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My brother is severely disabled and has been living in the same nursing home for 10 years. He was recently hospitalized and after 10 days the nursing home contacted me (his DPOA) and told me they could no longer hold his bed unless I paid the full daily price (he is on Medicaid) and signed the guaranteed hold. The nursing home is under new management with a new administrator. Last year my brother was hospitalized for over a month and the nursing home did not try to "kick him out". What recourse do we have? He will soon be discharged from the hospital.

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Thank you all for responding! My brother's story has a happy ending, at least this time. The first time the social worker at the hospital called me he said the nursing home had called and said they would not be taking my brother back. He then asked me what my plan B was. After I told him my brother had lived there for 10 years, he said he would call the NH and talk to them. In the meantime, I was researching state and federal laws related to nursing homes, Medicaid and Medicare. I found that if the nursing home's Medicaid certified beds were full at the time of his discharge, he would be entitled to the next available Medicaid certified bed. Luckily, they were not full at the time of his discharge. I also wonder if their initial reason for saying my brother could not return was because he can be a difficult resident. He is a double amputee who has to be transported to dialysis 3 times a week. He also needs a lot of care and can be impatient. I don't know if the administrator had a change of heart because that was his "home" or knew that they legally had to accept him back since they had a bed for him. Either way, I am so relieved. I read all of your responses and will definitely keep this for future reference. I thank you all for your advice.
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It's true that each state has a Medicaid bed hold policy, but how to enforce that policy varies from facility to facility. I toured 16 nursing homes in my area and they ran the gamut. One place told me that the very day my loved one went to the hospital, I would have to pay, or they would give the bed to someone else who was waiting to get in. The place my mother was admitted to will hold your bed, period. Provided you tell them your loved one is coming back. Their reasoning is that the NH is their home now. They have likely given up their "real" or former home to be admitted there, so they give that concession. Yet another nursing home told me that when a facility wants to get rid of a resident, or views them as a problem, they will simply refuse to take then back from the hospital. The director of nursing admitted this was a dirty trick, but told me anyway, in the interest of "honesty."

How very sad for all of us that we're at the mercy of these people.
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Bear, you have been given good input. We have not heard from you in six days. How are things going?
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Each facility has a bed hold policy, and the above response is correct: the bed hold is for anyone, private pay to Medicaid. Contact your local Area Agency on Aging or Bureau of Senior Services and speak with the long term care ombudsman. The ombudsman is an advocate and is very knowledgeable. She/he will be able to give you or assist you with this issue.
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It's probably "legal" but not the best in terms of "best practices" for the patient. I feel sad reading this happened to you. I hope you will have a good resolution, please post an update!
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Igloo, I am impressed that you know all this and thanks for sharing!
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Isn'tEasy - You're right. One would think that because brother is disabled and been there ten years, those in charge would give him a break. And your post about how many beds is good, too. I'm in FL and the problem here is we're in season and while there were more beds during the summer, there are none now!

It all depends where you live as to what's available. It's very disconcerting to have to scramble like this all the time especially when we're all caring/worrying about our loved ones, that's stressful enough.

Then, of course, we need to look at the other aspect, our 'loved ones' are just another number because the numbers are starting to rise. Nobody knows exactly what to do with this and one would have thought government would have prepared given they've been warned (at least since I was studying this) for years that this was going to happen!

Annoying and stressful when it need not be!

That's why I recommended contacting a state representative just so it could be documented that people are having problems. If more people did this (of coursed they don't care) perhaps we'd have more of a voice in this. We all need to email them so they know there is a problem. I just don't believe they'know' this yet.
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Nursing homes aren't "run like a business," they ARE businesses. If you find that fact to be disagreeable, vote for comprehensive, universal healthcare.

Whether they are non-profit or for-profit, they are businesses and must cover their expenses with revenue whether that revenue comes from Medicaid, private pay or any other source.

That said, 'bablou' makes a good suggestion. Ask the nursing home how full they are. If they have plenty of beds, you can probably release his and be pretty sure one will be available when he's discharged from the hospital. Be sure you let them know he intends to come back.

As others have mentioned, the fact that your brother is disabled (and not merely 'old') may put him in a position to take advantage of other programs that may help out in this situation.
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Ever try contacting your state representative? They're there for a reason and hopefully they will be able to help.

That being said, I believe that this is common practice today. I, too, was asked if I wanted to hold the bed. I did not. Do you have the original papers you signed when he was first admitted? I wonder if you could be grandfathered in under those terms and conditions that you or someone originally signed?

This seems to be the business model today. I know when I had my attorney look over the contract I signed for the rehab facility, she said that was in just about all facilities today.

These facilities are run like a business. They have so many Medicaid beds and people are waiting for that bed.

I feel awful you are going through this, but lots of good advice above.

And this is why we're all here. To kind of see that others are going through the garbage we're all going through. It needs to be fixed somehow, but we all know how that's going.

Call or email your state representative. You can find them under state representatives (look up your state). At least it's another thing you can do. The bottom line is still money. And like the saying goes (and it seems to be true lately) "Money is the root of all evil". We need it. Some crave it. And some make way too much of it. And I'm a conservative! (God, I can't believe I just wrote that!)
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One more thing. Medicare.gov provides a list State websites and contacts for filing a complaint about a nursing home that is listed by state All states other than North Dakota provide the ability to file a complaint electronically online.

http://www.medicare.gov/NursingHomeCompare/Resources/State-Websites.html
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igloo is far more on top of this theme than I am.

I have one more link with some useful information if you end up having to search for a new nursing home which I hope you do not.

Medicare.gov provides A Nursing Home Compare Service where you type in your zip code, press search and it will show you a list of nursing homes in that area and how they rate.

http://www.medicare.gov/nursinghomecompare/?AspxAutoDetectCookieSupport=1

Please come back and let us know how this all works out!
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Bear - my suggestion to to do whatever you can to enable your brother to go back to his old NH. If he has been there a decade, they all know him, he knows them, there is a whole rhythm to being able to care for him that is pretty priceless. See what you can negotiate. If he is a certain type of disabled, maybe their organization may have funding for "bridging" the costs. Like Downs Association. If it's another from birth congenital, I'd call you local March of Dimes to see if they know of something also.

What is going on is that Medicaid pays a daily reimbursement rate for their room & board. If they are NOT there for over a certain amount of nights, then Medicaid has to suspend payment as there is no eligibility to pay; no butt in bed no $. Apparently for you all, it's 10 days. I know for my MIL old NH in New Orleans, they could not "sign out" for more than 72 hours or Medicaid would be suspended.
When I moved from NH #1 to NH #2, they stressed that mom needed to be "moved in" by 10:30 AM, so that must be the time required for payment for the day. Kinda like schools get reimbursed for the # of students who are butts in seats by 9:00 as I can remember waiting with lots of other parents till the magic bell of 9:15 to take them out early, this school gave out a sheet on all this so parents could plan accordingly.

Now the Medicaid reimbursement rate will likely be lower than the daily private pay rate. Like in TX the daily r & b is slightly under $ 145.00 day (which is low), private pay rate is likely double or triple that. See if the NH will be OK with you paying the Medicaid rate that they are not being paid - at least it will be lower.

Also speak clearly with the floor nurse @ the hospital he is at as to what they think the future looks like. Are they waiting for good labs to come back, before he is discharged? Or is more likely he is there for a few weeks. Try to do this first, so you have an idea of just how long / how much $$ you might need.

The one bright spot in all this, is that when he gets discharged from the hospital, since it is a hospital discharge from a 3 day stay, MediCARE will be paying for his first 21 days. Medicare pay out is much, much higher day rate than Medicaid will ever pay. So that will help make the NH happier for their bottom line. If he can do any rehab, then Medicare will pay either 80% or 70% of his stay up to 100 days if he is "progressing" in his care. If he is on Medicaid, then Medicaid covers the 20% or 30% that Medicare does not pay. The hospital may be able to give you some insight as to that possibility too.

The facilities do a piss poor amount of explaining how this all works. They think family know the minutia of the rules. One issue I have is that if your family member is on Medicaid, you NEVER get a bill. Well at least that's the case for me on my mom's NH account. The statements are all about what you owe for your copay or SOC/Share of cost. So you don't' really have an idea of just what the huge costs are without a lot of work to get.

Good luck and let us know what you can negotiate.
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Here's some information about what Ombudsmans do. There are usually several in each state located in different regions of the state.

http://www.ltcombudsman.org/about-ombudsmen
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Each state Department of Aging and Adult Services has an Ombudsman Program to advocate for people in a nursing home or an adult care home.

They can be located by state @

theconsumervoice/get_help

Maybe this might help your situation. I hope so.
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I Googled medicaid and holding a bed in a nursing home. What I learned is that it is important to check with your state's medicaid program and find out what your state's policy is about paying for a bed to be held for a nursing home resident on medicaid.

For example, I found an article from April 2011 saying that in Georgian Medicaid will pay a nursing home for up to 7 days to hold the room while the Medicaid recipient is in the hospital.

My own state, NC, does not have such a policy. The policy varies according to what each state decides to do.

I also found a site from 2012 that listed the Medicaid Bed Hold Policy by State.

http://www.ltcombudsman.org/sites/default/files/norc/state-bedhold-chart-oct2012.pdf

What state are you in?

I don't know if knowing this information will help you and your brother now or not. Frankly, when the nursing home contacted you, the person who did or the social worker should have said something about your state's Medicaid Bed Hold Policy since he is a Medicaid recipient.
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Yes they can refuse to readmit your brother for nursing homes consider a resident discharged when sent to a hospital . My mother was private pay in assisted living and in the nursing home. When she fell and broke her hip at the assisted living, she was considered discharged and as her DPOA, I had to pay for them to hold her room for a month even though she did not go back there but ended up having to go to a nursing home following her hip surgery. She never regained the ability to walk again. At the nursing home, she had some lengthy stays in the hospital. She was considered discharged when she left and readmitted when she came back and I had to pay for her room in order for it to be held for her. If I remember correctly, her Long Term Care policy did not cover the days that her room was held for because she was not in the room being cared for.

The previous administrator where your brother was in the nursing home while he was hospitalized for over a month evidently was not following the industry wide practice of charging residents to have their rooms held while they are in the hospital. This probably explains why the nursing home has a new administrator. That is someone probably noticed that the nursing home was loosing money. Sorry,that is what it comes down to in the nursing home industry. They are for profit. I don't know if non-profit nursing homes are run differently, but I expect they may be.
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Every time my mom has left her nh for the hospital, the sw has contacted poa and asked if we want to hold the bed. ( we are private pay). I ask what the current census is and if it's low, we release it and save mom some money. From what I understand, this an industry wide practice, and not just for Medicaid patients.
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