Being an educated consumer of Medicare benefits can be overwhelming even at the best of times. Throw in a crisis situation and it becomes even more difficult to be sure that you are doing the right things. They say that hindsight is 20/20. But not knowing until after the fact with Medicare can cost you a great deal of money
Last Christmas, I found myself helping with my own family crisis: my father’s trip to the hospital after a day of significant physical and mental decline. He was admitted on the Thursday night before Christmas and the holidays were looming. I was concerned about not only my father’s medical condition, but also the reality that it was likely that he would be unable to return home again after this episode.
With my background as a case manager in nursing and rehabilitation facilities, I was well aware of the Medicare requirements that would need to be met if my father was going to be able to utilize his benefits for a stay in rehab after he left the hospital. It became paramount that I communicate closely with the physicians in the hospital and advocate for my father: We needed a 3 midnight stay after his date of admission. This would allow him to access his Medicare benefits for a post hospital skilled rehabilitation stay.
It is, unfortunately, a common pattern in the acute care setting to discharge those deemed ‘ready’ just before the holidays and/or weekends. Transfer activity is very high between facilities on Fridays and the day before major holidays. If they had discharged my father on Saturday (after only 2 nights), he would have lost out on access to his 100 day Medicare benefit period.
For a Medicare patient to access benefits for a skilled rehabilitation or nursing stay after discharge from the hospital (in a rehab center or skilled nursing facility), they must have a 3 day qualifying hospital stay. This means 3 midnights of a ‘head in the bed’ as it is sometime referred to in the industry; 3 midnights following the date of admission.
If you find yourself in the position of being faced with a discharge before you have met the requirement and believe that your loved one will need post acute care, I encourage you to work closely with the physicians who are caring for your loved one as well as the case managers that are providing oversight on the discharge plan. You need to advocate for your loved one and the care that they need so that they can work with you to provide the best continuity of care possible.
It turns out that with the holidays my father was in the hospital until the Tuesday after Christmas (more than giving him the qualifying stay). At that time he made the transition to a skilled nursing facility where he received therapy services under his Medicare A benefits.
If you are a caregiver/family member of a Medicare patient, I encourage you to learn the basics related to Medicare benefits and be an educated consumer. This can help you greatly in managing the monetary resources available to the Medicare recipient. If you don’t know where to access this information, seek help and guidance from someone who can help you (and visit www.cms.gov for more detailed information about Medicare)!
On the journey with you…….Kathy
Kathy Eynon, RN, CCM, CTACC
Eldercare Specialist: Parent Care Alliance