I was on the forums these past few days and one of the threads was talking about how many days are covered by Medicare in a Nursing Home or Rehab after a hospital stay. The answers were all over the map and quite confusing I must confess, so I thought I would do a post about it to clear things up. I have always told my readers I am no expert, but when it comes to this subject I know it all to well. You see my mom has been in and out of rehab 3 times in the past 2 years so we know the rules by heart.
According to Medicare rules a person must have a qualifying hospital stay of at least 3 days, ( 24 hours) and be in need of further skilled nursing or rehab care in order for them to pay for the stay. The doctor and the physical therapy department at the hospital must agree that the patient would benefit from continued care or therapy at a nursing home or rehab facility.
It is important to note at this point that the patient needs to be an inpatient at the hospital for 3 days, and time spent in observation or the ER does not count. They have to be admitted to the hospital. This is very important!
Insurance companies and Medicare are putting increased pressure on doctors so that they do not admit patients. They have narrowed the guidelines for admittance and now many patients are ending up in observation for 1, 2 or 3 nights and then they do not qualify to go to rehab under Medicare.
If a person has a qualifying stay of 3 days then Medicare will pay for nursing home or rehab as follows:
1. Day 1-20 Covered 100%
2. Day 21-100 partial coverage with a 161.00 a day co-pay
3. Day 101 and beyond no coverage
Many Medicare supplement policies like the one my mother has will cover the copay on days 21-100 so there is no out of pocket for the patient. However this is something you should look into ahead of time so you know your coverage should you or a loved one be in this situation.
During the time in rehab the patient must continue to show that the services provided are helping them to improve. So if at anytime during their stay the team feels they have done all they can for the patient the team is obligated to discharge them, even if they have days left.
Now there is something to be said about having days left over. If the patient leaves rehab or nursing care and they need to be readmitted to the facility within 30 days and have days remaining they will have coverage through Medicare. If they use up all their days then they would have to wait 60 days and have another qualifying hospital stay of 3 days before Medicare would pay for skilled nursing care or rehab again. This would start their 100 day benefit period over again.
I am providing a link here that goes to the Medicare.gov site for skilled nursing care. It has more information for you.
I do hope this information helps you understand the process a bit better. If you have any questions or comments please feel free to contact me or leave a comment at the bottom. We always love to hear from you. Remember you are not on this journey alone.
With so many people falling victim to dementia and other illnesses that rob them of their thinking ability these forms are becoming ever more essential.
As the population ages, more attention is being given to senior issues. This is a good thing. And some of the topics that are much discussed in relation to aging include: Are you prepared for an emergency? Do you have all the proper paperwork filled out? Are as my mom would say, “all your ducks in a row”?
Just what paperwork are they all taking about? Let take some time to explore the important, in fact, the vital forms every adult (not just seniors) should have completed and secured in a safe place in case of emergency.
There are 4 forms we will explore here and they are the:
- Power Of Attorney
- Durable Power of Attorney for Health Care
- Living Will
First let’s talk about…
Most people have heard of a will. However many people have the mistaken view that only very wealthy people need to have a will. Nothing could be further from the truth. Why so? We must first understand what a will does.
Your will is the document in which you state how you want your possessions passed on after your death. If you have minor children your will can be used to convey how you want your children cared for should your die before them and they are still minors. You can name the person or persons you have selected to raise them and how any assets are to be managed that you leave for them.
If you have been divorced and have two families, having a will can save a lot of ugliness that may result from feuding relatives, and assure that those you wish to inherit, do so.
People who have large estates should seek the help of an attorney in planning their will, to assure that all their assets are accounted for and set up properly in trusts or other financial management accounts. If you do not have a large estate you should still prepare a will, even a simple one conveying your wishes for any of your possessions. Perhaps there is a piece of jewelry you wish to pass on to a favorite niece or you want to make sure your neighbor gets that motorcycle he loves so much. Whatever you want you can put in your will. A simple will can be prepared online or even by hand, and you should have it witnessed by someone not stated in the will. Make copies and give them to whomever you wish and keep the original in a safe deposit box or other secure place.
In most cases you will also name an executor of your will. An executor has a duty to all heirs and creditors of the will. He or she is to safeguard the property of the estate and make sure that all bills are paid and assets distributed according to what is stated in the will. When choosing an executor do so wisely, someone you know will follow your wishes.
Let’s now explore the…
Power of Attorney Form
This form must be completed by an individual while they are of sound mind. I say this because of the prevalence of dementia we are facing now days, it is important that you speak to your parents or other loved ones who are getting older and make sure they have this form in place. If not, DO IT NOW, before anything happens. The Power of Attorney or POA is the form used by an individual giving another person the power to act in their behalf in regards to financial matters. Without this form financial transactions that may be necessary such as paying your bills, moving money from one account to another, accessing safe deposit boxes and the like would be impossible. With this form you can give broad powers over all financial and real estate transactions or limited powers. Some people seek the help of an attorney in filling out this form, others prefer to do it themselves and that is fine. Just remember this form must be notarized, so please do not sign it until you are in front of the notary. If you do not have this form notarized the banks and other financial intuitions will not honor it. And one fact about your POA, it is only good while you are alive. Once you pass your will takes over.
Now What about the…
Durable Power of Attorney for Healthcare
Do not confuse this form with the one above. The “Durable Power of Attorney for Healthcare”, or DPOAH, has nothing to do with financial matters. This form is used to appoint two people, a primary and a successor, who will be able to speak for you regarding healthcare issues should you be unable to speak for yourself. Again this form needs to be completed while the person is sound of mind. The person or persons you name will become your patient advocates and will step in to handle medical issues for you. This form is very important because with the HIPPA [click to view pdf] laws in place, doctors and other health professionals cannot speak to others about your condition without your consent. This form will address that issue.
This form can be filled out and completed without the help of an attorney, and it needs to be witnessed by two people so make sure not to sign it until you have two people (not your patient advocate) available to witness your signature. Copies of this form should be given to your patient advocates, your primary care doctor and any other doctors or hospitals that treat you. The original should be kept in a safe place.
Finally let’s talk about the…
Again not to be confused with your will, a Living Will is the document in which you convey your end of life wishes. Medical science now has the power to prolong a person’s life in many ways. Through medications, intravenous fluids, feeding tubes and the like, people can be kept alive in many cases longer than they would wish. Because by the time you are in a state of dying, you may no longer be able to tell the doctors when to withhold treatment your living will document can do that for you. While you are still sound of mind, you can make decisions for when that time comes. This document is easy to fill out and needs to be witnessed but not notarized. Once you fill this document out make several copies, one for each of your patient advocates, your primary care physician, other doctors you see regularly and if you or your loved one lives in an assisted living or nursing home they need to have one on file as well. You will also hear this form referred to as your DNR which stands for Do Not Resuscitate, however unlike a simple DNR, a Living Will covers several forms of treatment you may or may not want.
A lot to think about, yes, however once it’s done - it’s done. One thing to note too about all these forms, they can be updated and changed as life changes, as people move in and out of your life. So don’t worry if you appoint someone today as your patient advocate and down the road you marry or divorce or your relationships change, you can always make a change to the form.
And so these are 4 of the forms every adult, especially every senior adult should have. If it sounds like a lot of work, remember having them is for the best. And not having them completed and in the right hands will be something you may one day regret.
Don’t put off till tomorrow what you can do today.
We never know when life will throw us a curve.
With so many people falling victim to dementia and other illnesses that rob them of their thinking ability these forms are becoming ever more essential. Won’t you please take the time to make sure you have all your “ducks in a row”. And help your loved ones complete their paperwork. Having these filled out and in a safe place will take a huge burden off your shoulders. Life in a journey, let’s make it as smooth sailing as possible.
ADDITIONAL INFORMATION AVAILABLE AT:
Summary of the HIPAA Privacy Rule [click to view pdf]