My stepmom was placed in a rehab after a brief hospital stay. After 9 days they released her saying she could only stay if my dad would pay the (at the time) $436 a day. She had started walking to the bathroom etc., but they claim she was not making progress. I’m wondering how they can do that if Medicare was paying the bill for 20 days. Would it really have been Medicare making that decision and not the nursing home rehab? They didn’t want to reveal that information. I mean if Medicare was willing to pay why would she be kicked out!
Perfect timing for this question because I had an OT progress evaluation today.
Personally,I'm almost 2 months at the NH and close to 2 months with Rehab. I actively participate in both PT and OT, insurance has not made a fuss as of yet, and I don't see that happening.
Therapy documents progress which they share with insurance. Insurance, in many instances, is the one that makes the decision to continue or discontinue therapy.
He was home for two months and could not go to the toilet or do much of anything else. When he finally fell in January we refused to take him home from the hospital and he went back to rehab. The social worker said he had 21 days of free rehab through Medicare because the clock starts over in the new year. That is not necessarily true. since it was less than 60 days from his previous stay we only received 3 free days for some reason. Then he was paying 200 a day until Medicare said he was not responding which we knew he wasn’t. The purpose of this endeavor was to get him into this NH and this was the only way we could.
Each scenario is very different as to what Medicare pays and I learned that no one in charge knows a damn thing about it. It’s just one big nasty surprise.
Even though your stepmom is out of the rehab hospital now, I would ask to see her records to determine what occurred to have them state that she is not making progress. Could they have just wanted to stop PT because their expectations were too low for the age of your stepmom? (For example, they didn't expect your stepmom to be able to walk, and she was walking.) Could she have been a high maintenance patient and they didn't want to or could not spend the time that she was demanding? Could she have been refusing to see the PT or do the work that the PT wanted her to do?
...and I hope you got her out of there. Four years ago, when my 97 year old Mom was in the rehab facility, the PT determined that she shouldn't be walking at her age and therefore, she was completely cured. Therefore, Medicare stopped paying. Because I was away and she couldn't be discharged to a person, we paid the full fee. During the remaining 1.5 weeks she was in the rehab hospital, the PT never visited her again. Exercising completely stopped. Therefore, when I came to get her, she was completely confined to a wheelchair and couldn't stand up on her own. I found a PT who was willing to try to get her to walk again and she did within a month, completely not using the wheelchair within 4 months....at the age of 97. I'm still ticked at that PT in the rehab hospital.
So It is worth your while to find out what happened for the decision to be made that she could not be helped anymore. You might need that knowledge for the next time she goes into the hospital.
P.S. We now have a PT person who makes home visits. Medicare and my Mom's health insurance pay for it , when we need it. My Mom will be 102 within 2 weeks, and she is still able to walk short distances with a walker.
So now, I don't take my Mom to a PT's office. I have them come to her.
...and my Mom is in a Memory Care unit. The facility allows non-facility professionals to do "home" visits. This was a biggie for me since I wanted to choose who my Mom saw, rather than get the physican-of-the-day from a clinic. Because we do not use the physicians at the MC unit, we stopped numerous unnecessary ambulance rides, ER visits and new prescription drugs. However, it does make it tougher on the Head Nurse as she is the one who has to have the physician sign off on all the reports they send to him. He collects, batches them up and sends them back all at one time, not how they would like to have them handled.
Contact the Ombudsman's office in area where she was and tell them the NH/rehab put her out after 9 days and they refuse to tell you why.
Medicare makes the decision based on the notes of her progress. Medicare will pay for 20 days, but some folks get a little better or refuse prescribed therapy's and don't stay that long.
It could be as you say and wouldn't surprise me. The OP should still check with Medicare about how much they have paid out though.
If the rehab has billed Medicare for 'X' number of days and got paid, then tries to collect payment from the patient in cash that is fraud.
Your wife is fortunate that she was in a rehab facility that operates on an honest business model.
The majority of them do not and will try to work the classic nursing home/rehab scam of getting paid cash from the patient and also collecting the full amount from insurance. Then use the threat that the patient is getting kicked out of rehab.
My father's Medicare and secondary insurance already paid for the full number of rehab days.
The facility was trying to work the old "double-dipping" nursing home scam these places are famous for.
They got their money from insurance but still tried to collect it in cash from us.
I don't think so.
I had a nice talk with the good folks at Medicare. They didn't know anything about it and were very interested to hear what I had to say.
The rehab doesn't want to reveal any information to you because they are probably working the same scam that they tried to work on me when my father was sick.
Whatever you do, please don't pay them anything in cash until you talk to Medicare and get it in writing exactly how much they have paid out for his rehab care. If it turns out he's paid up like mine was, then he stays in rehab longer.
Good luck.
Medicare is saying "If you NEED this time, you have it", but it is not saying "We WANT you to use this time".
I don’t understand why your stepmom was kicked out. Was she uncooperative with the staff at the rehab facility and did not want to do the exercises? To get an answer to your question you need to call the rehab facility and ask them this question.
Rehab is not an automatic holding area even for the number of Medicare "allowed"days.
Why was Mom in the hospital? My Mom was sent to Rehab after 4 days in the hospital just to get her strength back. I was told for everyday spent in the hospital, it takes 3 days of therapy to get your strength back. Another way you get discharged is if u refuse therapy 3x in a row.
We encountered this several years ago with my FIL. HE maintained that he was doing everything that he was asked to do. I guess technically that was true. Because after day three of him literally beginning the "I'm in so much pain, my arms hurt, my legs hurt, my back hurts, my (insert body part here) hurts" the moment PT or OT even opened the door, they stopped ASKING him to do anything more than basically wiggle his toes or fingers. HE thought he had it made - he didn't have to do much of anything and he seemed to think that he was appeasing them. What he didn't seem to realize was that he earning himself a fast pass right out of the door and ruining his chances at a true rehab.
PT and OT cannot run the risk of injuring their patients, so they can only do what their patients are willing to do. If their patient displays reluctance to do as requested, they can nudge and try to work with them and encourage them certainly. But there is a line. And after a certain point, they have to stop - no matter how much they want to help or believe that there is a possibility that the patient can be rehabilitated, because they have a liability issue. They cannot FORCE them to comply. They will do what they can within certain parameters, but the real rehab, for those patients, ends up stalling out and they don't progress the way they could have, and end up being discharged way before they could have been if they had really committed.
That rehab stay ended up being the start of the downhill slope for my FIL. It was the very first of several "non-rehabilitatable" stays in rehab before he was finally transferred to a nursing home a couple of months ago - because he just never wanted to really do the work to get himself better. He had the capacity, he just never wanted to try.
As far as who makes that decision - it's the rehab and Medicare. Medicare goes by what the PT and OT say as far as their progress. Medicare is not going to pay if someone is not progressing. And they only have a certain amount of time to show progress or an attempt at compliance. My FIL the last time was in and out in 10 days.
The number you mention is the maximum for a patient requiring rehab care. These are reasons for discharge from rehab:
1. Patient is unwilling to cooperate in care and is unable therefore to make any progress.
2. Patient is unable to cooperate in care due to dementia or other concerns, and therefore cannot make any progress.
3. Patient has made all the progress that can reasonably be expected in present circumstances and is ready for either placement or homegoing.
The assessment is done by the trained personnel at the facility. Once they deem a patient ready for discharge the bill will no longer be paid by Medicare or Medicaid, and the patient will be "self-pay".
I believe you can appeal this discharge but it only buys her a day or two. Therefore, you will need to have a discharge plan for your step-mom asap. If you feel she is an unsafe discharge back to her home, then I would ask to speak to the rehab social worker to see is she can go directly into a permanent care facililty, like AL or LTC.
https://www.nolo.com/legal-encyclopedia/expedited-medicare-part-a-appeal-discharge-order-from-facility-other-than-hospital.html
Are you authorized by mom to discuss medical matters with her doctors and other providers?