My mother frequently falls out of bed. The doctor has ordered a special mattress to prevent her falls. What is shocking is that the nursing home is asking me (her daughter) to pay for it. The mattress is designed to prevent falls. The mattress has cushions that surround the edge of the bed to promote a safe bed environment, without the need for confining side rails. As a back story, it took 6 months for them to order an air mattress when she first arrived to prevent bed sores. Is this legal?
Mom did not fall out of bed and no rails are allowed, but she would get up in the middle of the night to go to the bathroom and collapse to the floor ( she was on a toileting schedule). Unknown to me, they started putting her to sleep in her recliner ( I signed a waiver to have it in her room years earlier). I did not know about this until the new care plan this month. So the hospital bed is just sitting there, but someday, when she is slipping away, she will use it.
Call her insurance company or Medicaid to see what her copays is. And yes, there us a limit to how often equipment is covered.
What MediCARE does for DME will be what other insurers & Medicaid do for paying for DME.
As others have posted, DME industry has had pattern of shady practices. Price gouging & outright scams over the years. MediCARE has paid out $M’s.
Which has meant that now it takes forever to get approval for DME. Add in that a mattress or wheelchair has a set lifespan of use, so getting a replacement or upgrade easily is kinda impossible if the item still is within its lifespan of use and the persons medical status hasn’t changed significantly. It sounds like it’s only a few months that your mom has her 1st mattress, if so, it’s just not enough time for MediCARE to pay for a newer version.
It was beyond really hard to get MediCARE to cover a newer wheelchair for my cousin w secondary polio, would take months to approve & have paperwork done by his therapists etc and him as to why a newer version would make a difference, yada yada. He had a SNT so had the $ to just buy one & that is what happened. But had SNT not been there, someone would have need to run over his old speciality wheelchair & flatten it in order for mediCARE to ever pay for a newer one.
Mom went in with her walker. Yes, they supplied the wheelchair, geri chair and eventually a concaved mattress. I never signed for anything to be ordered so I assume that the items were on hand, left by former residents. We as a loan closet when we got a overrun of donated equipment called around to the homes to see if they could use it and they usually did.
Just because a Doctor writes an order doesn't mean Medicare will cover the cost. I doubt the average Dr. knows what Medicare will and won't pay for. So if the NH is asking that OP supply the mattress its because they don't and it cannot be ordered thru Medicare or secondary insurances. I have found that facilities are very good about doing the ordering if they can get a patient equipment.
I agree strongly with Cetude that the reason for asking ought to have been made clear.
Medicare/Medicaid will NOT cover specialty walkers, such as an upright walker, but only one kind of walker with wheels and no elbow rests.
This is no scam. Her insurance will not cover it. You can call the insurance and verify. The nursing home SHOULD have given a REASON why they won't cover it. Shame on them!
Defined perimeter mattress will not guarantee she will not fall out of bed. They can still crawl over them.
She should be put in a very low bed near the floor. I find it very odd the nursing home does not know how to deal with high-risk fall patients since it is a nursing home.
Causes of frequent falls should be investigated. Any kind of psychotropics or narcotics increase risk for fall substantially due to decreased reflexes. Muscle relaxants, antihistamines, blood pressure medications, and anticonvulsants all too can contribute to falls. Any kind of room clutter, poor lighting, all play their part. Toileting is the most common cause of falls--they need to go to the bathroom, they will want to get up. Toileting should be scheduled.
It is the use of equipment and modifications that are not designed for and do not fit the beds they're used on that has led to (rare) fatal accidents and the consequent (almost universal) ban of important, valuable equipment such as bed rails.
Don't skimp and don't bodge. The reason the px'd equipment is so much more expensive is that skill and thought and quality control have gone into it, and these things are not free.
You say it took six months for them to order an air mattress for her when she first got to the nursing home. So, I'm going to assume that she's on Medicaid. They will pay the entire cost for the mattress.
The nursing home is working a scam on you. They will attempt to collect the cost of the mattress from you and will also submit the bill to insurance. So they get paid twice and none are the wiser.
Nursing homes pull this scam all the time on people. The one my father was in tried pulling it on me. They told me some things for him weren't covered by insurance and would have to be paid out-of-pocket. So before I paid one cent for anything, I checked with Medicare and Medicaid (he was on both by this time). Turns out everything was fully covered. Then the nursing home was discreetly reported to the attorney general of the state he was living in.
It isn't considered part of room-and-board costs if it was ordered by her doctor. That is when it becomes medically necessary. Medicare and Medicaid cover medically necessary costs.
The nursing home is trying to work a scam that's been going on for so long in care facilities that it's now a tradition.
Second, remind the nursing home that the funds, (if the NH receives the social security funds or the supplemental security income,) that your Mom has a personal allowance held back from SS, and it may have accumulated if not spent by your Mom. They can take out monthly payments from her personal allowance.
BTW. Where is her Stimulus money, located, or spent for her own needs?
The nursing home by law is not entitled to anyone's Stimulus money. I hope it wasn't handed over to them.
My mother falls out of bed in her Memory Care too. I was asked to get her a new mattress and I wound up getting her an adjustable bed which she hates (but then again, she hates everything in general). It helps the caregivers get her in and out of bed, but it doesn't help her from falling out of the bed. Mats on the floor help cushion the fall. I'm curious to know what kind of mattress this is that prevents these falls? What is the name of it, if you don't mind sharing? I wish my mother's doctor knew of such a thing so I didn't have to waste all the money I wasted buying an adjustable bed she hates when I could've bought something better! Ugh.
Good luck!
My Moms facility supplied everything but that may be because former residents families donated the item. Moms bed was put as close to the floor as possible with a concave mattress and mats on the floor.
6 months does sound like a long time to place and receive an order. Since you are paying for the item maybe you can find a Durable equipment store that can order the item. Or even on line looking for the best price.