Please advise on Medicare and the nursing home expense.

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My 93 year old mom fell and broke her hip. Spent 13 days in hospital for hip surgery (2 Pins put in) She had a congestive heart failure while in the Toledo ProMedica Hospital after the hip surgery. She was then sent to a local nursing home. Medicare only pays for 20-30 days..not sure which. She went to nursing home on Jan 10th, 2018. On Feb 14th she had another congestive heart failure at the home and they sent her to ICU at the local ProMedica Hospital. She was there 4 days and then sent back to the nursing home. One of the nurses there came into mom's room 2 days ago and told her that her medicare is all used up and that she will have to start paying now. They asked her what she plans on doing. She can't walk, go to the bathroom, or anything without lots of help. She was pretty upset that that nurse asked her this. I have POA so why didn't they talk to me instead? And I read that if a nursing home patient has to go to the hospital with another emergency situation for at least 3 days that they start all over paying another 20-30 days. Is this true?

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Unfortunately, it's not automatic or even typical that they will pay another 20-30 days. Instead, they will try to get her back to where she was (physically) when she entered the hospital, so 3-5 days would not be out of line. If your Mom is competent to make decisions, it's appropriate that they give her the 2-day notice (required by law) directly.

Every facility has a social worker that works with insurance, counts the days, issues the notices. She is also responsible to ensure that your Mom has a safe place to go. You should call the social worker to work out the details of her discharge.

BTW, the "clock" on use of Medicare days restarts after a patients is out of the hospital and rehab for 60 consecutive days.
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