My day went into nursing facility from hospital stay in early June. He is a heart failure and stroke patient. This was a very good quality NH part of a continuing care community that does not accept Medicaid. They only do short term Medicare rehab and reserve the long term skilled nursing beds for members of the community. They only accept private pay for long term skilled nursing residents. The social workers say we must move him since his rehab stay is over. The lawyer told us just to keep paying and that they can't make him leave. At this point, he will need skilled nursing for the rest of his life.
See, we had long been planning financially for skilled nursing for my dad. I had maintained my dad's good LTC policy. It now pays $350/day for skilled care (5 years of care) (the facility charges $450/day for skilled care). We set aside money to pay for the difference for a number of years. What we had not planned for is that getting into good, private pay skilled nursing facilities takes more than having the money. It takes long term planning - usually it means getting onto waiting lists ahead of time or joining continuing care communities with entrance fees.
The lawyer said that if he leaves, he will basically only be able to get into Medicaid facilities. Then he will be paying private pay probably for the rest of his life. That will really be a painful thing to deal with for us. At most of these facilities, most of the patients will be on Medicaid, paying almost nothing, while my dad will be paying for the full rate and still getting the same care. It would be difficult to deal with and he said we really should try and avoid it. Has anyone else been in this situation?
You are correct about the LTC insurance. Often they will ONLY pay when there is a full time RN on duty at the least. That is true at least of some policies. You will have to explore exactly what your Dad's insurance WILL pay for. These policies are often VERY expensive and seniors often do end up having to pay their own money because of restrictions of the policy.
Can't really advise you other than to get all the information you can from policy, and from SNF, and to wish you good luck.
If they don’t take Medicaid & take Medicare for short term rehab I am thinking this specific facility hasn’t or didn’t want to acquire a CMS Provider number. They do not have to take the lower reimbursement rates offered by Medicaid/Medicare & charge what they like. The rules are different.
If the facility is consistently able to get private pay, kudos to them. That’s why it sounds like an AL not a SNF.
Interesting set up. I’m not familiar with a center being structured this way financially. I’m curious about what level of care the long term folks receive (AL, MC or Skilled nursing).
1. Rehab only is done here, once Medicare stops paying the patient is discharged.
2. For LTC they ONLY except those people in the Community who can pay privately.
So, your Dad can't stay. Your lawyer is wrong. Rehab beds are just that, beds for people needing rehab. I think what your lawyer is thinking is "unsafe discharge". Which no, the facility can't do but Dad has money to find another LTC facility. And in my opinion should. The facility has told you Dad cannot stay. Looks like they get no government funding since they do not except Medicaid. That may be why they don't, so they can pick and chose their residents. If they don't want to except Dad, they don't have to.
As said, there are nice LTC facilities that except a certain number of Medicaid recipients but there are also residents that private pay. Because they except Medicaid does not mean they are substandard. My daughter says staff is not made aware who is PP and who is on Medicaid. All residents are treated the same.
A transfer or discharge is necessary for your welfare and your needs cannot be met by the nursing home. Your doctor must write in your medical chart why the discharge or transfer is necessary.
The transfer or discharge is appropriate because your health has improved sufficiently so that you no longer need the services provided by the facility. Your doctor must write in your medical chart why the discharge or transfer is appropriate.
You are endangering the health or safety of an individual in the nursing home. A doctor must write in your medical chart why the discharge or transfer is necessary.
You have failed to pay or have others pay the nursing home for your stay. The facility must have given you reasonable and appropriate notice of the amount you owe.
The facility has stopped operating or, if you are a Medicare or Medicaid recipient, the facility has been decertified or withdrawn from the program.
Essentially, if we keep paying, the lawyer said they can't discharge him. BTW, its not that Medicaid nursing homes aren't good. It's that given my dads probable life expectancy and the fact that he has a good 5 year LTC policy, he will never qualify for Medicaid. So, if you are going to be private pay for the rest of your life, you minus well do it at a place that has private rooms and only accepts private pay. That's the whole rational for this.
They really have to reserve their nursing beds for the long time residents, so my dad is really there using a "backdoor" method. The care director agreed to consider our application for a long term nursing stay, but we haven't heard back. Our lawyer thinks my dad has enough assets. He has LTC that pays $350/day for 5 years. My dad has IRA assets in the 1.5M range and owns his home outright. But, we still haven't gotten invited to stay long term.
The lawyer says that the issue that might be problematic will be if he needs a hospital stay. The facility may have more leeway to say they won't accept him back after the hospitalization.
Hmmmm
Kinda like the folks who paid the entrance fee and the monthly rent for however long being in the same LTC bed as your dad - who did not pay. Or worse - they lose that bed and remain paying rent while on the waiting list still - having lost the bed to your dad.
Hey, I won’t lie. If it were my dad, I’d do the exact same thing.
Just sayin’...
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