My parents were in a Medicare Advantage plan in 2010 when my father was accidentally struck by a golf cart. He sustained a fractured pelvis and internal injuries. He was transferred from the local hospital to the area level 1 trauma center about 25 miles away. Although it was not in his MA network, as the only hospital able to care for his severe injuries the MA plan had to pay for him to go there. At the time of his accident, my father was a very active, healthy 89 year old. He was in the trauma center ICU for over two weeks, most of that time on a ventilator. He had multiple surgeries. When the ICU physician said he was ready to leave Intensive Care. The MA plan said that he would be transferred to their in network rehab facility. My brother, sister-in-law and I were all ICU nurses and knew that the appropriate transfer after the ICU would be to a Step Down unit, not Rehab. My brother and I both went to see the “Rehab” facility. It was a nursing home, permeated with the smell of urine. I asked to see the location for physical therapy and was shown a small room with its floor competed covered with walkers, wheelchair and other equipment. It was obvious that no therapy was taking place there. If my father were to be sent there, he surely would have died. I suspect that would have greatly favored the MA plan’s bottom line. We called for a meeting with representative of the MA plan. My sister who is an attorney was also at that meeting. We made it clear that our father should not be transferred to their “Rehab” We would only accept transfer to an appropriate Step Down unit and that legal action would be taken if they refused. He was transferred to an in network Step Down unit only because we had the knowledge of three ICU nurses and the credible threat of litigation all in our family. How many others were not that fortunate? As it turned out he did have problems that were appropriately dealt with by the Step Down staff. I doubt that the nursing home could have done the same. He went on to return home and live for another seven years. He died from an unrelated illness.
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