Case Study: Ocean Breeze Home Care

I have spoken with the home care nurse regarding the wound and the physical therapist and occupational therapist. The physical therapist recommended a front wheeled walker as his weight bearing activity was progressing, including his transfers and more independence. The occupational

Fit Adult Care Home LLC is a residential care home located in the beautiful city of Gresham, Oregon, which is Multnomah County. Our historic community is the fourth largest in the state with wonderful restaurants and shops. Gresham is a wonderful place to live with lots of events and activities for family and friends to enjoy when visiting.

Howard Terry Newman is 67 year old retired printer who suffered from Parkinson’s disease as well as arthritis, voice impairment, hiatal hernia, and heart trouble. Mr. Newman, the appellee, is contesting his stay between September 19, 1968 and November 11, 1968 at the appellant’s facility, Big Town Nursing Home. The plaintiff was admitted voluntarily by his nephew to the facility with the ability to leave as he pleased. However, on September 22nd, when Mr. Newman attempted to leave the facility, he was told that he could not use the phone or entertain visitors without the administrator’s permission. He proceeded to walk out; he was brought back and restrained on Wing 3 with “senile patients, drug addicts, alcoholics, mentally disturbed, incorrigibles and uncontrollables” according to the administrator testimony.

The reporting party (RP) stated her husband Vernon Ferguson DOB: 11/29/29 was sent to the emergency room due to a frozen shoulder on 3/29/16. The resident was released to return to the facility 3/30/16, however the facility refuse to allow the resident to return. The facility notified the family on 3/30/16 the resident was at the hospital and he would not be allowed back in the facility. The RP stated the resident was abandoned and forced to spend two nights in the emergency room prior to finding an alternative placement (Mountianview Care Home). The RP stated she paid the facility $6500 for the month of April and due to the facility eviction she is entitled to receive a refund. According to the RP the administrator stated the check went out

Lisa Noel arrived to Manor facility on 6/15/2015. Client age -48; and her children ages are M-21 M-16, F-, F- 10 and F-7. Client and family were explains all the rules and regulation of the shelter. Clients were explaining that children over 18 yrs old cannot stay along in the unit.

Please be aware that the Bronx Health Home requires consent form to be filled out as follow:

We received your grievance request regarding your monthly explanation of benefits showing services for a walker that you never received nor need. This request was received by Blue Cross® Blue Shield® of Arizona Advantage (HMO) on December 30, 2016

We received your grievance request regarding Bayada Home Health Care advising you they are only allowed to treat home bound patients and a Nurse refusing to leave your wound care supplies at your apartment leasing office. This request was received by Blue Cross® Blue Shield® of Arizona Advantage (HMO) on May 24, 2017.

D/A: Mr. Brown had three appointments this week. On 02/20/17, Mr. Brown was transported to his appointment with Dr. Walsh at 10:00 a.m. and went for his PET scan at the Women Center in Dover on 2/22//17. The Christiana Care Home Health Physical Therapist visited Mr. on 02/20/17, 02/22/17 and 02/24/17 at the Connections Still Road Group Home. On 02/22/17, Mr. Brown received physical therapy treatment in his bedroom, because he was too weak to come outside his room to receive treatment. According to the Physical Therapist notes dated 02/22/17, Mr. Brown tolerated treatment well with a rest period between activities due to complain of fatigue, neck & back pain rated 8/10 where ten is the most painful. Mr. Brown met with his Psychiatrist Dr. Capiro on 02/19/17. Dr. Capiro provided Mr. Brown a direct service at the Residential Program. The service

On 10/9/17 at 2:30pm the patient’s aide’s father, Jacques lemonta, called New Century Home Care to inform that the patient, Divers Mary, and his daughter, Limonta Natania, were hit by the car on 10/09/17 and taken to Jamaica hospital. Patient and aide condition has not provided at this time. Well Care and patient’s PCP notified.

After living abroad, Mike came back to the UK and decided that it felt like the right time to look into fostering again. That was five years ago, now Mike is incredibly proud that he has helped stop children being sent to residential homes through working with them.

On 2/4/2016, you had a dental appointment, but DENCAP could not find you in their system. Therefore, you called Harbor Health and were advised that you have dental insurance as your premium was paid, however a spreadsheet that included your name wasn’t sent to DENCAP. Consequently, your appointment was canceled. Afterwards, you called DENCAP twice and DENCAP contacted Harbor Health but no one addressed your concerns or returned your call. You expressed, that you were unable to use your insurance and attend appointments due to errors made by Harbor Health and asked to be contacted to discuss these matters

After viewing this providers claims, I notice that the provider is billing on a CMS1500 and UB-04 for Home Health Aide Services. Because Home Health Aide is normally billing on a CMS1500, the claims are denying for G04 –Inappropriate billing for the contract. However, provider is also billing on a CMS-1500 which is passing the G04 denial to deny for OHI. I called Emery McDonald at 2:32pm to go over the details of his claims, however, he’s receptionist advise he out today and I left a voice mail advising I would call him back. I will call again tomorrow.

In many home care companies today, care givers often feel desensitized and de-valued. Broken systems, low pay, and competing priorities challenge care givers in providing the level of care delivery to which they aspired when they first chose careers in healthcare.

“After review of the available clinical information, the request for a Power Wheelchair with Power Standing Function, Power Seat Elevator, and Accessories has been denied as requested. The reason for this denial is: The clinical information provided does not meet UPMC Health Plan’s clinical criteria to support medical necessity, such as: The documentation provided fails to indicate that the member’s needs are unable to be met with use of his