Be Wary of Rehabilitation Facilities in Skilled Nursing Homes

[RandomPJ]

Medicare will pay for 21 days of rehabilitation after a inpatient hospital stay provided the doctor says you are improving. It’s not considered custodial care which Medicare won’t pay for. Since my friend left after 7 days they are losing 14 days of payment unless they can fill the bed.

Wow, all these rules, as I'm finding out. I'm sure they do serve a purpose but present tough problems too.

 

[Teacher Terry]

You bet, his assisted living facility sent over the paperwork to the nursing home the day before he wanted to be released. His AL facility helps with everything that’s needed but people are in their own apartment. They dress him, give him his medications and help with the bathroom. He wears a pendant and presses it when he needs something. You need the doctor’s release to take your medications with you, written prescriptions for refills and discharge notes with a list of all the medications. He’s on 14 medications and some were changed by the hospital this last time.

 

[youbet]

You bet, his assisted living facility sent over the paperwork to the nursing home the day before he wanted to be released.

It does indeed seem that, given that the assisted living facility gave written notification that they could handle the situation and were accepting liability for his outcome going forward, he should have been released to them soon after the paperwork was received.

I only brought up the liability concern concept since it does seem that docs today are aware of how cunning some lawyers can be if something goes wrong and the family is looking for a settlement.

Glad you were able to help and that things are working out for your friend!

 

[marko]

Like any other facility the spectrum of care runs the gamut. My mother and DW's father were in excellent places, and the outcomes were about the best one could have hoped for.

My grandfather, sadly, had a far different experience. Being in high school at the time I didn't know the difference but I sure learned later. He was in a place where they essentially put him in a bed, gave him a remote for the TV, and waited for him to die. It didn't take long, who would want to live in those circumstances?

They do vary. I visited 5 different places before choosing one for my brother. Two were good with one tipping the scales with what seemed better therapy--and it turned out to be right. Two others were pretty bad and one where I wouldn't put a dog in.

You have to tour the places, talk to the staff AND patients and be skeptical and pay attention to what isn't being said.

Also as I noted earlier, the squeaky wheel gets the oil in these places and daily visits by family keeping the pressure on and exhibiting high expectations makes all the difference. You have to be a bit of an a-hole even if it's not in your nature.

 

[athena53]

RetMD, I haven’t known one person that has gone to one actually benefit. This includes different people in different states.

A friend who had a stroke at age 64 went into one and they started him on PT immediately. He had no complaints about the place. BF also went into one after knee replacement surgery.

Let's be realistic- I believe you and I are in similar situations. Single, over 65, healthy but who knows what the future will bring, living independently in a traditional residence. I have one child- he's 3 hours away and my DDIL home-schools their 3 little kids. If I get knee replacement, hip replacement, etc. am I going to ask them to drop everything, come down and take care of me? They probably would, God bless 'em, but I'd rather let them live their lives and spend a few days in rehab.

Your point is well-taken, though- maybe I ought to research facilities if I see a need coming up and make sure I get into a decent one.

And yes, those facilities love Medicare rehab because they get paid far better than Medicaid. I believe LTC facilities are required to set aside a certain % of beds for Medicaid patients if they want to get the lucrative rehab patients.

 

[Teacher Terry]

Athena, part of the problem locally is getting into one of the better ones. I had a friend that supposedly was in a good place but her care after knee replacement surgery was dismal and she won’t go again. My mom had a similar experience in Wisconsin and the next time went home to her apartment. My mom had us 3 kids to help but none of us were in the same town and some years I used all my vacation and sick leave to help which I never regretted.

I actually have a group of close friends that would help and my youngest son whose living with me now for awhile until he decides where he wants to live. When I was looking for a condo he told me to get 2 bedrooms so if I needed help in the future there was room. Now if I have a massive stroke, etc I won’t have a choice but hoping to be like my mom and aunt.

 

[ncbill]

Medicare only pays if you can actually do the rehab.

My relative was released from the hospital to the rehab side of a nearby skilled nursing facility way across town...she got a whopping 10 days paid for by Medicare before she was kicked over to the custodial side (private to semi-private room) and had to start paying out-of-pocket...her terminal cancer had progressed to the point she was too physically weak to participate in rehab.

BTW, you'll find there is usually a big difference between the rehab & custodial sides of SNFs...after only a couple of weeks in the latter she begged me to get her out so after another week or so I moved her to a private room in a ALF very close to me.

Even with all the hands-on care she required (bed-ridden w/o assistance) the cost of the ALF was half that of the SNF.

 

[Masquernom]

What I've learned, beware of entrepreneurial medical facilities and doctors. Some are trying to heal people, some are trying to maximize income. Often it's hard to tell the difference.

I read a study once by a large insurance company. They took two towns in Texas, about the same size and similar demographics. Insurance costs in one town were much higher than the other. The company hired two retired doctors to review the claims in each town and visit the towns to try to determine why the costs were so much higher in one than the other.
The reviewers conclusion, the doctors in the high cost town were doing everything they could to maximize their incomes, versus the low cost town. They mentioned doctors with their own testing facilities, outpatient clinics, etc. Even doctors owning car dealerships, etc.

 

[jldavid47]

My theory is that the facility wanted to keep him for the 21 days that Medicare would pay for rehab.

DING! DING! DING! DING!

The entire medical industry is all about the money. Oh, yeah, and sometimes you get the care you really need.

Too cynical? I think not.

 

[jrendt]

What is the 21-day rule? (I'm going through a learning process for all this for a family member.)
Thanks.

If you need physical therapy Medicare will pay for the first 21 days in a skilled nursing facility (SNF). If you need to stay longer Medicare will only pay portion of the bill for day s 21 thru 90. How much depends on the plan: some of the plans like Anthem senior Advantage require different copays. This resets once you have been home and not admitted to the hospital for 60 days. This means it's 21 days per episode, not per year. One important thing to remember is that this only applies to SKILLED NURSING Care. Medicare does NOT pay for LONG-TERM CARE! (ie. After 90 days)

 

[RetMD21]

DING! DING! DING! DING!

The entire medical industry is all about the money. Oh, yeah, and sometimes you get the care you really need.

Too cynical? I think not.

seems to explain the situation

 

[youbet]

And yes, those facilities love Medicare rehab because they get paid far better than Medicaid. I believe LTC facilities are required to set aside a certain % of beds for Medicaid patients if they want to get the lucrative rehab patients.

In a nutshell, here's what we discovered while doing research for MIL to go into LTC in northern Illinois.

Clients fell into 3 categories: Medicaid LTC, private pay LTC and rehab.

1. To qualify to take Medicare-paid rehab patients, facilities must have a minimum specified number of LTC Medicaid beds. In the NH MIL was in, the number was 32 out of 180. There is competition for the 32 slots and all were filled by previous private pay clients who had run out of money.

2. Medicare-paid rehab is good business for NH's.

3. Private pay LTC is the best deal for NH's. NH's compete for private pay clients working hard to attract and retain them.

On rehab.......... If I could get into the place where MIL did her LTC, and if Medicare was going to pay the bulk of the bill, I'd go for rehab there rather that count on DW to be able to handle my needs at home. Because this place was dominated by private pay clients (people with choices), facilities were very nice and the staff seemed very competent.

But, I bet results could really vary if you went just anyplace the hospital assigned you.

 

[Teacher Terry]

Update on my friend is that he has been home for 10 days and doing great. He’s happy and getting the care he needs in his apartment and still has privacy and quality of life. He is enjoying the activities and other residents. He can choose what he wants to do. One of the biggest benefits is that they are handling his medications which is keeping him medically stable.

 

[RetMD21]

Update on my friend is that he has been home for 10 days and doing great. He’s happy and getting the care he needs in his apartment and still has privacy and quality of life. He is enjoying the activities and other residents. He can choose what he wants to do. One of the biggest benefits is that they are handling his medications which is keeping him medically stable.

That's great!

The Medicare post discharge SNF benefit is great for some seniors but institutions have their own goals. A local hospital developed a "program" with a particular SNF that allowed them to discharge joint replacement a day or two sooner. Since the hospital is paid per case this means faster bed turnover and the potential for more cases and revenue. The SNF gets the big $ from Medicare. For maintaining bed availability, they got preference on case flow. Win-Win. The losers are the patients who might have become independent and returned directly home with that extra day or two in hospital and, of course, the Medicare system. I wasn't in that business and just read the hospital's glossy annual report so I don't have a good idea of what proportion of folks may have been negatively affected.

 

[Teacher Terry]

Ret MD, that’s terrible but yes it’s all about money. I am never falling for the going to rehab scam. My friend was born with some significant disabilities and saved hard for his old age guessing that old age wasn’t going to be kind to him and he was right. Of course he didn’t plan on getting Parkinson’s on top of it.

 

[W2R]

Update on my friend is that he has been home for 10 days and doing great. He’s happy and getting the care he needs in his apartment and still has privacy and quality of life. He is enjoying the activities and other residents. He can choose what he wants to do. One of the biggest benefits is that they are handling his medications which is keeping him medically stable.

Teacher Terry, what a wonderful outcome so far! Getting the care he needs, and still being able to maintain privacy and quality of life sounds ideal to me. I think that maintaining some privacy, dignity, and quality of life can be so beneficial to aging people.

We are 69 (him) and 73 (me) right now. We are tentatively planning to "age in place" where we will have all that plus lower costs. But as we age our needs for care will surely increase, especially if/when one of us passes away, and the other is left alone. A place like the one you found for your friend would be great.

 

[youbet]

Update on my friend is that he has been home for 10 days and doing great. He’s happy and getting the care he needs in his apartment and still has privacy and quality of life. He is enjoying the activities and other residents. He can choose what he wants to do. One of the biggest benefits is that they are handling his medications which is keeping him medically stable.

That's good news Teacher Terry! Your intervention helped get him back to his ALF many days sooner than he would have otherwise and obviously he's happier there.

If he had not been already living in an ALF, do you think it would have been wise to pull him from the rehab facility? Or was it his residing in an ALF that made it possible?

 

[Teacher Terry]

You bet, he was originally in a independent living apartment within this same facility. 3 months ago I and a friend busted him out of a crappy facility that his ex wife put him in. Most of the people there were on Medicaid. He did fine the first month handling his medications, etc and then he got pneumonia and had a small stroke. He tried to go back to his apartment with home health care but it was a disaster and he was in and out of the hospital mainly because he couldn’t manage his medications and his other basic needs. We and his brother plus the facility told him he had to go to the assisted living apartment wing because he had no choice any longer. He can be very stubborn.

I wouldn’t have helped him get out of rehab unless he was going to assisted living. The hospital was discharging him and recommended rehab. I saw it as a placeholder for him until his apartment was ready. He was very upset about needing to go and depressed. I promised him the day his apartment was ready I would bring him home. There’s 4 levels of care and he is paying 6300/month for level 2. If you are at level 4 it costs 8300. Reno’s COL has gotten crazy and I am sure the cost is lower in other parts of the country. This is a wonderful alternative to nursing homes.

When he was in a facility he said it’s hard to sleep with all the activity in the hallways as well as his roommate making noise. Plus you have no privacy, control of when you eat, sleep, watch tv, etc. At his facility he can take advantage of exercise classes, movies, lectures, day trips etc. Today when I was there a group of 10 people were having drinks in the bar and having a great time. It’s open from 4-7 daily.

 

[ncbill]

In a nutshell, here's what we discovered while doing research for MIL to go into LTC in northern Illinois.

Clients fell into 3 categories: Medicaid LTC, private pay LTC and rehab.

1. To qualify to take Medicare-paid rehab patients, facilities must have a minimum specified number of LTC Medicaid beds. In the NH MIL was in, the number was 32 out of 180. There is competition for the 32 slots and all were filled by previous private pay clients who had run out of money.

2. Medicare-paid rehab is good business for NH's.

3. Private pay LTC is the best deal for NH's. NH's compete for private pay clients working hard to attract and retain them.

On rehab.......... If I could get into the place where MIL did her LTC, and if Medicare was going to pay the bulk of the bill, I'd go for rehab there rather that count on DW to be able to handle my needs at home. Because this place was dominated by private pay clients (people with choices), facilities were very nice and the staff seemed very competent.

But, I bet results could really vary if you went just anyplace the hospital assigned you.

Back when mom was sick (~20 years ago) here Medicaid paid $90/day for a SNF bed, as private pay mom paid $120/day, but Medicare paid $250/day for a rehab bed.

Just a couple of years ago here that had risen to $200/day for Medicaid, $275/day for private pay, and I don't know how much for a Medicare rehab bed...$400-$500/day?

 

[pacergal]

TT--glad your friend is doing better and you were there to advocate for him.

It really is a c**pshoot relying on the SW in the hospital to help place someone.
My dad had to go onto a rehab for 21 days twice. The first place was very nice, and he got good care. Until close to his discharge, all of a sudden they were telling me and my siblings that he needed assisted living due to memory issues, based on their "tests". We told them absolutely not, as we did not see in real life, what they were professing. It was a contentious family care meeting, and I simply ended the meeting by saying NO, we are taking him home, end of discussion.
Second place was wonderful. They were supportive of any choice we made, never mentioned any "tests".

Bottom line, people do better in hospitals, care homes, etc. with family or friends visiting/watching over them and their care.

 

[Teacher Terry]

Pacergal, I totally agree that people do better and get better care if staff knows they have visitors that care about them. They always think I am his wife or sister because I am so involved. This is my third friend from work that’s ended up in a facility younger. I helped all of them because none had family. This friend has a brother that cares but lives in California.

 

[RetMD21]

It's good to have people looking out for you.

Just for fun here is a document about RUGS-IV charges for SNF. I am not sure if it is current. More minutes of therapy and more disciplines = more money


https://assets.hcca-info.org/Portal...outs/Compliance_Institute/2016/P3handout1.pdf

 

[marko]

Bottom line, people do better in hospitals, care homes, etc. with family or friends visiting/watching over them and their care.

+1
I've mentioned the same thing in 2 or 3 posts on this thread. You could see them tighten up each day when I'd walk in to see my brother. They knew there'd be hell to pay if something was amiss. I've been told that I'm naturally intimidating even though I dont mean to be, so that helped I suppose.

"The squeaky wheel" applies in the medical community more than anywhere else.

 

[Teacher Terry]

Updating this thread to say sadly my friend had less than a year at the wonderful assisted living facility. He is dying and like usual the only way to ensure he gets his pain medication on a timely basis is for his other friend and I to each take a shift. She takes half the day and I take the other. He’s only alone at night. This will be the 9th friend that I have lost. My friend didn’t have kids or any local relatives to look after him.,

 

[chris2008]

Your friend can be envied to have such great friends.
Take good care of yourself, too.

Sent from my SM-G950F using Early Retirement Forum mobile app