FIL fell and hit his head two months ago. He spent several weeks in a hospital ICU before being transferred to A rehab facility. That facility now wants to send him to a nursing home, but so far none of the places that accept payment from his HMO are willing to accept him because he has a tracheotomy.
If no nursing home can be identified, what are the options?
Can the rehab facility be required to keep him until a nursing home is identified?
As far as I know, yes. They can look for an excuse to send him back to a ,hospital, and let their social service department look for a placement. Otherwise, the facility will ask for a specialist nurse, be it pulmonary or wound care.
Good. There are no family members in the area who could take him in even if insurance would pay for at home care. He needs to remain in the hospital/rehab/nursing home system.
I believe the insurance can refuse to pay for services (due to inability to progress. The purpose of rehab). Therefore, if FIL has resources, those will be spent down until eligible for Medicaid. From the title of your post, is he already on Medicaid?
One comment I heard was that he “doesn’t have Medicaid, just Medicare.” I don’t know what that meant. Maybe that he hasn’t spent down his Medicare yet?
To my knowledge, FIL has no resources other than social security income. I do know he has a bunch of consumer debt and was planning to file bankruptcy when he fell.
It’s not spending down Medicare. It’s spending down to be eligible for Medicare and/or Medicaid. You might want to talk to a social worker at the facility. If you can qualify him for Medicaid, then his costs will be covered. If his only assets are SS, it may be easy.
Thanks for that clarification @techmom99 Happydad can ask the social worker about Medicaid. Perhaps it has already kicked in. We are in MD, so all this is long distance.
Generally, Medicare covers costs of hospitalization (Part A) and physicians (Part B). Most Americans age 65 or older are covered by Medicare. Spenddowns are not an issue for Medicare, but there are yearly limits on reimbursement. Again generally, Medicaid covers costs of long-term care, mostly in facilities but sometimes in a person’s home. Medicaid has income and asset eligibility requirements and so spending down assets might be necessary.
Unless things have changed (and they may have since it’s years since I looked into this), there aren’t spend down rules for nursing home care, but there is a 5 year look back period before the cost of a nursing home is covered. In home care (in my state) through Medicaid has a three month look back and, unlike Medicare, one’s home is exempt from being taken for liens. My MIL now has 24/7 care in home paid for by Medicaid and her home is still owned by her. If she went to a nursing home, the government would eventually own her home.
We purchased our second home years ago because the Medicare lien was so high that the family would not have seen a penny, no matter how much the house was sold for, so they gave it to us at below market value because they thought our kids were cute! Every penny went to satisfy the lien. OP’s relative sounds like he is already pauperized so there may be no look back and no lien.
You are correct, @techmom99. The spenddown rules only apply for Medicaid coverage of the nursing home, not for the nursing home care itself, and they will come into play only if the Medicaid applicant’s income and assets exceed the limits.
Even if Medicare and Medicaid aren’t issues, there might not be nursing home beds available. Or there might be beds available but the person might not be able to pay right now. I agree that talking to the social worker and finding out about applying for Medicaid are good ideas.
My Dad had a fall a couple of years ago. He started in the hospital, then rehab, then a nursing home. All nursing homes are not created equal, you need to do your research and it may require a visit. Nursing homes prefer full pay patients, ie- those paying out of pocket. We hired a consultant, for a fixed fee of about $900, to put together the paperwork for us to get my Dad covered by Medicaid once his assets ran out. She required 5 years of checking account statements and a list of assets. She told us any gifts of money, and there were several over $1000 that my Father had written check for would require explanation. She was right, because Medicaid denied his claim due to several large checks written to my brother, they wanted the money paid back. My Father died while we were still in the paying out of pocket phase, which was a good thing, because my brother who had received those large checks had just died, and I would not have wanted to ask my SIL to pay the money back.
To get back to your original question, the rehab facility cannot just release your FIL because they are getting a lower reimbursement from medicare, but they may try to get him readmitted to the hospital so they get a higher paying patient. And that is fairly easy to do, there always seems to be a new issue with older patients. When my Dad was “no longer making progress” in rehab, we made in person visits to local nursing homes and did research to find a nursing home. It changes day to day, someone dies, ends up in hospital, etc. You don’t know.
Maybe there is a place local to you that can take him? I really believe that nursing home patients with regular visitors get better care. Best of luck to you. If nothing else, start to gather a list of his assets, get at least 2 years of checking account statements, etc.
It turns out that FIL does have Medicaid now. Whew. I have no idea when that kicked in.
Our concern at this point is that he stay in a facility of some type in Miami. At last report, the rehab facility was negotiating with one nursing home that might be willing to take him. SIL and MIL (his ex-wife) do visit him almost every day, but aren’t in any condition to take over supervison of care in a home-care situation. There also isn’t a clear place for him to go for home care. Second Wife has early stage dementia and is no longer in Miami as she has been taken to live with her daughter in Wisconsin. That SIL is very with-it and organized. She & Happydad are in communication about care.
Thanks to all of you for confirming my initial guess that once inside the system, so to speak, the system is stuck with him.
A rehab facility is not designed for long term care but since he has Medicaid, he should be able to be placed in a long term care facility. It may be harder to find one that can handle a trach. One of my aunts was on a ventilator and she stayed in the hospital for a while until they found a facility equipped to handle the ventilator.