<p>This thread is as much a vent as a request for guidance.
My mother fell down stairs and seriously fractured her hip. She had a plate and pins put in, and was sent to a rehab/nursing home facility. I live in another state, so have not been involved in any discussions with doctors or the facility. They told her up front that she would need to stay there for 2 - 3 months. Her sister has been helping with this. They called her sister the day before yesterday and told her she needed to get her out of the facility by Monday. Then, yesterday another person called, and said she didn’t need to leave, and actually needed to stay, but the cost after Monday would be 350 per day. She cannot put any weight on the leg now, but Apparently once she can put weight on the leg the cost will go down, maybe to 50 a day. (I can’t remember the number she said…I’m still stuck on the 350). The facility says my mother will LIKELY qualify for Medicaid, but they won’t know for sure for a month. (while she’s running up 350 a day charges that may or may not have to be paid at some point). My big gripe is this…if they knew she was likely going to need to stay there 2 - 3 months, why didn’t they start this paperwork when se arrived, or very soon after, instead of waiting so long…
This is my rude awakening and welcome to “elder care,” I guess. I certainly understand how people wind up in financial ruin pretty quickly. I think I’m going to look really hard at long-term care insurance.</p>
<p>You are right they should have discussed this with your mom & family on admission. Medicare only covers acute rehab 30 days and then a co pay kicks in. She is now not considered skilled rehab because she is maintaining at her current limited weight bearing status, when her orthopedist progresses her wgt bearing, therapy can continue in a progressive phase and medicare will pay again with that 50 a day co pay. It would be cheaper to take her her home and hire a live in and have home care therapy( covered by medicare) come in. Live ins, especially if you find one privately is no where near 350 a day depending on where you live. It is difficult to coordinated private help at a distance though. Once your moms resources are “spent down” to a minimal amount she will qualify for medicaid which is retroactive from time of applying but first her funds have to be exhausted. Qualifying for community medicaid has different cut offs versus nursing home medicaid. Benefits vary by state find a good social worker or elder care attorney in your moms state. This situation stinks</p>
<p>Thanks for the advice.
We had thought of having her go stay with a friend, but her Dr. Thinks she should stay where she is. I was originally ok with moving her, but got to worrying about if a fire or something occurred. She would not be able to get out…
I will think about letting her leave and paying someone to stay with her all the time. Good advice…</p>
<p>If I can vent too? Medical costs scare me.
My oldest daughter doesn’t have insurance because her job is a " temporary" position.
I don’t know when the last time that she went to the Dr or dentist. Ive offered to pay for a visit or to help her find insurance but she doesn’t want to talk about it.
To top it off she rides her bike to work.
Terrifying.</p>
<p>Something doesn’t sound right but that could be partly because you’re getting info second-hand. As her D, you can contact the skilled nursing facility, speak to one of the director level people, and perhaps get the real scoop on your mom’s status in case your mom is somewhat confused on what the status actually is - especially if they change what they say a few times. By ‘status’ I mean her ability to stay there covered by Medicare.</p>
<p>Medicare will only cover a certain period and to stay longer needs a clear justification from the doc - for example if she got an infection that needs to be treated, etc. They have some pretty strict rules about it so people won’t take advantage of Medicare and spend far more than they’re entitled to. There are also rules on the notification the facility is required to give before they can move your mom out.</p>
<p>It’s easy for the doc to say he thinks she s/b there if he’s not paying for it. And the idea of racking up $350/day only to find out thousands of $$$ on the bill later it won’t be covered isn’t acceptable or workable.</p>
<p>It sounds like she really doesn’t need to be in a skilled nursing facility if she doesn’t require actual medical care. An SNF is expensive and if one doesn’t really need an SNF then one shouldn’t be there paying for it.</p>
<p>Depending on her mobility and needs, can she possibly go stay with a family member and perhaps hire someone to come in part time, like maybe 8 hrs/day or so, to help with her? This s/b much less expensive than an SNF.</p>
<p>Another possibility might be to check out some assisted living facilities in the area or even in an area near you or another family member. Maybe they’d let her stay there on a month to month basis. An ALF should be quite a bit less expensive than a SNF since they don’t have the medical staff or level of staffing the SNF would have but they can still help with mobility issues to a degree (but they might require a certain level of mobility to accept her).</p>
<p>My mother’s first rehab stay was similar to this. Oh, she’ll only need to stay there a certain number of days. If your mother is on Medicare and has a Medicare Supplement, the facility will likely keep her for the amount of time they will be paid, which is usually 28 days, I believe. After that, you will have to pay the copay, which is what Medicare won’t pay, which usually amounts to about 125/day. If she has no Medicare supplement, that may be where you’re getting the 350. If your mom has Medicare Supplement F, she can have up to 180 days paid by the Medicare supplement with no copay.</p>
<p>While they have to have a valid reason to keep your mom, the facilities will get their Medicare pay for as long as they can.</p>
<p>Once your Medicare supplement expires, and you have to pay the 125 co pay, you will be surprised how fast your mother is ready to go home. Most places do not want to keep someone over the 28 days because they don’t want to worry about billing private people.</p>
<p>As for assisted living, I would really recommend going straight into SNF and work on getting her qualified for Medicaid. We spent all my mom’s money on ALF, and now we’re spending the last of her money down in SNF, with the hopes she will expire before her funds are spent down. She’s no where near expiring, but she’s also no where near qualifying for Medicaid.</p>
<p>As for having her live at home, if she has a home and you have a trustworthy caretaker, you may consider that. We never had that option, as my mother lost her home in Katrina.</p>
<p>But I did recently go through caretakers at home with my FIL while in hospice, and he went through about 10K in one month’s time, which we are now having to pay off from his estate.</p>
<p>Like the Who said, Hope I die before I get old.</p>
<p>Like the Who said, Hope I die before I get old.</p>
<p>[And if you don’t, please button your shirt.](<a href=“‘12-12-12’ Concert Performers and Issues of Aging - The New York Times”>http://www.nytimes.com/2012/12/20/fashion/12-12-12-concert-performers-and-issues-of-aging.html</a>)</p>
<p>We spent the week before last playing the “getting into rehab He__” game. He’s in a lovely facility now, with wonderful care, and making progress. I have been wondering what the cost is going to be?</p>
<p>Will also be spending a lot more time reviewing his coverage. He has one of the medicare replacement policies, which was a huge hold up in getting into rehab. We were repeatedly told how many more choices he would have if he had regular Medicare.</p>
<p>If you have a Medigap Policy or a Medicare Advantage Plan, your copayments for rehab will typically be covered. I’m not happy with Med Advantage as a public policy, because they suck money out of Medicare overall, but as a personal choice it may be to your advantage. On the other hand, Advantage plans, often organized like HMOs, may limit the number of providers who will be able to or want to accept your coverage. Straight-up Medicare has close to universal acceptance. </p>
<p>Medigap policies exist to pay copayments, and they are not ridiculously expensive–much cheaper than copays you are likely to require rehab. They also allow you to keep your standard Medicare. </p>
<p>For accurate info, go to the source: [Medicare.gov:</a> the official U.S. government site for Medicare](<a href=“http://www.medicare.gov%5DMedicare.gov:”>http://www.medicare.gov) There you will find this overview of your benefits and options: “Medicare Coverage of Skilled Nursing Facility Care.” This publication explains most of it, including qualifying hospital stays, copays, coverage periods, etc.</p>
<p><a href=“http://www.medicare.gov/Pubs/pdf/10153.pdf[/url]”>http://www.medicare.gov/Pubs/pdf/10153.pdf</a></p>
<p>My insurance agreed to pay $700/day for the rehab hospital after my heart attack. I was mobile, not hooked up on IVs or oxygen, and cognitively present. It did include meds and PT/OT services. This did <em>not</em> include all the charges for doctors who read my charts but never visited me.</p>
<p>Thanks for the info. Everyone.</p>
<p>Best with your mother’s recovery. If she is okay with you being in touch with her care providers and/or the billing office at her rehab, it would be a good time to gather information relevant to your mother’s care and insurance options going forward. There may be ways to improve her coverage and certainly better understand how rehab and skilled nursing facilities bill. Her state may also have a help-line to clarify options. In my experience, the more info. In caring family members’ hands the better. Also, legal input may be relevant as to managing any assets, Medicaid, etc. Good luck.</p>
<p>My mom had a United Health Care Supplemental Policy in addition to her Medicare, and all of her rehab costs were covered … however, even with the supplemental policy, I believe the hospital visit preceding it must be correctly coded in order for the stay to be covered. The person must be in the hospital as an admitted patient … if they are in for “observation,” it won’t be covered. Because hospitals don’t want to get fined by Medicare for re-admits, they are using the observation code instead of the admitted code. This creates huge problems for patients in terms of insurance.</p>
<p>Yikes, so much for us to know.</p>