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?
With excellent care your father may not need to be hospitalized anytime soon. So why not keep him put until that happens? He will have had the benefit of this level care for as long as it lasts and then, if necessary, might have to relocate after a hospitalization.
I would plan on him having to relocate at that time.
You could be looking for an alternate place, perhaps get him on a waiting list for a more permanent home.
The plan could be that dad is there until next hospitalization and then see the status of things at that juncture. If the facility has successfully faded the heat from the wait list, they might be willing to continue on but if this is the legitimate out they need (and it’s legal) to free up dad’s bed, I would expect them to use it.
I would guess they very well understand the five rules for discharge.
They ran the risk when they opened up for rehab for patients not in the community. Those extra fees and income must have been factored in as an overall benefit to the facility and their patients.
To be licensed they have to follow the state laws but it sounds like your attorney knows that a hospitalization might be a deal breaker.
When my mom (on Medicare) went into a rehab, that had private pay only continuum of care, i believe we had to sign that she would be leaving after rehab. and it was understood that she would have not been accepted otherwise.
It sounds like the attorney has been advising you all the way, so hopefully he knows what the contract stipulates and if it’s enforceable.
Also the fact that the facility has indicated that there is a possibility that your dad could be “invited” to stay, seems to indicate that there are provisions for a person who has not bought in previously to remain, else why would they even discuss the possibility?
I wondered if they would come back and say that the daily rate is only offered for those who have joined the community earlier and present you with alternate higher fees required for those who are transitioning from rehab? Of course until they offer, you can’t consider.
I hope you let us know what happens. We learn from one another.
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’...
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.
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.
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.
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).
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.