Many seniors and families have the perception that Medicare pays for nursing home care. That is not the case. Medicare has never done so nor can we anticipate that it will happen with the gray tsunami rapidly approaching.
Most nursing home care is either paid for privately or through Public Aid otherwise known as Medicaid. Medicare does pay for “up to” 100 days of rehabilitation in a nursing home. This is called Medicare skilled care and is paid under Part A of Medicare coverage. There is the caveat of a three night stay in a hospital that is a precursor. The second criterion is the senior must continue to improve as they participate in the therapy. This therapy can include nursing care, physical therapy, occupational therapy and speech language services. If the senior plateaus, does not improve adequately or reaches their maximum potential, the payment by Medicare will cease. The family is given a few days’ notice of this discharge and need to start planning for the next step in the care continuum for the senior. If the therapy providers or nursing home continue the therapy without the senior improving there are severe administrative and financial penalties.
It is rare that a senior is able to stay in a nursing home for therapy for 100 days in one stay regardless of the need for the rehabilitation. The Medicare skilled part A coverage resets for an additional 100 days when designated time lines have been crossed.
As we age, our ability to regain what we lost, both physically and cognitively, is a delicate balance. For instance, it takes 5 days to regain the baseline functionality if a senior is bed ridden. Now, include surgery, anesthesia, disability from an injury, pain medications and that rehabilitation will be even more prolonged.
Families often get upset when they hear that the senior will be discharged shortly after a Medicare nursing home admission. Most often the family is struggling with decisions that are difficult to make and faced with life changes for the senior. When we are in a stress laden state of mind, it is difficult to listen effectively. The discharge planner at the hospital cannot anticipate the length of rehabilitation stay for a senior patient. They can only tell the family that the stay can be up to 100 days. The senior’s ability to participate and improve is individualized and depends on many medical, functional, cognitive and emotional factors.
Medicare will not cover most nursing home stays and we can anticipate with the gray tsunami it will become even more limited rather than expansive. Plan for your long term care needs before you need them.
Please contact me for more information regarding what Medicare will and will not cover.