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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?

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Yes, apparently this special mattress cannot be covered by medicare/medicaid or her supplemental. In that case the home could not absorb the rental cost. These can be very expensive, so get the facts before you do this. We used to have tie on almost like crib borders in hospital and they would be less costly, but also a pain to take up and down to changes and getting people out of bed.
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sunayana14 Jun 2021
Hi AlvaDeer, thank you so much for the quick response!!
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Through her doctor's ordering this mattress, pursue an exemption/waiver from Medicare to pay for the mattress. Or even other insurance she may be covered by, ask for an exemption. The approach would be: "Will the patient get worse without the needed equipment?" I am surprised the DME (durable medical equipment) was not covered by insurance.

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?
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BurntCaregiver Jun 2021
That's a good point, Sendhelp.

The nursing home by law is not entitled to anyone's Stimulus money. I hope it wasn't handed over to them.
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the nursing homes should already have these kind of mattresses, as my father had to use one for awhile. And it should come out of the funds that you are paying for his room/board or medicaid. I would discuss with the admin and find out why being charged and let them know you will discuss with your attorney. I bet they will find a way to charge medicaid or they will say it was a mistake. like i said, i would think most nursing homes already have this kind of mattress. wishing you luck
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BurntCaregiver Jun 2021
wolflover451,

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.
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Check out "foam bed bumpers" on Amazon. They are made for toddlers, but I think some would be long enough for adults. The bumpers are put on the bed like a mattress pad, under the sheet. Sounds similar to what the mattress might do, and be cheaper in the process. If they work, great! If they don't, then you might have to buy the mattress.
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Countrymouse Jun 2021
Seriously, don't.

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.
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I had my mom with me. She has Alzheimer’s and continue to get worse. I had to put her in AL. I read that if you put a pool noodle on side of bed, under the bed sheet, it’ll help to keep them from falling out of bed.
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When you go to a Nursing home all that is covered is your care, Depends, wipes, chux, your prescriptions, your food, therapy if needed, your bed, side table tray, linens, hospital gowns, toiletries, woundcare,etc. But they do not pay for your durable equipment. And Medicare does not pay for everything, nor does a supplimental. Medicare has weird rules. If you get this, they won't pay for that. Yes, shower chairs are one thing they won't cover.

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.
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igloo572 Jun 2021
When my mom became bedfast, all her old walking stuff - a really nice & new Hugo, a speciality ordered for petite walker, 4 footed canes - went over to the loan out room at the NH. It was a sight to behold, what a variety!!!. This seems to be standard procedure for a NH. It was nice knowing that another family, who perhaps could not easily afford one, could use moms old Hugo.
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I live in assisted living. A.L. and nursing homes provide basic items, beds, chair, dresser. Anything "special" is always paid for by the families - or the resident. No one but them pays for anything special - ever.
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Side rails are 100% illegal in nursing homes -- they are considered a restraint; in fact, research shows side rails are more dangerous since they can still fall out of bed and get an arm or leg caught in it and have a catastrophic event.

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.
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The nursing home should be asking the resident (your mother) to pay for it. If she can't, is it really that shocking they've asked you? Who do you think should? Who pays for the rest of her medications and personal needs?

I agree strongly with Cetude that the reason for asking ought to have been made clear.
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Yes, it may be over and above what they are required to provide. The air mattress was probably covered by Medicare this one maybe not. If she needed a new wheelchair, Medicare would probably be paying for that, not the facility.

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.
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sunayana14 Jun 2021
Hi JoAnn, thank you, thank you. And for the information about the wheelchair which she also needs. Very helpful!
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