TKR Same day surgery release for 83 year old

[meishere30]

I'm actually looking for opinions based on experience...my 83 year old dad is scheduled for tkr surgery in about 10 days ... They just informed us he will not be staying in the hospital overnight or for an extended amount of time he will be going home the same day due to the fact his insurance considers it an elective surgery.... It appears there was no way around this no special circumstances... Even the social worker said this raised red flags all over the place.... He does live alone but I was prepared to take care of him after his hospital release when he was a little stronger... As of it stands right now that won't be the case being so be coming home the same day I have obvious concerns because my home is 2 hours away plus it has stairs to get in the house... I'm wondering if he'll be able to make it up the stairs he weighs 246 lb and his other knee is not in great shape.... Also can he tolerate a 2-hour car drive.... I just can't believe the hospital would demand he goes home the same day.. please if anyone has any of their own experiences they can share I would be very appreciative

 

[bsgrace]

I just had my total knee replacement on my left knee November 8 I came home within four hours of surgery and the first week of recovery is excruciating you definitely need somebody with your dad 24 seven I could not have done it by myself I am 60 years old and A nurse. Please look into full-time care for your dad he will definitely need it God bless you I hope all works out for your dad

 

[kate97497]

@meishere30 I'd be reaching out to the insurance company and protesting. He lives alone, he has stairs, he is older. Kind of a ridiculous decision. Raise a ruckus.

 

[meishere30]

Thank you both for yr input.....the insurance company isn't budging, I can be with him for the first 5 days, I'm just not sure the level of care he will need......our only other choice is to cancel this surgery, switch insurance companies before the enrollment deadline and reschedule for after the first of the year (his social worker said it will get him at least 3 days in the hospital after the surgery) I'm just afraid it could be another long wait to get a reschedule

 

[BEWITCHED Charm]

@meishere30
I have been very reliant and so grateful for having someone with me over the past four weeks.
I could no way have managed on my own ( this is just my opinion ). I am nearly 62 have found the whole experience overwhelming at times.
I couldn't have put my surgical stockings on, bathed ,made my own meals and beverages, fetch ice packs etc etc without support of another person. The pain control I found difficult too at first as I became rather disoriented to how much/ times of medication
due to a combination of being in pain and then the strength of the drugs used to combat this
Is there anyone else who could step in and help with your father's care? It's quite hard work on the carer to I feel. My care giver was definitely tired by bedtime each day.
Gosh I hope you get this sorted it sounds an awful predicament to be in .
Take care

 

[meishere30]

It's very frustrating to say the least...I would feel so much more confident if he could stay a couple days in the hospital under medical supervision then come to my house for care, he would be a little stronger....even his social worker was dumbfounded....yet assured me they send people home the same day all the time....everything in me is saying ....no....just wait and switch insurance companies

 

[GiantFinnegan]

What does the surgeon say? Has the surgeon talked to the insurance company? I would think it would be a huge risk for them to send him home - a fall, mixing up medications, etc. and perhaps if the surgeon talks to the insurance company he/she can pursued them to let him stay in the hospital for at least a night or 2.

Even after that, though, I would think he's still going to need some help. I'm relatively young for this surgery (45) and I still can't have imagined being alone for the first week. I know some people do it, but it was really helpful to have my partner keep track of medications, fetch ice packs, bring food to me on the couch, supervise me going up/down stairs, etc.

 

[meishere30]

To be honest....I'm not sure his surgeon is aware that he's being discharged the same day....that is my Monday morning phone call....all this just came to light Wednesday.....so now we are scrambling since his date is 12/6 for surgery....I actually said the same thing to the social worker...what if he falls, ends up back in the hospital...and leaves them with a bigger bill to pay....is it worth the risk?

 

[meishere30]

I have know issue taking care of him....I'm just scared I'll drive him 2 hours to my house and he can't make it up the stairs to get in my house....I've considered getting a motel room that you enter the room from the parking lot ...for the first night....

 

[Jockette]

We have found that if the patient is not ready to go home that same day, then they do stay until they are ready.

PT will help him do some steps in the hospital so that he can navigate them at your house when he is released. It would probably be a good idea to have someone at your house to help you help him inside, if he needs help.

I‘m sure right now any stairs are difficult, since he needs a knee replacement, but other than that, does he manage getting around well enough now? If so, he might be better than you think he will be.

I do hope you can get around the insurance’s current mandate. I’m sorry you’ve had this upsetting sudden complication.

 

[meishere30]

Thank you so much....yes my dad is very independent...he actually still "works" by volunteering driving people to their doctor appointments....maybe I'm not giving him enough credit....lol....I guess I need to make some aggressive phone calls Monday....I so very much appreciate everyone sharing their experience....

 

[meishere30]

What if insurance just flat out refusing to pay for any additional time in the hospital....even if he's not ready....can they do that?

 

[Jamie]

You do have options. First let the surgeon know what is going on. He is the one to be fighting it out with the insurance company. Who is the insurance company? Isn’’t he covered under Medicare? Or does he have one of the Advangage plans? Advantage has been known to try and cut corners like this.

Your father should not be going home the same day. The words you need to keep repeating is that no one is available to care for him (even though you say you could) and he is not safe at home alone. Even with you there….what are you going to do if a 146 pound man starts to fall? A fall on a new knee can be a very critical matter and obviously it should be avoided at all costs. Elective surgery or not has nothing to do with safety issues.

You need to keep going up the supervisory chain at the insurance company. When you get to a supervisor, ask how you go about disputing this decision because your father will not be safe at home alone. And then start the process - even if your surgeon is also working on it.

If nothing works, there is an option when he’s in the hospital. Be there with him on surgery day and refuse the discharge. Ask for a patient advocate to help with his case. There is paperwork to fill out when you refuse the discharge for safety reasons, but it’s worth it. He needs to be stable before going home at his age no matter what other factors are in place. They won’t know if he is stable the same day of surgery.

Keep enlisting the help of his surgeon too. He may have indicated to his doctor that he’d be fine at home if he’s the independent type. People just don’t realize how serious this surgery is. Don’t be afraid to be assertive in this situation. Hospitals cannot release someone who is not going to a safe environment.

Good luck! And let us know how things go.

 

[Pumpkin]

If your father is medically unstable for any reason (unable to do stairs for example) usually the insurance company will pay for additional days.

 

[CricketHip]

I wonder if he could go directly from the hospital to a skilled nursing facility? That's what my Mom was able to do, but of course that was maybe 10 years ago. Things change so quickly in regards to insurance policies. But that might be something to look into.
I was supposed to go home same day and for both of my hips was able to stay overnight with no issues.. my blood pressure was too low to get clearance to be discharged.
I am so sorry you have this to worry about on top of the all of the other logistics. @meishere30

 

[djklaugh]

@meishere30 It depends on the kind of insurance he has - Medicare or private or both. The medicare vs private insurance rules and protocols are very complex and hard to understand. It sounds, from what you have said, that some where in this process the insurance got the idea that knee replacement was being done, sigh, "just because pt wants it" rather than because your Dad is pretty severely disable because of knee pain and dysfunction. I don't know if the surgeon can talk insurance around or not but that is definitely worth a try.

Rehab or short term nursing home care might be an option but is likely to be expensive since insurance is saying this is an "elective" surgery.

Would it be possible for you to stay with Dad at his home rather than take him to your home? And would that place be easier for hi to get around in?

 

[meishere30]

I actually thought they might send him to a nursing home after a short stay in the hospital, but that appears not to be the case....I've also considered the "lying" method....and just flat out saying....I don't have the capability to take care of him the way he needs....but it wouldn't be my proudest moment...but there has to be other seniors who have no one to care for them.....how do they ever get surgery?

 

[meishere30]

He has Medicare, Medicare and Humana....they are using Humana as the primary insurance....they are where the problem is...
Since it's considered an elective surgery they won't pay for hospital stays...and yes the whole insurance topic makes my head hurt....and yes I could stay with him at his house but there are stairs and it's a very small mobile home....so a walker is tight that it would be easier at my house

 

[BarabooProud]

I wonder if you wouldn't be lying if you said that you weren't able to care for him. You mentioned that you are worried about him getting up the stairs. Do you have a job? He will need constant care for quite some time, given his age. I really think a nursing home would be the way to go for his recovery. Pain management is so difficult. Getting around the first couple of weeks is difficult. Will you be able to hold him up to get into the shower? So many things to consider. This is very major surgery with lots of potential complications. I wish you luck. I'll be thinking about you!

 

[montanagal]

He has Medicare, Medicare and Humana....they are using Humana as the primary insurance....they are where the problem is...
Since it's considered an elective surgery they won't pay for hospital stays...and yes the whole insurance topic makes my head hurt....and yes I could stay with him at his house but there are stairs and it's a very small mobile home....so a walker is tight that it would be easier at my house

I've heard terrible things about Humana...but I thought Medicare was primary and was controlling.

Three years ago I heard CMS was considering outpatient TKR but yet my second TKR, last August at least kept me one night. Though I had the option to leave earlier.

How did Humana get in the driver's seat on this?