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After the Hospital: Recovery in a Skilled Nursing/Rehab Facility
Mom's In The Hospital: Chapter 12 After The Hospital: If your parent's doctor says that your parent needs more skilled nursing or rehabilitation therapy after leaving the hospital, and puts it in writing, then original Medicare will fully cover up to 20 days. The regulations require that your parent continues to need and is benefiting from skilled medical services. If your parent is no longer benefiting from therapy, or declines to participate in therapy as ordered by the doctor, then Medicare coverage will stop. For those with original Medicare, care in a skilled nursing facility is covered by the daily co-pay of $228 per day from day 21 until day 100. Secondary (MediGap) policies may cover this co-payment amount in full, depending on the policy your parent purchased. Check Medicare managed care policies for their coverage and rates, which may be different. Many Medicare managed care plans use a case manager who must re-certify or re-authorize more care at regular intervals. Sometimes these intervals can be a short as every few days. Most patients do not stay in skilled nursing for 100 days of after-hospital treatment, so don't make the mistake of counting on this much time. Most rehabilitation departments in skilled nursing facilities are more lightly staffed than hospitals. Many do not have physical or occupational therapists or speech therapists working on weekends. This means that if your parent moves from the hospital or home to inpatient rehabilitation on a Friday, Saturday, or Sunday, she will often receive no therapy until some time the following week. Usually the first day in a rehabilitation facility is dedicated to the admission process. After the nurse has completed an initial physical assessment the various therapy professionals make their own assessments and begin creating a care plan. If your parent checks in on one of the "bad" days, the assessment process can take as long as four days (Friday, Saturday, Sunday, Monday). These are four days of the 20 fully covered Medicare days lost to assessment and "waiting around." Hospitals are eager to discharge patients before the weekend, because they are also more lightly staffed on weekends. Friday afternoon is a popular time for patient discharges. This creates a dilemma for your parent and for you. You would prefer that your parent not be discharged from the hospital for rehabilitation on Friday, because several days are likely to be "wasted" before therapy starts in the new facility. The hospital is not going to be eager to have your parent stay over the weekend. If you get the word that your parent is probably going to be discharged on a Friday, your first order of business is to have a conversation with the doctor. Discuss with the doctor the ramifications of sending your parent to rehabilitation on a Friday. If the doctor is willing to have your parent stay in the hospital over the weekend, grab the chance. . .no matter how badly your parent wants to leave the hospital. If you get the word on Thursday that your parent will be discharged on Friday, you also might have the option of protesting the discharge. This could "buy" you the weekend.
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