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Mostly Independent
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No, once the "failure to progress" mark is hit, the patient's bill is no longer paid by Medicare. He pays out of pocket until he has only $2000 left then he applies for Georgia Medicaid. The nursing home helps with the application for Medicaid.
Medicare does not pay for nursing homes. It pays for rehabilitation services, which may be offered in a nursing home building. That stops when the patient is no longer making progress, since then there is no reason to stay in rehab.
If the patient needs to have nursing home care (in the same facility as the rehab or in another facility) that must be paid out-of-pocket, from long-term-care insurance, or by Medicaid.
In any event, last I knew, Medicare "runs out" after 100 days at most, whether progress in rehab is progressing or stalled...Medicaid can be applied for and that does not 'run out" once approved providing the recipient continues to follow rules. (Very general comment intended to give the gist of things in a VERY broad brush way,)
This is a widespread misunderstanding, engendering lawsuits for years despite CMS's 2015 reiteration of the principal that rehabilitation is not tied to progress but also to prevent deterioration and maintain the current state of function. Preventing deterioration or further decline is different from Medicaid's "custodial care." That is required to help the person achieve the best status "practicable" (not practical -- which is a higher standard).
If your father is on Medicare and is in a nuring home then he is on Rehab. It will continue until he is no longer improving. Then the full cost of the nursing home will be leveled (in Pennsylvania the cost is $6000/month). This will continue until he has used up all his money. Yes sell his house (unless your mother is still living there), cash in his bonds and everything he owns . The nursing home will help you with this. It is called spend-down. When he gets to a certain level (different per state) then medicaid (not medicare) can kick in.
If you don't want him to spend-down then take him home and hire helps for him. If there isn't enough money consider a reverse mortage. Another option is assisted living (usually half the nursing home cost but his level of helping himself (going to the bathroom) must be good.
Bluebonnets - my experience is that the wider use of rehab to prevent deterioration & decline can now be ok & paid for by Medicare (or Medicaid) for those with MS, secondary polio, some brain traumas. So will now pay for PT & OT beyond the old usual strict & fixed # of days allowed in a year. But for elderly with dementia & aged related decline, well, they don't meet the standard for extending paying for "rehab" like say a person with MS does.
I have a cousin with polio. Cute poster kid in the 1950's & not so cute70 yr old with secondary polio issues now. His has a special /supplemental needs trust (i'm a trustee & we annually review costs & project for next year) which until fairly recently had paid for PT OT beyond what either medicare or medicaid would. For him, it is pretty important to work with therapists throughout the year as it does prevent decline. The PT group got notification from CMS that payments will now be paid following an updated evaluation for some. The group that seems poised most to benefit from the wider payment seem to be those with Muscular dystrophy multiple scoliosis. They have a very organized association that seems to be the force behind the change.
For the elderly the usual story is they break a hip and get post hospitalization "rehab" discharge to a NH with rehab wing. The PT OT therapy plan for post hip is pretty specific. Most elderly just don't progress and nothing the PT does will change the elders decline. So no extended rehab paid. beynd the initial first few weeks (usually 3 weeks).
Good answers but a visit to an elder care lawyer should be the first step to determine strategy in going forward. State rules are different and if your mother is alive there are spousal impoverishment guidelines so she still has funds to live. You mentioned mobility issues- that is my area of expertise so please let me know if I can offer suggestions that could allow your father to return "home".
How the determination of "progress" is made can also be a problem. About 16 years ago, my MIL who had COPD and diabetes was admitted to the hospital and placed on a respirator because of a lung infection. After about 10 days, she was able to be taken off the respirator and then dismissed to a nursing home for rehab to regain her strength. We were told that the rehab would be covered by Medicare. Unbeknownst to us, a few days later the nursing home staff determined that she was not making progress and was not going to make progress so she was reclassified as "custodial care". We did not know about this until we got a bill for a month of care not covered by Medicare, even though my husband had power of attorney. When we questioned this, the administration told us that MIL had signed a paper saying that she understood and would pay out of pocket. Since she was legally blind and fairly confused after the hospital stay, we wondered about the validity of her signature, but at that point we were too busy with children and jobs to challenge anything and we didn't know where to begin. In an interesting irony, MIL regained enough strength to return to her assisted living apartment after two months of private pay in the nursing home. It sure seemed to us that she had made progress.
I think this happened because nursing homes (and other health care providers) are reimbursed much less that the private pay rate by Medicare. It is to their advantage to have patients who are private pay.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
If the patient needs to have nursing home care (in the same facility as the rehab or in another facility) that must be paid out-of-pocket, from long-term-care insurance, or by Medicaid.
Grace + peace,
Bob
If you don't want him to spend-down then take him home and hire helps for him. If there isn't enough money consider a reverse mortage. Another option is assisted living (usually half the nursing home cost but his level of helping himself (going to the bathroom) must be good.
I have a cousin with polio. Cute poster kid in the 1950's & not so cute70 yr old with secondary polio issues now. His has a special /supplemental needs trust (i'm a trustee & we annually review costs & project for next year) which until fairly recently had paid for PT OT beyond what either medicare or medicaid would. For him, it is pretty important to work with therapists throughout the year as it does prevent decline. The PT group got notification from CMS that payments will now be paid following an updated evaluation for some. The group that seems poised most to benefit from the wider payment seem to be those with Muscular dystrophy multiple scoliosis. They have a very organized association that seems to be the force behind the change.
For the elderly the usual story is they break a hip and get post hospitalization "rehab" discharge to a NH with rehab wing. The PT OT therapy plan for post hip is pretty specific. Most elderly just don't progress and nothing the PT does will change the elders decline. So no extended rehab paid. beynd the initial first few weeks (usually 3 weeks).
I think this happened because nursing homes (and other health care providers) are reimbursed much less that the private pay rate by Medicare. It is to their advantage to have patients who are private pay.