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Spydoorman Asked January 2016

Assisted living direct to skilled nursing for physical therapy. Any way to do this and get Medicare to pay?

My mother in-law is in an assisted living facility in Ohio. She is has been falling frequently now. So much so that the facility and her doctor recommend that she go to a skilled nursing facility short term for physical therapy. They said she needs therapy beyond what they can supply where she now lives.

She has good supplemental insurance, but I have been told that that insurance will only kick in after 20 days and that Medicare will cover the first 20 days. However I am also being told that Medicare will only pay if she is being released from a 3 day stay at a hospital to the skilled nursing facility.

Does anyone know any way around this? We cannot afford to pay for 20 days of skilled nursing on private pay. Seems a shame. Guess they want to wait till she has to fall and break a hip before they will help her.

vstefans Jan 2016
You could see if a rehab hospital might accept her - some of the "community" ones have mostly people with strokes and deconditioning rather than major trauma.

pamstegma Jan 2016
Medicare should cover it, and if it is NOT covered, you should be getting an ABN (Advanced Beneficiary Notice) of non-coverage.
Please note, that once she leaves the AL, state law requires that the facility evaluate her prior to readmission. My MIL was in a SNF/Rehab when she had yet another stroke. The AL said she won't be allowed to return. So when the PT benefits ran out, she became a long-term case. She stayed in the same building, just moved to the other end of the hall.

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