For many nursing home residents, Medicare is—quite literally—a lifesaver. Medicare will cover a vast majority of the costs of skilled nursing for up to 100 days following a hospital stay. While this period of coverage is adequate for many, Medicare’s finite timeline is problematic for patients requiring care that extends beyond this 100-day window. For such individuals, termination of coverage often means a termination of care, as most are left without the means to pay for nursing home care themselves. However, despite what many seniors are being led to believe, a lack of means does not mean a lack of options.
When Medicare coverage expires, a patient is entitled to extend the duration of skilled nursing care by pursuing one of two options. First, every patient has the right to appeal termination of Medicare coverage. Alternatively, a patient may apply for Medicaid to help defray the costs of skilled nursing care. As long as the nursing home is licensed for Medicaid, the law permits the resident to remain at the home even if other potential residents are on a waiting list.
While these options are available to all, few are made aware they exist. This is because most skilled nursing facilities are profit-seeking ventures and delayed and/or decreased payments run counter to their bottom line. Medicare appeals are notoriously slow and Medicaid pays significantly less for skilled nursing care than Medicare or private payers. For-profit facilities want their money fast and in full, and the aforementioned options are capable of neither. Accordingly, these facilities often mislead patients into believing they are out of options.
To combat this deception, patients and family members alike must make themselves aware of the rights available to those on Medicare. Some of the most pertinent information is included below:
In most situations, nursing homes must provide patients with 30 day’s written notice of discharge and the right to appeal the decision to Medicare.
If licensed in Medicaid, the nursing home should help the patient apply for Medicaid.
During the Medicaid application process, nursing homes are required to continue caring for the applicant, regardless of payment status.
Remember: though they are tasked with providing care, many nursing homes are more concerned with making money than making patients healthy and happy. If you or a loved one requires skilled nursing, be sure to exhaust all possible options before electing to terminate care. Should you experience any problems asserting these rights, do not hesitate to seek professional guidance. Pennsylvania residents are encouraged to contact the Center for Advocacy for the Rights and Interests of the Elderly (CARIE), while those in New Jersey should reach out to the state ombudsman. If problems persist, contact a qualified personal injury attorney.