Since I am undergoing this process for R2 or R1 (whichever they decide) I thought it might be a good idea to start a topic and discuss what others went thru to receive it....
Currently my VA Primary Care doctor has stated that I would require skilled care 24-7 at home, or a referral to a nursing home. I filed the claim stating that if they couldn't provide the necessary funding, or some sort of home healthcare providers.. well they would need to place me in a nursing facility.
They came back with this huge list of claims... I was actually shocked.
I wrote them back stating that no I was not attempting to claim this or that... (I thought that listing my claims 1-5 and printing them in bold would be clear enough).. and restated my case. I then went to the medical C&P, and a VERY nice doctor did the eval. I had my primary care person (a CNA I pay for myself) present, and my sister.. a director of nursing at the closest VA contract nursing home.. also an RN. We had a care plan, etc.... and I gotta say the doctor was really really incredible. Now you never know exactly what they type until you pull the record, but she said things like "I not going to check that... its obvious and isnt going to improve" etc. etc... She had a LONG list of things she was supposed to check though, and with my sister/RN and the CNA I am paying a fortune for... $12 hr... (sigh) she was able to answer them without asking me almost anything. I do know that for all the rotation questions she answered no rotation possible due to injury and pain... or at least most of them.
I didn't realize that the VA does not provide home health care except for short periods. This is looking to be a long term issue, and I am honestly debating going into a nursing home. The ONLY thing stopping me right now is my 8 year old daughter.... (sigh)
Anyway, they also set up a psych C&P... thats going to be a joke though, they have me in weekly counseling now so they should have a fairly clear picture with me walking-wheeling in, but I expect a million and one questions. Just me and the wife for this one though.
Like I said its an issue between R1 & R2... I wondered if anyone had any experience with the differences... the applicable reg is CFR 38 3.350 and 3.352, but they are a bit vague to be honest I meet all the critrea for both. Obviously for those who know me this is all new. I have been out of the loop for quite a while, and am only VERY slowly poking around again from my bed (hey it gave me an excuse to buy the 22 inch LCD monitor and wireless keyboard etc.).
Anyway... just wondering. I am classed as "skilled" care if I was in a nursing home... so I wonder if that would make a difference?
Mmmm... probably need to know the new injuries... rupture at L5-S1/L4-L5 L2-L3... incontinence/w indwelling catheter... major pain major muscle spasms constant... (the doctor actually saw and felt them - I thought that was a good thing)in legs and lower back. Loss of ability to balance, loss of memory (pain meds I guess) etc etc..... loss of streangth, mobility, inability to dress or put on ortho aplliances by myself, bath etc. The CNA cooks, cleans -lightly, etc. Rehab has written me off not Voc-rehab... rehab. They say until this is fixed or the muscle spasms reduced physical therapy will do more harm than good. They even annotated this into my records so as to make sure no one tries...
How did it happen? You got me. One day I was bad but stable (had been for 2-3 years)... next morning I woke up with this... go figure.
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sixthscents
Since I am undergoing this process for R2 or R1 (whichever they decide) I thought it might be a good idea to start a topic and discuss what others went thru to receive it....
Currently my VA Primary Care doctor has stated that I would require skilled care 24-7 at home, or a referral to a nursing home. I filed the claim stating that if they couldn't provide the necessary funding, or some sort of home healthcare providers.. well they would need to place me in a nursing facility.
They came back with this huge list of claims... I was actually shocked.
I wrote them back stating that no I was not attempting to claim this or that... (I thought that listing my claims 1-5 and printing them in bold would be clear enough).. and restated my case. I then went to the medical C&P, and a VERY nice doctor did the eval. I had my primary care person (a CNA I pay for myself) present, and my sister.. a director of nursing at the closest VA contract nursing home.. also an RN. We had a care plan, etc.... and I gotta say the doctor was really really incredible. Now you never know exactly what they type until you pull the record, but she said things like "I not going to check that... its obvious and isnt going to improve" etc. etc... She had a LONG list of things she was supposed to check though, and with my sister/RN and the CNA I am paying a fortune for... $12 hr... (sigh) she was able to answer them without asking me almost anything. I do know that for all the rotation questions she answered no rotation possible due to injury and pain... or at least most of them.
I didn't realize that the VA does not provide home health care except for short periods. This is looking to be a long term issue, and I am honestly debating going into a nursing home. The ONLY thing stopping me right now is my 8 year old daughter.... (sigh)
Anyway, they also set up a psych C&P... thats going to be a joke though, they have me in weekly counseling now so they should have a fairly clear picture with me walking-wheeling in, but I expect a million and one questions. Just me and the wife for this one though.
Like I said its an issue between R1 & R2... I wondered if anyone had any experience with the differences... the applicable reg is CFR 38 3.350 and 3.352, but they are a bit vague to be honest I meet all the critrea for both. Obviously for those who know me this is all new. I have been out of the loop for quite a while, and am only VERY slowly poking around again from my bed (hey it gave me an excuse to buy the 22 inch LCD monitor and wireless keyboard etc.).
Anyway... just wondering. I am classed as "skilled" care if I was in a nursing home... so I wonder if that would make a difference?
Mmmm... probably need to know the new injuries... rupture at L5-S1/L4-L5 L2-L3... incontinence/w indwelling catheter... major pain major muscle spasms constant... (the doctor actually saw and felt them - I thought that was a good thing)in legs and lower back. Loss of ability to balance, loss of memory (pain meds I guess) etc etc..... loss of streangth, mobility, inability to dress or put on ortho aplliances by myself, bath etc. The CNA cooks, cleans -lightly, etc. Rehab has written me off not Voc-rehab... rehab. They say until this is fixed or the muscle spasms reduced physical therapy will do more harm than good. They even annotated this into my records so as to make sure no one tries...
How did it happen? You got me. One day I was bad but stable (had been for 2-3 years)... next morning I woke up with this... go figure.
Anyway... opinions accepted.
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