Good morning!!!!

[buckeyefarmer]

Got a new cat. Wife got it from a “rescue” group. Not that friendliest, I prefer the neighbors kitties, they are super friendly.
It doesn’t like the basement, but gets into everything.

 

[txdon]

Thanks for all the prayers! My mom's catherization went well, they said the blockage was at 90%, and they put a stent in.

Now I'm having trouble with getting the next phase of skilled nursing rehab care authorized. Her doctor is frustrated about it. So far I've been transferred by 2 people to other people and still waiting on hold. They said wait time is 32 minutes, due to Covid problems.

Has anyone had to appeal an insurance medical denial? I believe she needs 24/7 care for maybe 2 weeks or so.

My mom's situation:
92 yo
lives alone
family over 100 miles away
home not ADA compliant
can't go to restroom or take bath by herself yet
still on O2
has blood in urine

I appealed for skilled care for my father. Medicre declined skilled nursing rehab after the facility reported no improvement after 2 weeks. I completed the appeal form and won on a technicality. I made my appeal a day before July 4th and the facility had to respond in 24 hours. Since that included the holiday, the deadline was not met and my dad got another 2 weeks.

Is your mom able to do physical therapy? If so, that should qualify her for at least a week or two of skilled nursing care. Other things that would qualify her would be IV therapy or injection, wound care...anything that requires a LVN or RN rather that a general caregiver. Unfortunately, not being able to go to the restroom or bathe herself doesn't qualify. I would focus on the physical therapy. Unfortunately, since my Dad did not progress with physical therapy, he ended up having to go to a nursing home.

 

[txdon]

Don, sounds like excellent progress but “wife maid” aslip I’m sure

Good catch.
However it is allowed only on Fridays when she calls in the maid (herself) to clean the house and pays herself the going rate.

 

[txdon]

I was in the Physical Therapy waiting room waiting for the therapist to come in and they were all there except Egore. I was really hoping he had come down with covid and one of the dainty therapist would work with me today. But then the room shook and he made his thunderous linebacker entrance, with his shaved head, rolled up sleeves on arms as big as thighs, evil eyes and smirk hidden behind his mask. I told him that I walked a mile yesterday and my leg was still red and swollen and might need to do an easy session today, and his reply was just a smirk. So far not good.

He put me through the warm up exercises and on the bike I was surprised I could not pedal all the way around. I asked him if I had pedaled this close Wednesday because if I had I'm regressing because I cannot do it - probably because of my mile walk. He just chuckled and said he moved it closer that I'm not regressing. After the last exercise he pointed to the torture table and pulled out the knee flexion angle measuring device. I trembled.

He instructed me to lay on my back and pull my heel as close to my butt as possible. I pulled it back till I was almost crying and he s-l-o-w-l-y took a measurement . . . twice. I had to ask him what it was and he disspointly said 115˚. Then he disappointing said: "That's it see you next week". I was still in shock that he was not going to flexed my knee more to unbearable pain but apparently I was able to reach todays goal without his "assistance". I Felt like I dodged a bullet.

 

[buckeyefarmer]

Beats being in the snow.

 

[Kyle_in_Tex]

I appealed for skilled care for my father. Medicre declined skilled nursing rehab after the facility reported no improvement after 2 weeks. I completed the appeal form and won on a technicality. I made my appeal a day before July 4th and the facility had to respond in 24 hours. Since that included the holiday, the deadline was not met and my dad got another 2 weeks.

Is your mom able to do physical therapy? If so, that should qualify her for at least a week or two of skilled nursing care. Other things that would qualify her would be IV therapy or injection, wound care...anything that requires a LVN or RN rather that a general caregiver. Unfortunately, not being able to go to the restroom or bathe herself doesn't qualify. I would focus on the physical therapy. Unfortunately, since my Dad did not progress with physical therapy, he ended up having to go to a nursing home.

Thanks Don. She is being given PT. She is being given a diuretic, on oxygen, and has blood in her urine. It has boiled down to her doctor arguing "peer to peer" with insurance representative doc. I heard they get a bonus for denials....I guess they weigh the cost vs the risk of being sued. It's a game that they are pros at.
I wonder why physical fitness or the lack there of, doesn't matter?

 

[txdon]

Thanks Don. She is being given PT. She is being given a diuretic, on oxygen, and has blood in her urine. It has boiled down to her doctor arguing "peer to peer" with insurance representative doc. I heard they get a bonus for denials....I guess they weigh the cost vs the risk of being sued. It's a game that they are pros at.
I wonder why physical fitness or the lack there of, doesn't matter?

My wife said that medicare is very strict regarding skilled care versus custodial care. They have a list of what constitutes skilled care. It's sad but unfortunately medication and O2 do not require a skilled, licensed nurse. This may be why medicare is declining. Are you thinking that she will be able to go home if the blood in the urine resolves. If that is the case, maybe the doctor could argue that skilled care is needed to resolve the blood issues.


"What’s SNF care?
Skilled nursing facility (SNF) care is health care given when you need skilled nursing or therapy staff to treat, manage, observe, and evaluate your care. Examples of SNF care include intravenous injections and physical therapy. Care that can be given by non‐professional staff isn’t considered skilled care. People don’t usually stay in a SNF until they’re completely recovered because Medicare only covers certain SNF care services that are needed daily on a short‐term basis (up to 100 days in abenefit period).
Skilled care is nursing and therapy care that’s so complex it can be safely and effectively performed only by, or under the supervision of, skilled nursing and therapy professionals.
Skilled nursing and therapy professionals include:

• Registered nurses
• Licensed practical and vocational nurses
• Physicalandoccupationaltherapists
• Speech‐language pathologists
• Audiologists
  Medicare doesn’t cover custodial care if it’s the only kind of care you need. Custodial care is care that helps you with usual daily activities, like getting in and out of bed, eating, bathing, dressing, and using the bathroom. It may also include care that most people do themselves, like using eye drops, oxygen, and taking care of colostomy or bladder catheters. Custodial care is often given in a nursing facility. See page 20 for ways to get help paying for custodial care. Generally, SNF care is covered by Medicare only for a short time after a hospitalization. Custodial care may be needed for a much longer period of time."

https://www.medicare.gov/Pubs/pdf/10153-Medicare-Skilled-Nursing-Facility-Care.pdf

Kyle see page 23 for info on a fast appeal if you think services are ending too soon.
You are your Mother's medical advocate.

 

[Kyle_in_Tex]

Thanks Don. I believe she needs physical therapy for starters.

 

[txdon]

Also a good source of information is the hospital social worker. He/she should have an office in the hospital.

 

[sodamo]

Got the over the range microwave hood hung before leaving for town. Progress

View attachment 728343

 

[sodamo]

Try again

 

[Buppies]

Looks really nice Sodamo

Prayers for your mom Kyle and you and your family

Thanks to Don for sharing his knowledge

 

[mostly_gas]

Good evening all. 17F for the start, partly cloudy, light breeze. Light to moderate wind, sky became overcast, and high temp was 43F. restoked the insert the insert after cleaning out most of the ash. stayed too cold and got too windy for bike ride on the road, so got 15 miles on indoor trainer. Garage was 52F, and was dripping sweat after 30 minutes Do miss the wind cooling on regular bike . No nap today, startup issues on trainer delayed start of ride and it ended to late to nap . Trip to town for dinner and groceries finished the day.
Covid update: Cooke 4552 confirmed cases, 323 active cases, Montague 2934 confirmed cases, 176 active cases, Grayson, 17942 confirmed cases, 1574 active cases. Cooke 32, Montague 32, Grayson 141, new cases.
Buppies glad you made it home, bet extra days were nice
Dennis have fun with retirement planning.
Dennis sorry about the poor listing quality
Roy hope you had a good day at work with the concerns to deal with.
Drew sad story about donating tractor to church. Hope you had fun with snow blower
Bill hope all goes well with DIL, enjoy energy conservation day.
Ron glad housework and paperwork done. It is a challenge to have conversation with so many people. nice cardinal pic. thanks for response
Billy lp not work so good in gas carb Good news finding young woman
Mike good luck with Christmas lights when snow melts
Buppies sorry about tree down and other damage
Drew glad snow work went well
Paul good to hear shingles healing, welding shop sounds like fun. Sorry about no band
Buppies glad only the 1 tree
RNG are they just doing peak generation at dam now? looked 24 hour outflow and just evening outflow.
Thomas will be driving fire trucks as part of maintenance program. I believe CDL will be exempt ( not involved in commercial activity).
Thomas enjoy your snow and nap
Ken nice snow pics, sorry about wood rack
PJ that's cold! sorry about not able to get medicine.
Don good news on the knee, glad there are machines that will work for you. Nice on the peanut butter, good luck with soy milk.
Eric 2 nice surprises in one day, did you dance a jig?
Dennis seat time on day off. enjoy!
Kyle prayers sent for phase 2.
Ken good idea on hospital help.
RNG I bet Kyle does find it therapeutic
Dennis sorry about extra gravel removal.
NHBX nice snow pic
Chris snow wont make the leaves scatter more!
David glad appeal worked for Sophie.
David sorry about green house glad sink worked out. hope followup worked well.
RS bummer about wrong spring. Have you checked voltage on sprinter?
Dennis he may get more friendly as he gets used to you. interesting pic
Don love your description of Egore session congrats on meeting goal w/o much torture.
Dennis nice kitty, he looks happy.
Don thanks for info
David pic does not open, try 2 worked kitchen really shaping up.
prayer for all, especially Jay/Peg, Kyle's daughter/friend PT from Covid, /mom o2 levels, Bird/aging issues/, Don/knee recovery /ring bearer/back broken & infections, Randy/FIL living alone adjustments /MIL Covid, /new cancer surgeries /cataract surgery, PJ/FIL death, Roy/ palpitations, /angina, /shoulder, wife/ankle recovery, Billy/ wife fall, David(moss)/remodel/divorce, Buppies/good biopsy report, Thomas/gout, Phil/reflux/wife's eyes, Steppenwolfe/son-auto immune disorder, Grev/wife's eye, Ted/knee recovery/retirement, Doug and wife/health issues/nerve and pain/ wife's eyes, Ken/aunt fall injuries, David(sadamo)/Sophie's new eye surgery follow up, Chris/neighbor's granddaughter and Covid issues, Scaredy/injuries from fall, Paul/ wife's disc issues, Gale and KY/ tornado victims, Bill/ DIL's decision and Country.
stay safe and healthy you all.

 

[sodamo]

Mostly, do you count indoor training miles to yearly total?

 

[Looking4new]

Good morning, low temp is -20°F (colder than a well diggers butt) and the high is going to be 19 on the plus side. Warm enough to snow. Wind calm. Forecast says snow today, tonight and tomorrow.

The kitten that goes outside every day, went out yesterday morning and 5 minutes later was back inside. His brother didn't go out at all. They are 14 months old, but in this house with three senior cats, they are still kittens.
I'm not sure yet, but I think in March I will get their knackers chopped off. I cringe at the though, but it is necessary.

Other than the snow, I will be conserving energy until Monday at noon when I take the DIL to the hospital for the PIC line.
I told Junior back in September to squirrel away some money each month to pay for his wifes' funeral. He didn't.
You should have seen the look on his face when I told him how much the funeral home wanted up front.
He thinks that the pension plan (Canada Pension Plan) that he and her never paid into will pay for the funeral. Not likely. I will be very surprised if CPP comes across.

Enough of that.

Have a safe day all

 

[Buppies]

L4N you are up ear;y this morning

Mostly I found two more trees down yesterday for a total of 3

14 this morning might go lower as sun comes up

Prayers for all

 

[ronjhall]

Drinking first cup of hot coffee. -2° with clear skies this morning. Heading to 30° with partly cloudy skies. Got paperwork done yesterday and got back in house where it was warm. Going to be a conserve energy day today.

David, I stopped at Kawasaki dealer on way home. It 3 miles from my house. Checked out the Mule Pro MX model. I like the wider seat and cargo box than my SX. But the cargo box is still very short. Did not take it for a ride. It was to cold for no windshield ride.

Everyone stay healthy and safe.

Good Morning All.

 

[Looking4new]

Buppies, I went to bed at 10 and one of the cats woke me up at 2 and my bladder told me that the bed was going to get VERY wet if I didn't get up at 3 A.M. , so I got up and stayed up.

 

[Buppies]

L4N I just hate that almost guaranteed to happen once a night. Sometimes you go back to sleep sometimes not

 

[daugen]

good morning all
dripping sweat
Mostly, not for most of us, it's mighty cold out, 17 here and very cold for coming week.
Well....it's January.
Ron, stay warm, you and Bill are even colder than the rest of us.

having problems with my neck. It was fused with a titanium rod 12 years ago and has always hurt but two days now
of changing from heat to cold packs haven't helped. Stabbing pains in neck, eyes go wide and you just sit there thinking please
go away....just part of my personal version of falling apart. And I have no idea why it started to hurt two days ago.
Guess it's time for an epidural, takes forever to get scheduled. I can't get the pain to go away and am trying like crazy to not take
any pain meds. I did up my celebrex and steroids, my only non narcotic solution.

I had hoped to have a co-Clerk to help me with guiding our Quaker Meeting, but no one has volunteered.
So it looks like this is all on my shoulders for awhile. I'm honored, but also a little overwhelmed. So many things became dysfunctional
during Covid, now trying to start up programs again and clearly the health realities out there are not good. Need to get past omicron as fast as we can.

at least the new snow plow guy showed up on time and did a nice job plowing our snow yesterday.

A nice sunny Saturday here.