Case Background

Mr. and Mrs. G are ages 72 and 70, respectfully. Mrs. G was diagnosed with a brain tumor and underwent brain surgery 30 years ago, which left her fully paralyzed on the right side. Her husband and children were her primary caregivers from that time on. Mr. G was an active executive until his retirement three years ago. Soon after his retirement, Mr. G began to experience cardiac and vascular difficulties. These medical conditions resulted in the need for numerous medications and subsequent surgery.

Following Mr. G’s surgery, the couple was placed in a skilled care facility at the doctor’s request for the purpose of rehabilitation for Mr. G, and because Mrs. G could not care for herself. Mr. and Mrs. G’s children, now grown and with careers and families of their own, did not have time to provide care within their homes. The children were left to search independently for several weeks for what they thought was the most appropriate placement.

IKOR was contacted by two of the four adult children who lived nearby. The children had recently been informed that it was no longer suitable for their father to stay at the skilled care facility because he had greatly improved. The facility recommended that the father be moved to an assisted living center owned by the same company some distance away.

The children were concerned about the financial effects the move would have on their parents. At the time of IKOR’s intervention, Mr. and Mrs. G were spending well over $10,000 a month to live in the skilled care facility. When the money and assets ran out, the family was resigned to total Medicaid dependence as an inevitable conclusion.

IKOR Approach

IKOR Advocacy with Wisdom and CompassionSM approaches these situations understanding that financial motivation of the care facility may not be consistent with the best needs of the clients. The family was completely unaware of the financial drivers affecting the facility’s motivation to move their father. Based upon the current criteria for Medicaid admission, Mr. G would bring the facility the lowest level of reimbursement possible. If the facility moved Mr. G to their own assisted living center, they would continue filling Mr. G’s skilled care bed with a client who could provide the facility with the maximum Medicaid reimbursement.

An IKOR Patient Advocate met with the family and assessed both parents in their skilled care room. Mr. and Mrs. G were adamant about remaining together, as they had been for over the last 46 years. Mr. G was so adamant about remaining together that he had hidden his full capabilities from the staff.

They discussed their wishes and hopes regarding a new environment. Among those wishes was that they could live in an apartment-style home instead of one small room. Their children had one specific request – that the facility be near a full medical center to address any potential crisis for their father.

The IKOR assessment clearly showed that Mr. G was mentally and physically far more independent than warranted a skilled care level. Mr. G was assessed by the IKOR RN to be appropriate for an assisted living level. Mrs. G, although needing more assistance than her husband, was in many respects beyond skilled care as well. Mrs. G’s capabilities placed her somewhere within the void between assisted living and skilled care.

The IKOR determination was that assisted living with limited additional care was the best response to the needs of both individuals.

Case Outcome

IKOR successfully found and recommended two possible facilities. Both were able to meet all the clients’ desired objectives. Mr. and Mrs. G would have a one-bedroom apartment living environment with cable television and a full kitchen where Mr. G could keep his favorite snacks. The couple would have the option either to take their meals in their apartment, or to eat in the restaurant-style environment, personally selecting what they would eat. Mr. and Mrs. G would have the opportunity to participate in activities both inside and outside of the facility. Both options were geographically situated within an easy driving distance from the nearby children and within a mile of a full medical center. In both options, IKOR assured 24-hour nursing service and more than four hours of direct care for Mrs. G every day.

IKOR presented a plan meeting all of the requested options and all of the identified needs. This solution also saved the family over $6,000 a month in costs.