Does the 10 days in hospital restart the Medicare 20 day benefit and negate the 4 day co-pay charge?

If only the SWs and other medical resources/organizations would be consistent with information. Mom was in a SNF/Rehab Facility for PT/OT after shoulder replacement surgery/reconstruction. They truly did verbally/emotionally abused her, and turned off her call button when she wanted to go potty [without tending to her needs nor request for pain meds]. They yelled at her to go in her briefs. She grew to be afraid to use the call button. They hollered at her when they got her out of bed. [Mom has NO upper body strength and is not able to do for herself - even eating with utensils is a feat. She started eating mashed potatoes with her fingers, or not at all. [Now the new SNF/Rehab thinks she's got dementia, when it's actually learned fear!] It took 3 weeks for first SNF to dx a UTI and dehydration, causing hospitalization for 5 days which was counted as 10 [the reason for hospitalization was _not_ the surgery, but dehydration/IV fluids and need for antibiotics].

The first 20 SNF/Rehab days were covered by Medicare [she has Pt A and B]. Days 21-100 were covered by her Medi-Gap Policy and Medicare at a 80/20 pcnt. She's STILL in a Rehab facility - 11/3 would be day 101 - so one month of _private pay_ is $7,350 for 30 days [to be "discharged" 12/3 - but she's not ready at all for discharge].

Mom's still not recovered/heeled from her bout with the first SNF. They kept her dehydrated [more IV fluids in OCT], bed sores on her feet, bum, and elbows. She's lost over 20 lbs.

We cannot afford another $7,350 for another month, but don't qualify for Medicaid, either. i'm disabled and live in the family home. We hope that Mom will get the spark back in her to work at rehab once home. But if she must go back to a SNF because of my inability to lift her [change of briefs, bathing, etc] do i need to wait _30 days_ [because of the private pay month] or would it be _60 days_ after her leaving the current SNF?

Is home care an option that would be covered under Medicare? i'm grateful for any suggestions/insights. i've lived in the family home [spinal cord disease] - i'm just a disabled daughter with a heart filled with love, worry, and hope.

Information is hard to find, and i'm weary of hearing "not my area of expertise" - even from SWs. The Agency on Aging merely sent me booklets of optional 'private pay' facilities. Private pay isn't an option. i've called Medicare, but does a doctor need to write a script for homecare [shower, etc] -- Mom now can no longer walk - she's too weak. And somehow, i need to get her to her upstairs bedroom - that's where the shower is. Dec 3 is coming all to fast.... Thank you.

Image: Your post is a moot point to me since my mother is now deceased.

Image, Westford House (an NH in Westford, Massachusetts) asked us for it after Medicare covered I think maybe even less than 10 days, which as it turned out wasn't long b/c she suffered a stroke, went back to the hospital and deceased.

This was the biggest jolt I've ever had after several years of caring for husband and now in AL. "IBEG YOU "PLEASE" read 'Getting Medicare to Pay for Nursing Home Care," by John L. Roberts, Expert Cert. Elder Law. I would judge that 99% of Medicare patient in NH's, A:L.,AND being sent home to manage their own medicine for one. I found this article by chance on "Aging Care" and there is MUCH more we are not being told. (It's to convenient to blame the computers! And just who exactly puts this information into these computers that seems to conveniently "not be caught up currently?" Read this and find out. I would be very interested in your take and thoughts on this.. I would correspond with any of you personally but I'm pretty new at this so if you would like to help &\or enlighten me I would be glad to hear from you By the way this is a FEDERAL law just state by state. Thank you, Hope to hear.
atty..

I used to go to Medicare team meeting pand it was only the highest trained DON's that knew how to keep people on their 100 skilled days for a significant period. The rest of the time it is just like ImageIMP shared - you'd be surprised at what you can advocate for. The appeal paperwork alone scares them!
Medicare skilled days are also not just for therapy - you can stay on for nursing skill if there's a need for certain types of wound care or medication changes (like for pain) that need monitoring.
The 60 days reset is correct for new benefit periods.

No the why that the skilled nursing works is that you go in say after a hospital stay fall or whatever happens you go back to the hospital then end up going back to the skilled nursing home that days that you were there before count toward the total hundred days it does not start over even if it is a new thing that the are going in for. You will have to be out of the hospital or skilled nursing for 60 days before the benefit will restart.

Llamalover, why did you have to pay privately after day 20? That is NOT necessarily required! I have been going through this identical issue for the last 3 months... My Mom, 95/blind, fell on June 20 and broke her right hip & right wrist. She was admitted to hosp. following ER, and had ortho surgery (successfully) to repair breaks the next day. My Mom ONLY has Medicare Part A, and has never had Part B (that is what is deducted from SS and adds additional Medicare benefits, but many people don't realize it is actually optional). Medicare Part A ONLY covers in-hospital and rehab/skilled nursing after. I was told by everyone she had 20 days, and then it would be private pay... After 6 days in the hospital she was discharged to a "skilled nursing/rehab" facility (that's another story... They were horrid and in 6 days damaged her feet so badly she'd can't wear shoes, almost lost her feet, and it's still an ongoing wound issue to get healed..). Anyway, that was the first 6 days of her initial 20 covered by Medicare following hospital. I transferred her to a competent facility, and at new facility, I was given a discharge notice effective at the 20-day coverage end. No one had told me there is a potential 100 day total Medicare benefit! The first 20 days are covered completely, and after that there is a co-pay ($157/day), and a requirement that the patient show measurable progress in rehab to continue that Medicare coverage. I didn't know about that, and only found out from the transition coordinator at the hospital she'd been in (when I stopped to show him photos and tell him of her experience at the first facility, to which he'd given a thumbs up in the first place. He doesn't recommend them now!). There had just been a therapy progress meeting that morning, and he called the Center and talked to Social Services... When the SS worker stated Mom had to show a certain level of progress, I told them of the reports I'd gotten that morning FROM the therapists, she checked, and said "OK, we'll cancel the discharge...". Mom continued in that unit for about 2 weeks, and I was again given a discharge planned date with the stated reason that she wasn't making adequate progress to justify continued stay (that date is always an assessment by the therapists at the facility, not by Medicare! They are "guessing" what Medicare will approve, based on certain guidelines).. At that point I appealed to Medicare (you have that right every time they are going to discharge!). Medicare has physicians review the patient's complete file and they make the decision within 24-48 hours whether to grant continued coverage. My appeal was upheld, and she was allowed to stay - and receive the rehab/therapy benefits she needed with partial Medicare payment - for almost another month. She was then transferred to a lesser-care unit of the facility (again, because of their assessment she wasn't making enough progress for Medicare to accept), and I allowed the transfer then... However, after two weeks of lesser care, 2 persons/room, no therapy or rehab, and 2x the $$, her surgeon issued an order for her to receive rehab/therapy, and they had to transfer her back to the first, Medicare covered unit. (Again, there is a $157/day co pay after that 1st 20 days). We now have a new planned discharge date of probably Oct. 9, but if I appeal again, and that is upheld, the maximum date for coverage is October 19, because at that point she will have exhausted the entire 100-day Mecicare benefit! (I've gotten the impression that doesn't happen/isn't approved very often...) If that 100-day benefit is used up entirely, she must stay out of the hospital for at least 60 days, or have no benefits for post-hospital rehab/nursing available. If she goes in-hospital (for 2 days?) after that 60 days, though, the entire 100 days starts over... Don't just buckle under and accept as gospel what a nursing center is telling you about coverage, or incremental discharge requirements! You can call Medicare yourself and inquire about benefits or file a Medicare appeal of the nursing home's decision to discharge or charge you private pay (this center doesn't allow private pay). Sorry so long, but this is a really confusing and misunderstood topic! We were within 24 hours of her discharge at the 20-day mark, which would have resulted in paying thousands of $$$ out of pocket with lesser coverage because no one informed me of the actual Medicare rules...

SNF=Skilled Nursing Facility. For my mother, we had to private pay after day 20 in the SNF.

Dolores, SNF is the abbreviation for Skilled Nursing Facility.

I need to know what SNF stands for. Where do I find info about this issue?

Dolores

In order to start the 100% coverage for the first 20 days there must be a 60 day break in the spell of illness. That means no hospitalizations for the 60 days after the person discharged from the nursing/rehab center. Other wise if they return to the rehab, they pick up where they left off. So sadly, yes, you will have copays for any days after the 20th.

So if she didn't have a 3 day stay and a new admission diagnosis then yes it's correct. You can always appeal (on Medicare Summary Notice) SNF demand bills Medicare and you collect any evidence needed for appeal. Tips for appeals on http://www.medicareadvocacy.org

Only if she was admitted for 3 days for another medical problem/different diagnosis. Always 3 days inpatient (not observation) to access SNF benefit. You also have 30 days to be readmitted to SNF under first diagnosis/episode.