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Steve (or anybody else), Do you have any ideas about what can be done about this. One of my family members who is in her mid forties suffers from multiple disabilities. She has recently moved from a house where she lived for many years with her mother, into a nursing home. The goal is for her to move into assisted living however the state medicaid requires her to stay in full nursing home care for several months before she will be evaluated for assisted living. That is not the problem.
The problem is that she is on 24 hour oxygen therapy. She has an oxygen concentrator in her room and they (not sure if this is medicaid or the nursing home) will allow her only 4 mobile oxygen tanks/ month. This amount of oxygen is not enough for her to be able to leave the nursing home for her scheduled medical appointments let alone anything else. Without a mobile oxygen tank she can't even leave her room in the nursing home. The result is that she is effectively shut in to a small room day in and day out. Her current quality of life is, as result, nearly insufferable.
Do you know of any resources available that we could use to get medicaid (or the nursing home) to provide her with mobile oxygen.
We would just go out and buy her a mobile oxygen cencentrator ourselves (despite the high cost) but if we do, we risk disqualifying her for medicaid all together.
Posts: 12591 | Registered: Jan 2000
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posted
I'll check with folks at the office tomorrow and I'll post again when I get some info.
And, btw, if anyone needs to get ahold of me for something like this after this weekend, please just email me through the email address in my profile. I won't be on at all for many months after this weekend, but I'll still be registered and happy to help if I can.
Posts: 4344 | Registered: Mar 2003
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I'd suggest contacting an elder care agency or an attorney who specializes in elder rights and/or Medicare/Medicaid issues in your area.
Although I had some medical experience prior to my entry into the legal world, none of it was with Medicare/Medicaid, so I don't want to steer you wrong there. I would guess based on my limited experience that some doctor someplace is documenting that she only needs 4 tanks a month, though.
Posts: 4515 | Registered: Jul 2004
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posted
I've never heard of a mobile concentrator (and I am a specialist in home care nursing), but there is an oxygen conserving device that will greatly extend the life of an oxygen tank. It is a regulator that allows oxygen to flow only when the patient inhales.
There is also the liquid oxygen option, with refillable, portable tanks. The Helios system ought to be covered by Medicaid and Medicare. At least it is for my Medicaid/Medicare oxygen dependent patients.
Lots of times, it is not Medicaid that is limiting the options, but the equipment vendor. If they are paid a flat rate, it is to their advantage to be tight fisted with supplies. I've seen a change in vendors just open up that supply list.
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There are portable concentrators, smaller in size that can be driven around in cars, I think. Not portable enough for carrying around, tho. She just needs more tanks. Or refillable tanks. Aren't her tanks refillable from the concentrator?
I've never heard of a limit that low on portable tanks for outpatients. The goal is to keep people OUT of nursing homes, not jail them there. The doctor ordering the oxygen should be able to order what she needs to any old oxygen supply company.
You'd have to ask the nursing home who is controlling her portable oxygen while in there. I was going to say that the nursing home probably is, but then she's got a concentrator in her room? So maybe there IS a supply company. If there is, just call the company and ask what they can do for medicaid people who need oxygen. If it is the nursing home then talk to the respiratory therapist and if they aren't helpful ask to talk to an administrator.
You just need to talk to the live person who is responsible for supplying the tanks, basically. If they tell you it is the doctor, then you know where to call next. I've never ordered a set number of tanks for my patients, though. How would I know know that? Usually the company arranges that with the patient.
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An e-tank is a high pressure oxygen cylinder, filled up with compressed oxygen gas. On the standard variety, you set your flow rate and it just flows until you turn it off or it runs empty. On the models with an oxygen conserver, the oxygen flows only on inspiration. You can not refill these yourself -- you need a source of compressed oxygen.
Liquid oxygen tanks are bigger, filled with super-cold liquid oxygen, and can fill a portable liquid oxygen tank. One big tank will last for a week or so, depending on flow rate. You can not refill the big tanks yourself -- you need a source of liquid oxygen. The portable, fillable tanks last from a couple of hours to maybe 12 hours (for the Helios, which has a built in conserver). You can add an oxygen conserver valve to the portable tank.
An oxygen concentrator runs on electricity, and concentrates the oxygen in the room air to whatever liter flow (usually up to 5) you need. It won't work in a power failure, so everyone with a concentrator must have backup oxygen cylinders. They are the size of an end table -- not portable. Mobility is limited to the length of the oxygen tubing running from the concentrator to you.
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My grandfather using the liquid oxygen (with lincare) and has found it to work very well. The portable tanks are very easy to fill (until recently he could do it himself).
He does have a backup tank in case both the power and the backup generator fails in his assisted living place...but he has never had to use it.
One thing about the liquid oxygen portable tanks...they do leak a bit (at least the ones he has always have). It is not all that bad, but you couldn't fill it the night before and expect it to still be full the next day.
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He does have a backup tank in case both the power and the backup generator fails in his assisted living place...but he has never had to use it.
But liquid oxygen doesn't rely on electricity. It stays cold not by refrigeration, but by means of a giant thermos-type device.
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And you know what? Come to think of it, there ARE portable concentrators. They just aren't that popular. They are a bulkier than the portable liquid tanks, weigh about 10 pounds, need to be plugged in, make a humming noise while in use, and cost $5K or $6k. Most people prefer the portable tanks.
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Rabbit, can you find out exactly who made the decision and what the written regulation is that it is based on? That will help you decide the next step.
You may want to call Utah Legal Services. I assume eleigiblity isn't a problem because she's on Medicaid. They can tell you what pre-lawyer steps to take and possibly help if more formal action becomes necessary.
At minimum, they'll be able to give you an overview of the process. Good luck.
Posts: 26071 | Registered: Oct 2003
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Well, I just finished going over this with Diane and she thinks Dag's advice is right on point. It's hard to know if this is a facility policy or a medicaid thing - ordinarily she'd suspect the former, but states are doing all kinds of things to medicare and medicaid these days.
When a person is out in the community, billing for durable medical equipment is between the individual and medicaid. In the case of nursing facilities, they get paid a per diem rate for the person and - in many cases - durable medical equipment costs are subtracted from that rate. So ordering more of what a person needs can reduce or eliminate profit.
That's why many people in nursing facilities who want to get out independently in an electric wheelchair don't get them - the nursing homes refuse to order them. But all of this varies widely from state to state and from facility to facility.
This really is a rights issue - when policies unnecessarily limit someone's freedom, it doesn't get more basic than that.
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The oxygen is provided by a medical supplier who I assume subcontracts from the nursing home. They are the same supplier who provider her oxygen while she was living independently and they have been a problem for some time. They contract with the state to provide oxygen for a fixed rate so to Medicaid patients and they are constantly looking for reasons to cut back on service in order to increase their profits. We went through at least half a dozen fights with them directly before SIL moved to the nursing home.
Now that she is in the nursing home there is another whole layer of burocrats to deal with. The nursing home is also paid a flat fee from medicaid. SIL has 27 different diagnoses so her care is way over what medicaid will allow. As a result, the nursing home is looking for any and every opportunity to cut corners on her care.
Additionally, when she was living independently she could move from room to room in her small home while connected to her stationary oxygen generator. Now that she is in a nursing home, she really can't even leave her bedroom with out an oxygen take so she need more tanks.
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