Hi. My mom had a recent fall in her assisted living/memory care facility and required a hospital stay of three days where they then admitted her to a nursing home for rehab. I would like to have her transferred to one in the state that I live in so we can be closer. She had previously lived with me for five years and had only been at her facility for two months when this happened. She had gone back to live close to my sister. She suffered a brain injury so not sure if rehab will help her or not. All this has happened within the last week. Thank you for any help/information.
if where she is currently has affiliated facilities in your state, this can be easily accomplished IF she is completely private pay or on Original Medicare and a better secondary health insurance that does not run on an in-network system. But you need to get on this ASAP while still early on rehab. You will need to private pay for her transportation to the new place. Will be $$$.
But if she is on Medicare Advantage for insurance in the new state, this will be quite quite daunting & $$$$ of a project to do.
Right now she is in the very VERY narrow window and time limited coverage that rehab provides. She went to the hospital (MediCARE pays) and was discharged as a rehab patient (again MediCARE pays) to a facility that does rehab and skilled nursing care. Rehab has tight & exacting qualifiers as to what can be done. I would highly suggest that you clearly speak with therapists she is seeing as to how she is “progressing” and what they anticipate for her length of stay in rehab. MediCARE routinely covers first 20/21 days at 100% then up to 100 days at 50% if needed. Most rehab is fell and broke a hip story and that is a pretty much a 10-15 day rehab period and only if progressing do they continue past the initial period to usually 5 weeks. Once no longer “progressing” (all this is in her chart and with details filled in by PT, OT, Speech Therapists, etc) she will go off MediCARE in 24/48 hrs.
But she is a TBI, right? That’s way more complex care. I’d be concerned that if rehab place is not speciality rehab facility that’s all about long term TBI care…. that if it’s an average NH/rehab place they will take viewpoint that she’s older and maybe some early dementia issues so that she’s going to get initial 20/21 100% MediCARE paid days and then written up as “no progress” and then goes from rehab patient (MediCARE) to a long term care resident at day 20/21.
Issue then becomes that LTC care room&board is not covered by MediCARE or secondary health insurance. Its considered custodial care, so not covered. It’s private pay, Medicaid or some costs covered by LTC insurance if she has had this done years b4.
To me, decision needs to be made ASAP before she transitions from rehab patient to LTC resident. Decision made to if she stays in new state of 2 mo or moves back to her old state. So…..
Does she have $ to private pay for NH? For how long?
Has she become resident of new state?
Like moved mailing address to the new state, gotten a new drivers license or ID in the new state, new banking?
Is there someone in new state to deal with getting her into new states system to become a resident, who can pay for her care from her bank acct; who can figure out & file for Medicaid if that’s what needed.
LSS it’s going to be paperwork hell to go through whichever state path is taken. Again, right now while she’s on MediCARE, facilities are being paid by Medicare and they are ok on her being there. Do what you can to have her stay in rehab, be actively participating in whatever rehab needs for her to do. Often you have to become a personal cheerleader to get her up & off to rehab room to “work” once/twice a day. If she’s all “maybe manana”, “it hurts/I can’t” in attitude, she’s toast on staying in rehab. (This was my late MIL, she was toast within days for rehab after hip replacement). Once she stops progressing, wherever she is will be on you or Sis as to either filing for Medicaid or doing a financial responsibility contract 2 private pay or taking her back “home” whenever that is.
Does she own anything- home, land, auto- in old state? If so, that’s a huge sticky for getting approved for Medicaid in the new state.
Really speak candidly w/rehab staff as to likely prognosis is and soon.
Let us know what they say, ok. Good luck!
My own Mom was in a nursing home for rehab due to a fall in her own home, a house she refused to leave as my Dad wanted to downsize. Mom had also suffered a brain injury in her fall but her injury left her unable to stand or walk. Rehab didn't help as my Mom was no longer able to understand.
Since your Mom had been at her Memory Care facility for only two months, she could relocate to another facility closer to you. In those two months chances are she hadn't made many new close friends or know who were her Aides/Nurses.
Facilities- whether it’s a free standing rehab place or a LTC NH or a LTAC - and providers imo tend to totally gloss over that continuing on rehab basically has to be earned by the patients ability to do and their sincere participation in their therapy. If they go 3-4 days to therapy and cannot do what is needed to show progress they are considered to have reached a plateau and rehab ends. Families think all will be ok as mom/gran/Auntie will be comfortably ensconced at the NH for 3+ mos with no worry. Then r gobsmacked when they are told that mom is on a 48 hr Notice of the end of Medicare rehab coverage.
Personally I’ve only know 2 to ever even get close to the 100 day max MediCARE rehab payout, both were younger side early 70s and were busy, active, still working, viewed as healthy: 1 male massive auto accident with a TBI rehab after weeks of post surgery recovery, he went the full 100 but in a TBI speciality facility and the other female college prof with a sudden breast & blood cancer & diagnosis who went onto a clinical trial and got almost 3 mos of rehab to build up her upper body lymph nodes stripped out areas. They both seemed way younger than their years and had similar spouses who were big relentless noisy advocates for their spouse healthcare. An older elder likely won’t have the drive and ability to be a real gunner on rehab…. their chart will show lagging progress and then a plateau and they are off Medicare. Appeal can be done but the determination is already based on there’s daily items and getting an appeal reversed ain’t happening.
The OP needs imo to get on finding out just where her mom is in rehab as once mom hit that plateau, she is toast on MediCARE coverage paying for the facility. It then becomes crisis decision making and that is not good, beyond stressful and can get quite expensive. Facilities know family is vulnerable at this time and many will take advantage of the situation to have families under the illusion that it’ll be a few weeks or private pay and all ok for mom to stay here, so sign this document (for financial responsibility) and we’re all good. Yeah sure and I’m gonna fit back into my size 6 capris… not happening!