Long-Term Care: From Hospital to Rehab

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More than 60 percent of nursing-home admissions come directly from hospitals, so it's not surprising that most people face the decision about entering a nursing home in a crisis or just after one. The crisis might be a stroke, a bad fall, or a worsening of a chronic condition.

Going home from the hospital may be the preferred choice, but the family may not be able to provide the needed care, even with the home healthcare and rehabilitation therapy that Medicare and other insurance coverage provides.

A short stay in a skilled nursing facility rehabilitation program is one option that can give the person and family time to adjust to the new requirements and be better prepared to manage at home.

Don't panic if the hospital nurse or social worker says, “We're sending you (or your parent) to a nursing home tomorrow.” Although this information should not come at the last minute, it often does. What it usually means is that you are being referred to a rehabilitation program at a nursing home, not being sent to a nursing home permanently.

In these situations, you will be asked to make a quick decision about which nursing home rehab program to choose, and the choices may be limited. The discharge planner at the hospital may hand you a list of five nursing homes in the area and say, in effect, “You choose.” The discharge planner will then see what is available right away.

Your choices may be limited by the facilities’ bed capacity, their ability to provide the kind and level of care needed, location, and other factors. Frequently the list includes only those nursing homes with which the discharge planner works on a daily basis; it may not include the full range available and appropriate.

If you are interested in nursing homes not on the list, you can ask that specific nursing homes be put on the list, but the hospital will not keep your parent until a bed in your preferred nursing home becomes available.

You can try to push the hospital to delay discharge for a few days, and you can file a formal appeal to postpone it. (If you lose the appeal, however, you will have to pay the costs of the additional hospital days.)

The push to move patients quickly from hospitals to nursing homes is in hospitals’ and nursing homes’ economic interests. Hospitals want to ensure that they can discharge their patients quickly, and nursing homes want to maintain that source of new income.

Medicare pays for the initial episode of nursing-home rehabilitation services if the person has been discharged after a minimum three-day hospital admission, but patients don't always get to stay for three days.

Original Medicare pays for the first 20 days of each benefit period; you pay a coinsurance of $152 per day for days 21–100 (in 2014), and you pay all the costs for each day after day 100. You must be hospitalized for three days to start a new benefit period. If you have a Medicare Advantage plan or private insurance, check with the plan.

To be eligible for Medicare coverage for short-term rehabilitation services, you must have been formally admitted as a hospital inpatient for three days. If the hospital makes a referral to a rehab program for further treatment in a nursing home – for example, to improve your ability to walk after a fall – after an observation stay, no matter how long the stay lasted, Medicare will not pay.

Check to make sure your family member has actually been admitted to the hospital. You can also complain to the hospital if you are not given accurate or timely information.

There are steps you can take without the pressure of an imminent hospital discharge or a rapidly deteriorating situation at home. The first step is to look broadly at the options in your area. Then you can be more focused on specific nursing homes and how to evaluate them.

Sometimes a person admitted for a short-stay rehab program is unable to return home as hoped, and then another decision point is reached: to stay in the same nursing home as a long-stay resident or move to another facility. There may be interim steps to prepare for going home, for example, home modifications or hiring extra help.

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