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My BIL was in ALF and had 2 stay in the hospital for surgery. Once discharged he had to take rehab in SNF. Now, ALF says he can not return, he know longer has a bed.


If this is protocol, it needs to change. No vulnerable senior should have to go through that. thanks

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There’s probably couple of things going on for this:
- if he’s currently in a skilled nursing facility, his chart is showing he needs that level of care...... he’s getting & needing “skilled”. AL is not that & AL cannot readmit him unless he can clearly show to totally be able to do his ADLs with very minimal assistance.

He would need to have a needs assessment done & it shows in detail he’s ok on ADLs. The needs assessment usually done by a RN & SW duo - the current place will know of an independent firm who does these. In my experience it’s rare for elderly to go from a SNF to AL. Younger in their 50’s & 60’s who are stroke or accident victims might can do enough rehab in a SNF to transition back to AL, IL or even return to their home.

- AL cannot hold a unoccupied room or a bed indefinitely UNLESS its being paid for. If he’s been private pay & he can continue to pay the AL & the Rehab/NH at the same time, the AL will gladly take the $ & upkeep his vacant room.
But I'm guessing that is not within your BIL financial ability. If so, then whatever the terms of his AL admissions paperwork will state what happens to the room due to a vacancy. You or your SIL do have the admissions contract, right?

This isn't just an issue for AL. NH have this issue as well. It’s referred to as a “bed hold”. Usually it’s a 72 Hr hold that’s placed on a Medicare & Medicaid bed in a NH. (It can be actually closer to 90 hrs if the place wants to make it that cause they want the resident back). Observation status at a hospital or ER can’t run more than 72 hrs..... they have to be either admitted to the hospital or discharged from “observation” by then. If they are on LTC NH Medicaid, Medicaid will pay the daily room & board charge for 3 days so the NH can & will put a “bed hold” on their space as $ still coming in.

But if looking like gonna be a week or 2,, then in my experience it really is going to be interdependent on the elders & your relationship with the facility on “bed holds”. If they are a easy care resident, pay their bill or copay on time, have a good SS monthly income, family is helpful, and the place has several other empty beds, well in that scenario, they can extend the bed hold. Family will need to private pay as Medicaid will not be paying. The $$$ amount kinda depends, it could be daily private pay rate, the reduced Medicaid daily room & board reimbursement rate or whatever you can quietly negotiate with the NH. The “devil that you know is better than the one you do not know” comes into play......
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GraceNBCC Sep 26, 2019
Thanks igloo for the helpful information. Years ago LO went from NH to DR to Hospital for 3 days of testing...events that were being ignored or underdressed in NH. NH Committee met and decided they were 'cured' so LO was sent home from hospital. No home services at all. 6 steps to enter or exit home. In PT they had her get up step with on PT holding her and one holding weight of walker...a basic one..not Rolator she used. She never did 3 steps independently but because no $$ to pay daily ( plus mortgage) she was graduated out of Skilled Care while they confirmed she had been having seizure type events!
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As Worried said, read the contract. I know with Mom, after 2 weeks they didn't charge for the care part but I did pay for her rent and board.

As long as rent was being paid, I don't see the problem. Was ur Dads surgery such that they don't feel they can give him proper care? Call your State Ombudsman and ask about this. The facility has to provide you the info.
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Reply to JoAnn29
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I have heard of that - but the friend whose mother was denied the bed still got back, she just had to wait for a free bed again. Sometimes it's only a matter of days. Sometimes when the patient is actually ready to be moved, their bed is available again. That is what happened with my friend and her mother.

Yes, it is extremely scary to be told the bed is no longer available.
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Reply to RayLinStephens
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In order for the ALF to keep his bed open he would have to pay "bed hold." This simply means he pays for his room while he is in rehab. The bed hold rate is usually the daily rate of any community. If he went in the hospital in the middle of the month and had paid for the whole month the room his until the end of the month.

Question; You mentioned your B-I-L was only in the hospital two days and then went to rehab. How old is your B-I-L? I asked because if he is 65 plus and on Traditional Medicare, Medicare requires a three midnight stay as an inpatient (not observation) in a hospital before they will pay for rehab in a skilled rehab. If he was not in the hospital as an inpatient for three midnight's, Medicare will not pay the cost of his rehab!
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RedVanAnnie Sep 26, 2019
That's good for all of us to know. Thank you.
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How long has he been gone, what does his contract with the AL say and was his bill at the AL paid up while he’s been in the hospital?
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Reply to worriedinCali
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As a medical social worker in Pennsylvania, I can honestly say that the only scenario where a resident could not return to assisted living was when the resident required more care than the assisted living could provide. Typically those residents went to skilled nursing or acute rehab in order to attempt to achieve their prior level of functioning to return to assisted living. As assisted living usually is private pay with rent paid monthly, I'm having difficulty understanding why your BIL couldn't return. Did he owe the facility rent? If it was a Medicaid sponsored facility, there still should have been a bed hold. My suggestion is that either he (If he is competent) or his POA should arrange an appointment to speak with the administrator if the facility.
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haileybug Sep 26, 2019
Peanuts56

Thank you so much for responding. I had contacted the long term care ombudsman about helping to get my BIL transferred to a facility closer to home. (he was in a MC 4 hours away from all family). The long term care ombudsman stated to me that the administrator what my BIL out of her MC facility just as bad as we wanted him closer to home.

Long story short …. That same weekend, BIL ended up in the hospital for surgery and discharged to SNF for rehabilitation. SNF said he recovered well and is ready to go back to the same level of care, however, administrator says she no longer has a room at her facility.
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During the last year my father was private pay at an MC, he had several hospitals stays from 3-10 days and always returned to his MC. The MC did reduce the bill for the "care" component of the full days he spent in the hospital but we still paid "rent" on his room. They also required additional care for the first 24 hours he returned to help Dad re-integrate and to re-access his needs.
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Reply to TNtechie
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I am in IA and this question is very helpful. Not long ago had IL manager pressuring/ bothering me about how I should really be in AL. Once after multiple falls and TIAs. I had no home care, no family nearby. PCP took 5 months to follow up 2 weeks of PT/OT/RN with outpatient services! Yes I am filling a report with State Licencing Board.
After about 6 months I finally got homemaker services, and medical alert system from the state. I was qualified for Medicaid Waiver, but there was no funding! So I had to wait..then took 3+ months from approval to start services.
My IL says you Only have to pay for 2 months more on lease if you have to leave for higher level of care..AL or LNH. Very scary to think that if I had gone to AL last year I could have been homeless after complcations of 'same day orthopedic surgery' this year.
Thanks for making me aware of what to ask!!
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Reply to GraceNBCC
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cjwilson Sep 29, 2019
If someone has to leave an Assisted Living (ALF) because they need a "higher level of care / skilled care" the ALF cannot charge the resident the 7, 15, or 30 days prior notice that a resident agreed to when they sign the admission papers.
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How is the AL being paid for? It certainly sounds wrong and was not the case for my mother although her rehab stay was for 3 days in the neighboring facility. I think you need to get more information from administration. Is the AL for or not for profit? Is she on Medicaid? I have been told by financial advisers that an AL facility is not allowed to discharge a resident when there is not an option in place for further placement. I wish you the best and hope you speak personally to those in administration.
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Reply to Riverdale
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To the best of my knowledge if someone in assisted living has to be in rehab or the hospital, the room at the assisted living must be paid in full as normally is done. Then they must take the patient back.
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Reply to Lockett2166
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haileybug Sep 27, 2019
Lockett2166

Thanks for responding. That is what I thought as well.
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