Dear Advocate,

My mother is a resident in a nursing home in San Diego. Until recently, my mother paid privately for her care, but she is now on Medi-Cal. She has been incontinent for about three years. I have been buying her disposable diapers because she is prone to skin breakdowns, and the doctor recommended them. I’ve spent as much as $120 a month on diapers, and it’s still not enough. Every time we go into the facility, she seems to be “running low” on diapers. I suspect that the staff is using her supplies for other residents. What can I do? I really can’t afford to spend much more.

Daughter in Encinitas

Dear Daughter:

There are two issues here. One, the facility staff are using your mother’s supplies. This is illegal. Find out how many diapers you mother uses in a day, count the diapers; and, if there is a marked discrepancy, hold the facility accountable for the missing diapers. Incontinence supplies are the property of the resident and are not to be shared with other residents. They are supposed to be labeled with at least the resident’s name and physically separated from other residents’ property.

The second issue is: who is responsible for supplying the diapers? Since your mother is a Medi-Cal resident, and incontinence supplies are included in the facility’s daily Medi-Cal rate, the facility is responsible for paying for incontinence supplies. However, the facility is not required to provide a specific type of incontinent supply, such as disposable diapers, unless they are in the patient’s plan of care and are ordered by the attending physician. Since cloth diapers or incontinent pads, for example, are usually cheaper, many facilities use them instead of disposable diapers.

The physician must write an individual prescription for disposable diapers; note in your mother’s medical record the anticipated rate of use; and note the specific medical reason that disposable diapers were prescribed. Talk to your mother’s doctor and ask her/him to write a prescription for the diapers.