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pamelaj2230 Asked July 2015

Facility charges for holding a room while a resident is hospitalized and then returned to the same facility for therapy on Medicare?

My mother is 85 and suffers from Alzheimer's. She is has a private pay room in a skilled care facility. Recently she was hospitalized and had surgery after she fell and broke her hip. She returned to the facility after a week in the hospital and was moved to a "medicare room" in the same area of the facility. She has received therapy for six weeks. This was the 4th room change in a 6 month time frame. The additional 20% of her care is covered by additional insurance. I was told that I only needed to move what she needed to the "medicare room" and she would be moved back to her private pay room after she completed her therapy.
I have received a bill from the facility for the full private pay rate for the room they were holding for my mother to return to after her medicare stay was exhausted. My question is this. Is it appropriate and common place for a facility to charge the full private pay rate to hold a room for a resident that is required to move to a medicare room for the care and therapy she has been ordered, even though there is no care provided for that room, no meals associated with that room and no cleaning or maintenance of that room. The facility is full and I was told that if we did not paid the full rate for her private pay room while she was absent from it there was no guarantee that there would be a private pay room for her after her stay in her medicare room was exhausted.

GardenArtist Jul 2015
Yes, I believe it is. I remember choking a bit when I read that in the terms and conditions during intake procedures. I thought about it and decided that if the facility was worth it, it might be better than having to start over at another place. I could always decide to give up the room later if Dad had to be hospitalized.

It's a financial issue; the facility is losing money if it could otherwise be renting that room to someone else. I don't like it either, but I understand the justification.

Babalou's suggestion is good; give up the room, but you take a chance that it might not be available when your mother returns. It's a gamble. If your mother and you are happy with the facility, it might be worth it to ensure that she returns there rather than change while probably already somewhat confused from dementia, and have to start over in a different facility.

And I hope your mother's recovery proceeds well.

BarbBrooklyn Jul 2015
Each time mom has been hospitalized, we've given up her private pay room for the duration. Each time, she has returned to the same room as a Medicare pay patient. This facility is rarely full; this is in Connecticut.

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Rev2elt Jul 2015
As far as I know, all facilities do this. If you lived in an apartment, or rented a house, you'd have to pay the full rent every month. If you go on vacation for 2-3weeks, you still have to pay the full monthly rent, and it works the same way in AL or a NH.

pamelaj2230 Jul 2015
This seems to be glitch in the medicare system. In this facility the Skilled Care Center is made up of "private pay" rooms and "medicare rooms". The rooms are in the same area, receive the same meal plan, the same nursing and cna care and are identical in every way except the number on the door. However when a resident becomes sick and hospitalized if they qualify for medicare upon return they are moved to a "medicare room" which may be across the hall or next door but the number of the room has been approved as a "medicare room." The only difference in the room and care received is the number on the room. Seems that medicare should be approving an alotted number of medicare rooms for the facility and these aged individuals should be able to stay where they are for their qualified medicare time as long as there are medicare allotments available at the facility.

Rocknrobin Jul 2015
Yes it is appropriate. At the AL I worked in for 10 years this was standard practice. I know this is a care facility, but the bottom line is it is a business. The private pay room is her home.

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