7 Jul 2019
What are your rights as a resident of a nursing home? Most people start their journey in a nursing home setting via an admission after a hospital stay for short term (sub-acute) rehab. From there, people either go home on their own, need ongoing care once they’re home or, due to a significant change in care needs, decide to stay long term in a nursing home.
Here are eight things you should know:
1) For Medicare purposes, a person must have a three-day hospital admission prior to transfer to short term rehab. If this criterion is not met, Medicare will not cover rehab at all. Sometimes, people spend a few days in the hospital under observation but are never admitted. It is critical to know your admission status at the hospital.
2) Medicare only covers 20 days at 100%. For days 21 through 100, you must pay the coinsurance of $170.50 per day unless you have supplemental insurance that covers this. Medicare advantage plans also typically have copays but when they start and how much can vary. Therefore, know your supplemental or advantage plan coverage limitations up front.
3) You do not get 100 days automatically under Medicare. You must continue to meet the coverage requirements such as continued improvement in physical therapy. When the skilled need ends, as determined by the rehab center, you can appeal. Ultimately, your coverage can end at any point. If you do not leave by the time the coverage ends, you will have to pay the full daily rate to stay.
4) Start to think about and plan for discharge upon admission. Your stay can end with very short notice. If you have not considered the options for necessary long-term care post-rehab, you will be scurrying at the last minute.
5) If the rehab center says you are ready for discharge, but you do not have a safe and adequate plan to return home, they cannot send you home. Nor can they force a family member to take on care if they are not willing. However, they can start to charge you privately if you do not qualify for Medicaid.
6) If you are staying past the date of your insurance coverage, and you are eligible and plan to apply for Medicaid, they cannot force you to give them private pay funds pending Medicaid.
7) Most nursing homes no longer file Medicaid applications in-house. They will connect you with a private company or an elder law attorney to help you file for it. This is almost always a fee-based service. If you cannot afford to pay, the nursing home really should help you file free of cost.
8) If you have any assets above the Medicaid limit of $15,450 when you begin to consider a long-term nursing home placement, you should be speaking with a Medicaid specialist. They can help you with strategies to protect your assets. Not all Medicaid and/or senior planning companies offer strategies beyond just filing the applications once there is a permanent placement. But there are ways to protect assets at the last minute when someone is admitted for a long term stay in a nursing home, as well as strategies on filing if the stay is extended but not permanent. So seek out a Medicaid specialist or elder law attorney who will do more than just file for Medicaid.
If you have any concerns or are unsure of your rights regarding discharge planning or finances, consider reaching out to a Medicaid specialist. However, you can always connect with your facilities ombudsman (855-582-6769) or file a complaint with the New York State Department of Health (888-201-4563) or obtain a complaint form online via https://apps.health.ny.gov/nursing_homes/complaint_form/complain.actionb