After a person suffers a medical crisis, such as a fall, or a stroke or heart attack, and after hospital treatment ends, rehabilitation services are often required to get the person back to the best possible level of functioning. What services are needed, where to get them, and who pays are the critical concerns that all families have. What services are needed are determined by the doctors and nurses diagnosis of the underlying medical causes, and by the social workers at the hospital for discharge and rehabilitation. They will provide suggestions for rehabilitation facilities appropriate for the physical and mental needs at places that have a bed available. For example, if a person needs a ventilator, only a few facilities can handle ventilator care. Getting a place at a facility near the family, and which can give the rehabilitation needed are the critical factors.
To help families decide where to go, Medicare has a new tool to help, which is the Nursing Home Compare website at Medicare.gov. It will give a separate rating to the quality of rehabilitation services within a nursing home. Before this new rating system, there was only one rating that did not distinguish between rehabilitation services and permanent residency. The quality of rehabilitation matters because the goal is often to get the patient back on his feet and go home. Other sources for information are geriatric care managers or attorneys who assist families with short and long term care decisions.
How long can a person get rehabilitation? They have to have had at least a 3 day hospital admission unless they have a managed Medicare plan that allows it. The standard rule is up to 100 days, but few people get that. The rehabilitation staff and social workers will make a decision based on the need for services to maintain the patient at his best possible level of functioning. When the determination is made to cut off the services, a “discharge” notice will be sent. This often frightens the family members who think their spouse or parent will be kicked out. The word discharge does not mean a person will be put out. It means that the Medicare payment will end, and that further care in a nursing home, or at home will have to be paid by the person, or by another payment source, which is usually Medicaid.
Sometimes a person leaves rehab, but if that person needs to return to rehab in less than 30 days, Medicare will continue to pay up to the 100 day limit. If a person leaves rehab, and more than 60 days pass, then they can again qualify for rehab if they have another 3 day stay in a hospital.
There is an option to appeal the discharge and the appeal form is attached to the notice. It only requires checking the box that an appeal is requested. This does not take any special knowledge, and the appeal may or may not be approved. If it is approved, services will be continued for an additional period of time, but the 100 day rule still applies to the total number of days.
The rehab workers and the social worker in charge are the critical contacts for concerned family members. Don’t be afraid to ask any questions you have on the plan of action and the progress being made. Most rehab places are quite good at giving objective evaluations of what is needed, and whether the patient can go home if the goals are met. They can also give their thoughts on what care will be needed at home, if the physical or mental deficits will require either supervision or hands on care. This evaluation will include a visit to the home for an assessment to evaluate if the home needs modification to make it safe. For example, a ramp may be needed if stairs are a problem. Handholds in the bathroom, or tub modifications or a shower transfer seat may be advisable.
The important fact to keep in mind is that once rehabilitation ends, and if continuing care is needed, then a long term plan needs to be done for care and how to pay for it.