What type of lawyer can help us with violation of resident rights in skilled nursing facility and against Medicaid managed care plan?

JoAnn, your thoughtful response has led me to mention one more point. Dreamari86, please listen to JoAnn! Dreamari86. You've been concerned that your father's knee osteoarthritis hasn't been treated in this facility. However, he is not in the care facility for knee osteoarthritis. He was being treated for it before his stroke, I assume with outpatient physical therapy. If he is to have more physical therapy for that condition now, his doctor will need to prescribe it and his insurance will need to pay for it unless he wants to pay out-of-pocket.

However, your father is a long way from being in a condition in which knee replacement is appropriate, and the chances that PT will be prescribed and paid for are probably not good right now. Dreammari, when I was preparing for unilateral knee replacement when I was close to your father's age, I did about 1 hour of PT 7 days/week at home; I saw a PT 1 or 2x/week. That was plenty--and I was having only 1 knee replaced! I could not possibly have managed this in addition to the therapy needed for another major, critical health issue. Even if the facility is not offering as much therapy as you want, he still must have exercises to do in his room! If he has his computer in his room, Stanford probably gives him a password to access videos of his exercises, which can be of great help.

Dreamari86, I realize your request was for a recommendation as to what type of lawyer you should be hiring. Like some others here, I have concerns that hiring a lawyer will not solve your problems, some of which seem to me to arise from your and your father's needing a better understanding of what's realistic for his stroke rehab at this time and what's realistic to expect Medicaid to cover now. It cannot be good for either of you to be pushing forward in the way you've been doing, and I feel for you (or I wouldn't be writing so much!). Your father can have a good quality of life without the probably unrealistic amount of further stroke recovery that you expect. It sounds as if many of his faculties are intact, and he can use those to make a better life for himself! Please consider making this your focus instead of pursuing legal actions that may lead nowhere and that can cost your family a lot both financially and emotionally.

After the stroke, my father's admission to an inpatient rehabilitation facility posed significant challenges due to language barriers. Staff primarily communicated in Spanish, whereas my father only speaks English, compounded by dysarthria that hindered his ability to speak. Despite my daily efforts to explain the language barrier, they declined to transfer him elsewhere and restricted visitation due to Covid-19 protocols. Only after urgently needing to inform him about his mother's funeral did they permit my visit, but by then, his time at the facility was nearly over. During the visit, I emphasized his English-only communication needs on his room's board and name tag. This adjustment led to better comprehension of therapy instructions, showcasing improvement, particularly in his right hemiplegic arm. However, the facility claimed his lack of understanding was due to the stroke and insisted on transferring him to a SNF. Despite my repeated explanations that UCSF Hospital affirmed his cognitive abilities except for Spanish, the miscommunication persisted.

Upon transitioning to the SNF, his speech started to improve after a day of collaboration with the speech therapist & he was able to talk. He explained he was having trouble swallowing at the inpatient, which was why he kept refusing to try the solid food they were trying to give him. However, inaccuracies persisted in his records, including incorrect diagnoses like hemiplegia on his left non-dominant side, diabetes, & major depressive disorder. My repeated requests for corrections went unanswered. Occupational therapy was suddenly discontinued without notice, and I only learned about it weeks later when he was disenrolled from the managed care plan. Their struggle to request therapy from fee-for-service Medi-Cal persisted for six months, coincidentally aligning with the managed care plan's resumption of coverage. However, therapy was abruptly halted again after a week following my complaint to the Department of Public Health.

The SNF's therapy sessions were inadequate, neglecting his affected side and focusing on activities he could already perform. Despite Stanford's recommendation for higher therapy levels and the Department of Managed Health Care overturning the denial for an inpatient transfer, the SNF resisted, falsely accusing my father of noncompliance. This refusal persisted despite DMHC deeming the transfer medically necessary, emphasizing the need for a Zero G walking harness only available at inpatient rehab. The SNF falsely attributed my father's decline and weight loss to medication noncompliance, specifically refusing Remeron (antidepressants). However, they continued to withhold appropriate food portions, causing malnourishment and dehydration. My father refrains from eating before appointments to avoid accidents during physical therapy sessions. Stanford will address his toileting needs, but he still requires assistance with balancing, walking, and pivoting, unfulfilled by the SNF.

As my father's participation in a stem cell trial approaches, the urgent need for neurorehabilitation therapy becomes evident. However, the SNF's refusal to provide adequate care & falsifying records hampers his progress, leaving us struggling to secure the necessary inpatient transfer. Despite recent developments, the SNF's retaliatory actions persist, obstructing his path to recovery. Their refusal to adjust the care plan to address his medical concerns, such as bilateral knee osteoarthritis, & their insistence on retaining the inaccurate major depressive disorder diagnosis further complicate the situation, hindering his prospects for inpatient rehab participation. They are writing the insurance that he has improved there because he can now move his left arm, but he could always move that arm, his stroke affected his right side. In order to have the knee surgery he must be able to walk & balance, currently working on, but at slow rate since he only goes 2x a week for 40 min.

Stem cells or wartons jelly injection is helpful but not FDA approved. I went to 2 lectures on this. Costs 7 to 15 k out of pocket and requires follow up with PT, not necessarily found at a facility.

I have reported it numerous times to the ombudsman and cc her in all my emails and requests to the facility and they still won't come down and do a report. I wish they would come down, once in a while they will get in on the meeting on zoom, but the facility just promises to help us and never does and falsifies even more records. It is ridiculous that no one has stepped in, especially when the facility is now putting in my father's care plan that "daughter is disruptive, difficult, dictates care as evidenced by: - poor coping patterns, invalid complaints and unrealistic requests and expectations" and the goal they list is "communication will improve between family and staff through the review date" and interventions are "assess causative/contributing factor, encourage verbalization of guilt, speak to family in a calm manner to avoid confrontation, identify family strengths weakness needs and priorities." I am my father's power of attorney and chosen support person, he tells the facility to call me when they are not understanding what he is trying to explain to them, but they refuse then write in the nurses notes that my father runs to me everytime and I report them to the ombudsman and this is a typical behavior of resident. Now they are documenting that resident has behavioral problems because of this. They are violating his rights I believe and still nobody will step in or transfer him to the medically necessary acute care level that was ruled by the Department of Managed Health Care. Every facility is refusing him because of the notes and statements the snf is documenting which are untrue.

Alva, he had a stroke.