If you're looking for assisted living, home health care, skilled nursing or a nursing home, it's usually because of a medical crisis involving a loved one. You're probably in a time crunch —
decisions have to be made quickly. The hospital may have said that your loved one will be discharged tomorrow. They've given you a list of rehab facilities, and it's up to you to pick one. But,
how do you know which one is best? Are some better than others?
If you're in this situation — take a deep breath — relax a little — and read the next paragraph. You might make a better decision as a result.
- Medicare has special rules to keep patients from being discharged from the hospital too soon. In spite of what they may have said, your loved one cannot be discharged
until 3 days after the hospital gives you a form called a Notice of Noncoverage. If they have not given you the Notice, insist that they do. (You won't get into trouble by
insisting, and neither will your loved one.) This will give you additional time to find the rehab facility that's best for your loved one.
Several readers have asked whether their loved one who is receiving treatment in a Medicare skilled nursing facility can come home for a short visit on Thanksgiving, Hannukah or Christmas.
The answer is, "Yes," if you follow the rules:
- While many patients participating in a Medicare inpatient nursing or rehabilitation program are not able to leave the facility, some are more than able to leave for a short time. So, there is
really no reason why a patient who is able, and who would enjoy a short visit, can't be part of the festivities on a special holiday.
- While some nursing home executives proclaim that Medicare won't continue to pay for inpatient skilled nursing or rehabilitation if a patient is well enough to leave the facility for a short
time, this is not exactly true. In fact, the Medicare manual itself states, "An outside pass or short leave of absence for the purpose of attending a special religious service, holiday meal,
family occasion, going on a car ride, or for a trial visit home, is not, by itself evidence that the individual no longer needs to be in a SNF for the receipt of required skilled care."*
- In fact, Medicare continues to cover the full facility cost if the resident returns from an outing before midnight of the same day. Because a "Medicare day" is defined as extending from
midnight to midnight, if the resident is back in the facility by midnight, he or she is considered to have been in residence for the day. There is no financial or coverage liability to the
patient for a short outing.
- When a patient is gone from a Medicare-covered skilled nursing facility past midnight, the day the resident was not in residence at midnight is defined as a "leave of absence day." Medicare
will not pay the facility for leave of absence days, although the resident is certainly permitted to return and resume treatment after a leave of absence of less than 30 days.
- If a patient is out of a facility on a "leave of absence," many facilities do charge a "bed-hold" fee to cover their costs of not having a patient in that bed. Whether your facility
will charge a bed-hold fee, and when the fee will commence, should be covered in the documentation you were given when your loved one was admitted. No nursing facility can arbitrarily choose to
charge a bed-hold fee without advance notice. However, you may not have seen the notice in the overwhelming number of documents you must review at admission. Review your contract.
- So, if your elder is physically and mentally up to it, if he or she would enjoy a few hours with the family on a holiday, and if you, your home, your other guests and you can accommodate his
or her physical and mental needs, then by all means, plan for the visit.