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My stepdad spent three weeks in a physical-therapy facility for his hip and knee problems. Mom told me that Medicare would pay for 21 days. On Day 21 (which might have been Christmas day), Stepdad fell and broke his shoulder there. As a result, he spent three days in the hospital and then was returned to the same facility.


I told my mom that I remember reading on this forum that there is something significant about staying three nights in a hospital in regard to being discharged--maybe to a rehab facility or nursing home. Maybe that they qualify for Medicare-paid therapy in a facility after three nights in a hospital? So maybe Medicare will pay for another 21 days since he has a new injury for which he was hospitalized? I know this is a vague question, but of what significance are those three nights? Of course, Mom will find out soon regarding payment, I'm just trying to remember what I read.

So, correct, the three midnight stay is what qualifies you for a Medicare paid rehab stay.

But....in order for Medicare to "re-set" and restart the clock, the patient must have been out of care (out of the hospital and out of rehab for I think 60 days).

Have you or mom talked to the discharge planning folks at the hospital about this? Was dad about to be discharged from the rehab or was he about to be approved for further coverage? How was it that he fell?

You might need to play some hardball with the rehab center to get them to cover this stay if the fall was due to negligence.

How is his stay being paid for now?
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Reply to BarbBrooklyn
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DePopa Jan 3, 2020
Thanks, Barb, for your quick reply. I am across the country and kind of out of the loop, so I don't know the answers to those questions yet.
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https://www.medicareadvocacy.org/medicare-info/skilled-nursing-facility-snf-services/

I think that your stepdad's care in the rehab facility will be partially but not fully paid for by Medicare. My understanding of the rules is that Medicare pays in full for the first 20 days in a skilled nursing facility (e.g., rehab) for a "spell of illness" and then pays in part for the 21st to the 100th days. In your stepdad's case, I think that the new injury will be considered part of the same spell of illness as the original reason he was in rehab, because of the 60-day rule: "A 'spell of illness' begins on the first day a patient receives Medicare-covered inpatient hospital or skilled nursing facility care and ends when the patient has spent 60 consecutive days outside the institution, or remains in the institution but does not receive Medicare-coverable care for 60 consecutive days."
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Reply to Rosered6
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I would check with the rehab. Ask to speak to a Social Worker there in charge of your Dad's case. The typical is that after a three day hospitalization your will have medicare pay for your rehab for 21 days. They may pay for more if you NEED more, that is to say that you are making progress still, but you have not progressed to the level they believe you can attain with more therapy, etc. It is true that to qualify again you have to have another hospitalization (as far as I understand) but you ALSO need a period without hospitalization, injury, rehab need. I believe it is 60 days. Each year Medicare puts out a handbook and the new one is out. You can call them and request a copy. You can also ask about this circumstance when you call. They are generally very nice on the phone, though you may have a waiting time. I still think your easiest route is going through the social worker. I know that when my bro was in the 21 days was up, and the physical therapists thought he had done great, and now at the level that could be attained, good stamina and walking but balance was and would remain rather poor with a benign tumor sitting on his medulla and affecting his balance centers; the doctor however had wanted him in rehab until a 30 day repeat MRI could be done to insure him that this was a benign scleroma, not a blossoming tumor--so they kind of got around things. He had a wound that wasn't healed from his accident and they put him in for request for more medicare days due to wound healing needs. So they are able to function within this system in some ways. Do ask to see a social worker. Or stop in their business office to see who you should talk to.
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Reply to AlvaDeer
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DePopa Jan 30, 2020
Thanks AlvaDeer. I am not personally involved in any of his care or decisions. My mom is handling all of this. But I will pass on your advice.
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Here's an update. Stepdad fell and broke his shoulder in the rehab facility because he had tried to get from his bed to the bathroom without calling for help. Mom said that after he came back from a 3-day stay in the hospital, there was a charge for his return to rehab. But he didn't stay in his room long because he had to go into isolation due to C-difficile. The first two weeks of antibiotics did not work, so now he is on a second round with a different antibiotic. He's still getting rehab for his shoulder and, I suppose, his lower body but all exercises are limited to his being in bed.
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Reply to DePopa
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I would see if you can talk to the finance office. Like said Dad maybe on the same 20 days. Medicare pays 50% for 21 to 100 days. Hopefully their supplimental will pick up the rest. In my Moms instance she pid $150 a day. I think that amount is higher. If Dad is in full 100 days, thats about 8k.

Sounds like ur Mom will not be able to care for SD. This would be the time to have him placed in LTC. Mom would be the Community Spouse. She will not be left impoverished. Assets will be split with his split being spent down and then apply for Medicaid.

Your profile says you live in separate states. You may want to go there so ur more hands on. This is probably overwhelming for Mom.
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Reply to JoAnn29
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Yes, it's a lot for Mom. I cannot travel, as I have a farm full of horses and small animals, with no one to care for them while I am gone.

Stepdad's brother lives in city near Mom and Stepdad, and has become involved in Stepdad's future. This includes moving Mom and Stepdad to an AL community near Brother when Stepdad is able to do so. Meanwhile, Mom is making do with home-healthcare workers two days a week. Since she has Parkinsonism, I hate for her to be living alone for fear of a fall, though she says she is fine with the setup.

That's very interesting what you said about Mom being the Community Spouse and splitting the assets so Stepdad can apply for Medicaid. They have some savings but we all know it will go fast! I will pass this advice on to Mom. Thanks.
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