Need advice/ombudsman for a Medi-Cal hospital discharge situation
July 23, 2024 10:10 AM Subscribe
I'm trying to help a friend who lives in California, is on disability and is covered by Medi-Cal, but I don't live there or understand the intricacies of the system. She's being told she will be discharged from the hospital where she is now, but she cannot walk or do any ADLs and she doesn't have any support at home. What can she do?
Friend had a very bad motorcycle accident about six weeks ago, compound broken leg and several arm/hand injuries requiring more than one surgery. (She also has several chronic health conditions and has been on disability for decades even before the accident.)
She was moved from the original treating hospital to an acute care facility, where she has been for about 4 weeks doing PT/rehab. They told her today that they are discharging her on Friday, but she has no one else at her home to care for her, she can't walk by herself or do any ADLs alone (toilet, bathe, etc), she has had no walker/wheelchair training, and she doesn't even have a way to get home. They told her they want to set her up with In-Home Support Services, but she cannot be evaluated for that until she gets home.
They have not provided any written discharge notice or given her any concrete reason for discharge. The social workier at the acute care hospital told her to look online for resources and said she would be evaluated for IHSS once she got home. Even if someone were to drive her home and put her in her house, she would be unable to move around, feed herself, go to the bathroom, etc.
There could be more details here that I don't know about ... my friend is freaking out and might not have told me everything correctly. Still trying to get more information. But I don't see how they could discharge her to home with no care plan. Wouldn't that be patient abandonment?
Can anyone advise how this system works in California, whether there's a particular office to call for complaints, maybe an ombudsman or some organization that advocates for patients? The hospital social worker doesn't seem to be helpful.
My friend doesn't want to stay at acute care forever, but she is frightened to be sent home alone with no way to care for herself.
Friend had a very bad motorcycle accident about six weeks ago, compound broken leg and several arm/hand injuries requiring more than one surgery. (She also has several chronic health conditions and has been on disability for decades even before the accident.)
She was moved from the original treating hospital to an acute care facility, where she has been for about 4 weeks doing PT/rehab. They told her today that they are discharging her on Friday, but she has no one else at her home to care for her, she can't walk by herself or do any ADLs alone (toilet, bathe, etc), she has had no walker/wheelchair training, and she doesn't even have a way to get home. They told her they want to set her up with In-Home Support Services, but she cannot be evaluated for that until she gets home.
They have not provided any written discharge notice or given her any concrete reason for discharge. The social workier at the acute care hospital told her to look online for resources and said she would be evaluated for IHSS once she got home. Even if someone were to drive her home and put her in her house, she would be unable to move around, feed herself, go to the bathroom, etc.
There could be more details here that I don't know about ... my friend is freaking out and might not have told me everything correctly. Still trying to get more information. But I don't see how they could discharge her to home with no care plan. Wouldn't that be patient abandonment?
Can anyone advise how this system works in California, whether there's a particular office to call for complaints, maybe an ombudsman or some organization that advocates for patients? The hospital social worker doesn't seem to be helpful.
My friend doesn't want to stay at acute care forever, but she is frightened to be sent home alone with no way to care for herself.
Not in CA, but I work in healthcare. I believe she should have a Medi-Cal "health plan" or administrator - a consumer company (like Kaiser Permanente) that manages her Medi-Cal benefits. Your friend should call the member services line of whatever company provides her Medi-Cal paperwork/access, and tell them her situation and that she needs to speak to a Care Manager (sometimes called a Case Manager).
Since she's been twice admitted (hospital and then acute care) and has gone through a transition of care process, she may already have a care manager assigned to her. If so, they may be waiting to contact her after she's discharged to start assisting - most plans have some form of required post-discharge assessment that they'll need to do. But this doesn't mean your friend can't reach out beforehand to get things moving.
The Care Manager is the person who can help guide her through the discharge process, talk her through her options, and help her figure out how to get set up for success upon discharge.
posted by invincible summer at 11:10 AM on July 23 [2 favorites]
Since she's been twice admitted (hospital and then acute care) and has gone through a transition of care process, she may already have a care manager assigned to her. If so, they may be waiting to contact her after she's discharged to start assisting - most plans have some form of required post-discharge assessment that they'll need to do. But this doesn't mean your friend can't reach out beforehand to get things moving.
The Care Manager is the person who can help guide her through the discharge process, talk her through her options, and help her figure out how to get set up for success upon discharge.
posted by invincible summer at 11:10 AM on July 23 [2 favorites]
Agree she should ask to speak with the RN Case Manager (or, if this is a rehab facility, they may only have a social worker) assigned to her case and ask the following questions:
- I believe I need Home PT/Home OT to regain my functioning. Has that been ordered yet? Which company and what is their contact information?
- I cannot walk, has a wheelchair already been ordered? (possible they will recommend a walker instead - ask for a rollator). I believe I will also need a Bedside Commode (or possibly a toilet riser if your friend thinks they can get to bathroom, but unlikely their bathroom is wheelchair accessible. )
- I would like to meet with PT and OT today to go over how I will use the toilet at home, how I will bathe at home, how I will transfer to chair at home, etc.
- I'm concerned about the length of time it takes for IHSS to start. Does this facility work with another agency that can bridge my care until IHSS is in place? (FYI, MEdi-Cal now pays for these bridge programs. In my county (Alameda) that company is Omatachi Home Care, but it differs from county to county.
She should also call the Managed Medi-Cal plan for her county and ask for their member services department. She can request a few things:
- Case management (will help with system navigation, they are a reimbursed benefit of Medi-Cal now)
- The above program to bridge her homecare needs until IHSS kicks in
- She can also say she does not feel safe discharging and ask for support about that but unclear to me exactly what member services will do.
Can you suggest that you or another trusted friend be on the phone when she has the above conversations? Pitch it as helping to take notes and keep track of information since she has so much going on right now.
posted by latkes at 11:35 AM on July 23 [4 favorites]
- I believe I need Home PT/Home OT to regain my functioning. Has that been ordered yet? Which company and what is their contact information?
- I cannot walk, has a wheelchair already been ordered? (possible they will recommend a walker instead - ask for a rollator). I believe I will also need a Bedside Commode (or possibly a toilet riser if your friend thinks they can get to bathroom, but unlikely their bathroom is wheelchair accessible. )
- I would like to meet with PT and OT today to go over how I will use the toilet at home, how I will bathe at home, how I will transfer to chair at home, etc.
- I'm concerned about the length of time it takes for IHSS to start. Does this facility work with another agency that can bridge my care until IHSS is in place? (FYI, MEdi-Cal now pays for these bridge programs. In my county (Alameda) that company is Omatachi Home Care, but it differs from county to county.
She should also call the Managed Medi-Cal plan for her county and ask for their member services department. She can request a few things:
- Case management (will help with system navigation, they are a reimbursed benefit of Medi-Cal now)
- The above program to bridge her homecare needs until IHSS kicks in
- She can also say she does not feel safe discharging and ask for support about that but unclear to me exactly what member services will do.
Can you suggest that you or another trusted friend be on the phone when she has the above conversations? Pitch it as helping to take notes and keep track of information since she has so much going on right now.
posted by latkes at 11:35 AM on July 23 [4 favorites]
I'm also not sure what you mean by acute care facility. Is she in an Acute Rehab facility? A skilled nursing facility?
The state ombudsman does sort of regulate these facilities, but the are really unresponsive and mostly staffed by volunteers (the system is trash). But yeah worth a call if the facility admin is not responding to concerns.
posted by latkes at 12:00 PM on July 23 [1 favorite]
The state ombudsman does sort of regulate these facilities, but the are really unresponsive and mostly staffed by volunteers (the system is trash). But yeah worth a call if the facility admin is not responding to concerns.
posted by latkes at 12:00 PM on July 23 [1 favorite]
It is possible that your friend is refusing a recommendation of custodial nursing home care which would be the generally the next step after acute for someone who hasn't recovered enough. I can't speak to how well medi-cal covers rehab, but here in Illinois on medicaid is very limited. If she goes into a facility as custodial her benefits would go towards the facility and she likely would be unable to maintain her housing.
I do certianly hope that this is a discharge planning issue and there are options. However, in home services for help will not be 24 hour care or even close to it. There may not be the resources out there for her to continue living alone in her current condition.
Good luck. I hope she and you are able to make this work.
posted by AlexiaSky at 4:58 PM on July 23 [1 favorite]
I do certianly hope that this is a discharge planning issue and there are options. However, in home services for help will not be 24 hour care or even close to it. There may not be the resources out there for her to continue living alone in her current condition.
Good luck. I hope she and you are able to make this work.
posted by AlexiaSky at 4:58 PM on July 23 [1 favorite]
Ah, jeez. IHSS is a broken system that moves at a glacial pace. That's...not going to help much.
The county will have an office of the Ombudsman which looks over licensed nursing facilities but I don't know that that's a super immediate response, either.
Your friend may end up needing to go back to the hospital and make a big stink about safe discharge because technically a hospital should not be making unsafe discharges. They do, but they're also sometime nervous about the consequences...
If she's on disability she may be considered a dependent adult in which case she can call Adult Protective Service which may or may not do any good. It's a pretty powerless state bureaucracy but they can sometimes help people navigate situations like this one.
posted by less-of-course at 9:49 PM on July 23 [2 favorites]
The county will have an office of the Ombudsman which looks over licensed nursing facilities but I don't know that that's a super immediate response, either.
Your friend may end up needing to go back to the hospital and make a big stink about safe discharge because technically a hospital should not be making unsafe discharges. They do, but they're also sometime nervous about the consequences...
If she's on disability she may be considered a dependent adult in which case she can call Adult Protective Service which may or may not do any good. It's a pretty powerless state bureaucracy but they can sometimes help people navigate situations like this one.
posted by less-of-course at 9:49 PM on July 23 [2 favorites]
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posted by peppercorn at 11:07 AM on July 23 [3 favorites]