving license? When the next assessor arrives, get him to demonstrate his hypothetical skills. What a schemozzle, to use my late mother’s expression!
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Clairesmum Sep 2022
as a hospice nurse, I want to clarify that there is a long checklist of required assessments to determine eligibility. The attending MD writes the order for hospice care....but it is the admission nurse's responsibility to gather the data that justifies hospice eligibility. Hospice medical director and referring MD will converse, to come to a plan. Even if he needs help with ADLs and IADLs, there needs to be some symptom to be managed or having unstable changes or signs of disease progression. This gent may have 'fooled' the admission nurse....and the skill level of nurses varies widely.
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