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Was just told of this rule, but not sure if it's accurate. This is in regards to my uncle who fell. He was in the hospital two nights and they recommended sending him to rehab. My cousin didn't want to do that unless necessary because his father would prefer to stay at home. Cousin was told he could always change his mind.


Uncle was discharged from the hospital after two nights. My cousin now needs help caring for his father and was considering rehab. Was told by the home health people that Medicare only covers nursing, physical and occupational therapy, and an aide to help with bathing.


Supposedly if uncle stayed a third night, Medicare would've covered rehab and possibly a caregiver to help at home. Was also told it has to be three consecutive nights. Is all this true? If so, the hospital misled our family.

So we spoke to a case manager from the hospital. She's in charge of setting up home care and all that stuff. We asked her about this rule since my uncle was in the hospital a second time. She said we don't want him to spend another night there because he could get sick. She told us to go to the Medicare website. She didn't help at all.

I don't know anything about the insurance. My other cousin is in charge (POA) but we haven't heard back from her. She's supposed to be the smart one but I think she gets overwhelmed. I don't know why, she's not the one doing all the physical work.
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Reply to KateH2
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It is a rule but if you have supplemental insurance the rule might be waived. That's why you have to be clear when someone stays overnight in the hospital that they are admitted and not just there to be observed. They have to be admitted for the days to count.

Check the supplemental insurance if there is any. On our policy, they specifically waive the requirement for the 3 day hospital stay.
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Reply to needtowashhair
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Yes that is true. When my mother had aortic valve replacement the nursing facility next to her AL informed me about this and I certainly agreed that this be made available to her.
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Reply to Riverdale
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How old is he and what type of insurance does he have. Does he live alone?
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Reply to Iris29
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This is very true.
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Reply to Iris29
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Luz stayed the three midnights and was transferred to rehab. The last few days in rehab the case worker talked with me about our needs after rehab. This included wheel chair, visiting nurse, therapists, personal aide for bathing, etc.
Our insurance , including medicare, paid for everything. She was required to stay the three nights in the hospital and the hospital arranged everything and was glad to be rid of her so they could put another patient in that bed.
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Reply to OldSailor
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KateH2
If your uncle has Original medicare part A and B then yes Medicare requires three nights as an inpatient in a hospital to qualify for inpatient rehab.
Here is a link that explains this in some detail.
Always tell your doctor you want your loved one admitted and push for the 3 days. It’s much better to go to a SNF for therapy as a rule. It largely depends on the patient and compliance. There is generally more compliance in a rehab than at home, more equipment, daily medical attention, more therapy. Other patients which sometimes helps motivate your patient and sometimes a break for the home caregiver.

https://www.medicare.gov/pubs/pdf/11435-are-you-an-inpatient-or-outpatient.pdf

about Home Health. What they told you is correct. I’ve worked with having HH in for years with my loved ones.
It depends on the condition of your uncle as to how long they will work with him.
The only thing you mentioned that I haven’t Experienced is the caretaker at home after rehab. You can get HH, like he has now, after rehab to continue the therapy etc.
All of the other details you mentioned are correct regardless of which state as long as he has original Medicare. If he has one of the Medicare Advantage plans, then he will find that they deviate from original Medicare in many instances and can be different in different states. Medicaid also has different rules.
Hopefully uncle has original Medicare with part A and B and a medigap plan to pay the 20% that Part B doesn’t cover on outpatient charges.
If your uncle is dizzy or has balance issues then HH PT or OT will work to get him stable to help prevent another fall. OT usually helps identify fall risks and modifications that may be needed in the home for safety.
Kate there are a lot of gotchas for seniors that often fall on the caregiver to sort out. This forum covers most of them. And just to keep us on our toes the rules can change so there is that to watch out for.
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Reply to 97yroldmom
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My mom has Medicare and Humana Gold Plus as a supplemental plan. It covered 20 days. She had to be admitted into the hospital for three days.

When she arrived in the hospital she was in observation and that did not count. After she reached the end of three days the nursing home sent a transport van to the hospital to pick her up.

They decided to keep her a short while longer and we paid the balance out of pocket.

Rehab helps so much. You may need to follow up with home health too. My mom did. They will continue to work with them. It’s a lot of work.

I was proud of my mom for trying her best. The occupational and physical therapists would tell me that she worked hard to improve. She did. She pushed herself and it’s tough.

I watched her at home when she did home health. It is closely monitored. They will not push them past their limits.

My mom was fearful in the beginning. I understand having a fear of falling again. That is a justifiable and natural fear but the therapists are wonderful with making them feel secure.
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Reply to NeedHelpWithMom
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If your cousin would have said yes to rehab, your uncle would have been kept another night.

The rule is, admitted to the hospital for 3 midnight's. And hospitals are very aware of this rule and they make it happen when they believe that rehab is required.

This is the kind of thing that we all learn in the beginning of our caregiving experience. Make sure that future hospitalizations are admitted and not observation, because that may not count.
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Reply to Isthisrealyreal
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That is true in my state. After 20 days in rehab they can apply for Medicaid to stay longer but that takes a bit of leg work. Uncle can get in home care for a few more weeks after rehab to help with his daily care. This is good for them in my experience if they give these OT, and PT a chance and are cooperative.
You have to speak up and ask for the patient advocate in the hospital. Maybe Uncle was wanting to go home but once home they get very non compliant with family members.
Also, yes most hospitals want them gone asap and you probably were misled but lesson learned, hopefully there won't be a next time but if so-now you know. Good luck and take care.
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Reply to Rbuser1
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Not sure if the 3 day would cover homecare. This should have all set up by the hospital. Call his PCP and see if he can put an order in for homecare. They will evaluate if Uncle needs help.
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Reply to JoAnn29
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My mother has a Blue Cross PPO Medicare plan that does NOT require a 3 night hospital stay in order to qualify for paid rehab. Check with your uncle's plan specifically and don't rely on US to give you info which may or may not be accurate!
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Reply to lealonnie1
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Rehab helps so much. My mom went after a fall. Home health is good too but rehab is more intense.

There is a three night rule in order to be accepted. The rehab last for three weeks and is a big help in helping an elderly person regain strength.
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Reply to NeedHelpWithMom
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JoAnn29 Dec 4, 2019
Rehab can last for more hatn 3 wks. Medicare pays for the first 20 days 100%, 50% 21 to 100 days.
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It was true for my FIL, each time he fell (at least 2 or maybe even 3 times).
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Reply to Geaton777
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