Medicare pays for the first 20 days in a nursing home, then we are responsible for the co-insurance. I heard you could get thirty days, but how?

If they we’re discharged from a hospitalization to NH or other rehab facility, the first 20/21 days is covered 100% by MediCARE, then after a $ 167.50 a day co pay due. As Jjariz wrote thier Medicare gap plan often will pay this.

BUT they have to show progress in their rehab.
If they don’t, then they are discharged from rehab. Medicare stops paying once discharged. If they need to stay in the NH, either it’s private pay, LTC insurance or if eligibile they can apply for Medicaid.

You should speak with their PT, OT, Speech therapist & other rehab staff to see where they are on rehab course of care & on compliance in doing rehab. Your elder may need you or other family to seriously motivate them to get with rehab. Some just flat won’t work with the therapists or make an attempt & get discharged even before the first 20/21 day period.

Some people have gap insurance that covers more. If you don't have gap insurance that offers this, then you have to pay.