In late November 2010, Julie*, a resident at a Bowling Green nursing facility contacted the Ombudsman Program because she was going to be involuntarily discharged from the facility in 30 days. The reason for the discharge was non-payment for the services provided at the facility. Julie was, at that time, $20,000 behind in payments. Facilities have only limited reasons they can discharge a resident, and non-payment is one. After speaking with Julie, the Ombudsman learned her Medicaid application had been denied, leaving her without a payer source for her care.
Julie was not the typical nursing facility resident. She is only 35, but due to her medical diagnoses had needed a hip replacement a few years ago. Since the initial replacement, she had had over 20 more surgeries and had struggled with infections and wounds. She is married, but was estranged from her husband. Her three children are in Indiana with the rest of her family. Julie had no one to turn to except the Ombudsman Program.
The Ombudsman Program informed Julie of her right to appeal the discharge notice to the Administrative Hearings Branch, and assisted her in doing so. The Ombudsman was able to get the first discharge notice dismissed due to deficiencies in the notice. The notice did not contain the information that was required by law. This was not a permanent solution and the facility issued a second discharge notice. The second notice was deficient as well, and was also dismissed. By getting the first two notices dismissed, Julie gained more time to stay in the facility, more time to work on the real issue which was a source of payment.
...The Ombudsman Program empowered Julie to take action on her behalf, helping her to help herself.
Besides the source of payment, another issue with the discharge was the location to which Julie was to be sent. The facility listed her mother-in-law's address as the location, however the mother-in-law lived in government housing which would not allow her to have guests for an extended period of time. If Julie did not prevail in the appeals process, she would have nowhere to live.
In order to resolve the Medicaid question, Ombudsman called upon the expertise of both Kentucky Legal Aid's Benefits Counseling Program and the Disability Resource Initiative. These agencies were able to advise Julie on the Medicaid issues and help her to know how to proceed with the application process. These agencies and the Ombudsman encouraged Julie to do as much as she could from the facility to expedite the process.
Julie did receive a third discharge notice, but fortunately the case was resolved before a hearing was held. Two days before Julie’s discharge date, her Medicaid was approved and the facility was no longer seeking to discharge her. In fact Medicaid would go back to the date of her initial application and pay for those months as well.
Without the Ombudsman Program, Julie would have not known how to appeal the discharge and would have had to leave the facility upon the issue of the first notice. Not only did the Ombudsman Program provide direct advocacy by assisting in the appeal, the Program utilized other resources in the area to help facilitate a resolution. In addition, the Ombudsman Program empowered Julie to take action on her behalf, helping her to help herself. This case exemplifies how the Ombudsman Program's work does improve the quality of life of long term care residents.
*Client’s name has been changed been changed to insure confidentiality.