Medicare patients are being discharged from skilled nursing facility rehabilitation when they need it most. Unless the family quickly takes steps to fight the discharge, Granny is sent home when her health needs would be better met by staying in the rehab facility. Few families know they can fight the discharge and keep Granny in the rehab facility for 20 days.
And if Granny has a Medicare Supplement policy that covers an additional 80 days of rehab, she can be knocked out of that if the family does not know to fight a wrongful discharge.
There is widespread misunderstanding of Medicare rehab coverage. Most families think (wrongly) that 20 days of rehab is an absolute right. Most medical personnel think (wrongly) that the patient must be showing progress or else Medicare rehab is cut off.
Here is the scene. Granny goes into the hospital with an illness or injury. She is hospitalized for longer than three days. This three-day hospitalization qualifies Granny under Medicare laws for up to 20 days of rehab in a skilled nursing facility. Granny must be either (1) improving due to the rehab or (2) need skilled services to prevent further deterioration or preserve current capabilities.
The second of these criteria is not well known by elders, families and medical personnel. Here is the actual Medicare wording of the second standard for 20 days of rehab: “A patient may need skilled services to prevent further deterioration or preserve current capabilities.” This rule is being ignored to the detriment of elderly patients.
Granny needs to continue with her rehab, but someone with the facility comes in and announces: “We are discharging her tomorrow because she is not making any progress. She has plateaued.”
That does not sound right to the family or patient. If she is not making any improvement, then she needs more rehab, not a complete stop of the rehab.
If the family fights the discharge, they have an opportunity to prove that Granny still needs the rehab to prevent deterioration or to preserve her present capabilities. Fighting the discharge starts with immediately filing a written objection and appeal of the decision, stating the reasons.
A September 28, 2010 federal court ruling upheld the right of the patient to Medicare rehab when the patient was not improving but needed the rehab to prevent deterioration.
There is no legal requirement that an attorney be used to fight a Medicare decision. The family can conduct a “do-it-yourself” legal fight. But the complexity of rules and procedures and the importance of Granny’s health point to the need for a quick phone call to an elder law attorney.
Better still, if the patient or family have already established a relationship with an elder law attorney for estate planning or elder care planning, then that call to the attorney is more likely to result in the quick action that is needed. An appointment with a brand new attorney next week may be too late.
Zeigler ElderCare Answers: Families may fight a discharge from rehab if Granny still needs the rehab. Already having an elder law attorney for advance planning makes this task easier and more likely to succeed.
Upcoming topics in Zeigler ElderCareAnswers seen here: It is NOT too late to do nursing home planning.