Medicare will pay for 21 days following a 3 day hospital stay and if you have supplement insurance may pay up to 100 days for rehab and some nursing homes are happy to keep them in for the whole time that the insurance covers if they need long term you need or the social worker needs to put them on medicaide pending and the application has to be done for medicaide have the social worker help you or get a elder lawyer to assist you it is very difficult for a person to do it on your own if they sav the persons assests are too high they will have to spend dowm which means they have to pay for their own care which is about 450 dollars a day and when they have spent down they will be covered by medicare -you will need an elder lawyer in your area who will know all the rules it does not help you to call medicaide because some of their employees do not always know the answers and will make up an answer that may be wrong.
In reference to Medicare/medicade paying for respite or nursing home...does anyone know if they will pay for this stay more than once and if so the frequency? Wil they pay for 21 days everymonth or every three months or ????
Thank you for asking the question...and thank you for answering
Medicare only pays for rehabiltation stays at a nursing home, they do not pay for permanent residence. Medicaid will pay after the Medicare period has run out, but the person's income has to be below 22,000 dollars a year for them to pay.
Medicare pays for skilled care in a facility if: 1. The beneficiary is first hospitalized for at least 3 days 2. The beneficiary then enters a Medicare approved facility 3. For the same condition for which they were hospitalized 4. Within 30 days of discharge.
If these conditions are met Medicare will pay: 1. The full Medicare approved charge for the first 20 days. 2. All but $137.50 per day for the next 80 days (in 2010). 3. The additional charges are typically covered by Medicare supplements.
The skilled nursing benefit is PER BENEFIT PERIOD. NOT ANNUAL. A benefit period is described as periods of care separated by at least 60 days.
The Medicare beneficiary may be denied skilled nursing benefits even if they have benefit days left. This is because of the definition of skilled care. The patient must be receiveing physician ordered and professionally rendered medically related services and must be making progress. Once progress ceases then the patient is no longer eligible for skilled services and hence, no longer eligible for Medicare skilled nursing benefits.
It would be a this point that one would apply for Medicaid if continued skilled, intermediate, or custodial care was required in a facility.
If things have progressed this far you have hopefully begun to seek some financial guidance. If not, this would be the time to do so. I would suggest that no gifts or transfers or financial commitments or any kind be made until you have done so.
My question is how to get one into the nursing home for a short time in order to for them to gain weight to have surgery and refuse to go but is also not really safe for them to be at home . when they do have medicare and V.A. benifits but refuses to pay for anything out of pocket
This is a very tough situation and one for which there is not a succinct answer.
It is not as easy to gain the required 3 day hospital admittance to qualify for Medicare skilled nursing facility benefits as it used to be so cooperation from your loved one's physician would be required. Even so, it may not be doable if there is an absence of medical need.
The most extreme option would be to have the elder declared incompetent, have a guardian appointed, and then have the guardian spend the funds necessary for a private pay nursing home stay.
Less extreme: Does someone have a health care proxy and durable power of attorney for the elder? If so, that person may have some luck in obtaining funds and therefore the services the elder requires as follows:
Simple "refusal" by the elder to gain weight for surgery may not be enough to establish that he/she is not able to make decisions for him/herself but having the proxy will allow the holder thereof to at least speak to the physician(s) involved and see what they believe as to the elder's capacity and find out what the medical recommendations are. If a physician is willing to state that the elder does not have capacity then the agent (the person designated as the holder of the power of attorney) could take a written determination to a financial institution and gain the funds necessary to implement the physician's recommendations. This does not, of course, address the elder's "refusal".
To that end, you may also want to consider the enlistment of a geriatric care manager or social worker who may be able to gain the confidence of the elder and then guide him/her in the right direction.
My father has Alzheimers and has been in a nursing home since my mother passed away over 2 years ago. He is on medicaid. I am the only living child and am his health power of attorney. However, he is in Florida and I reside in Wisconsin. I am disabled and on medicare and unable to travel. My husband and I are financially strapped. However, the nursing home sent me a notice telling me that I am responsible for a payment outstanding on my father's account and that since it has not been paid, they are now going to evict him. He is 83 years old, unable to care for himself at all and has nothing but a burial policy which I purchased from an overage last year in his account when it went over $2,000. Can they evict my father? Can they force me to be financially responsible for him even though I have not lived at home for over 40 years? Thank you for your help.
Thank you for asking the question...and thank you for answering
Medicare pays for skilled care in a facility if:
1. The beneficiary is first hospitalized for at least 3 days
2. The beneficiary then enters a Medicare approved facility
3. For the same condition for which they were hospitalized
4. Within 30 days of discharge.
If these conditions are met Medicare will pay:
1. The full Medicare approved charge for the first 20 days.
2. All but $137.50 per day for the next 80 days (in 2010).
3. The additional charges are typically covered by Medicare supplements.
The skilled nursing benefit is PER BENEFIT PERIOD. NOT ANNUAL. A benefit period is described as periods of care separated by at least 60 days.
The Medicare beneficiary may be denied skilled nursing benefits even if they have benefit days left. This is because of the definition of skilled care. The patient must be receiveing physician ordered and professionally rendered medically related services and must be making progress. Once progress ceases then the patient is no longer eligible for skilled services and hence, no longer eligible for Medicare skilled nursing benefits.
It would be a this point that one would apply for Medicaid if continued skilled, intermediate, or custodial care was required in a facility.
If things have progressed this far you have hopefully begun to seek some financial guidance. If not, this would be the time to do so. I would suggest that no gifts or transfers or financial commitments or any kind be made until you have done so.
It is not as easy to gain the required 3 day hospital admittance to qualify for Medicare skilled nursing facility benefits as it used to be so cooperation from your loved one's physician would be required. Even so, it may not be doable if there is an absence of medical need.
The most extreme option would be to have the elder declared incompetent, have a guardian appointed, and then have the guardian spend the funds necessary for a private pay nursing home stay.
Less extreme: Does someone have a health care proxy and durable power of attorney for the elder? If so, that person may have some luck in obtaining funds and therefore the services the elder requires as follows:
Simple "refusal" by the elder to gain weight for surgery may not be enough to establish that he/she is not able to make decisions for him/herself but having the proxy will allow the holder thereof to at least speak to the physician(s) involved and see what they believe as to the elder's capacity and find out what the medical recommendations are. If a physician is willing to state that the elder does not have capacity then the agent (the person designated as the holder of the power of attorney) could take a written determination to a financial institution and gain the funds necessary to implement the physician's recommendations. This does not, of course, address the elder's "refusal".
To that end, you may also want to consider the enlistment of a geriatric care manager or social worker who may be able to gain the confidence of the elder and then guide him/her in the right direction.
Good luck!