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Husband is 68 and there for short term rehab after surgery for abdominal bleeding. He is unhappy there and wants to come home and have home health care instead . We should have done this to begin with but thought the other might be best. A CNA at the facility threatens that Medicare won't pay for time already there if we just leave. Who should I talk to at the facility and does the Dr. that discharged him from the hospital (who is his regular Dr.) need to be involved with getting him out? I know he has to be involved with the home health care. I already have all the meds he takes at home and can get those from our regular Dr. Can the Nursing facility Dr. deny Medicare for this?

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One more thing, that home health bridge is a part A Medicare benefit but does not cover any type of custodial care..
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I was going to give the advice that morrishall gave in terms of the specifics of the Med A piece. The CNA should not be discussing this with you and the social worker in your facility should be educating and guiding your through this process.

Also, typically the doctor following him in the facility will write the discharge order to home and should read something like "discharge to home: include medications, home health: RN, PT, OT, CNA and any other treatments he is receiving. The social worker or discharge planner should then make a referral to the home health agency of your choice (not their choice). You can always leave against medical advice and I have heard but have not experienced (and I have lots of experience at this) that leaving AMA does put your Med A coverage for that stay in jeopardy. Hope this helps...
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From my experience, you should be able to take him home with home care coverage. He will not likely get the daily PT/OT that he is getting currently in the rehab under Medicare Part A, but he should qualify for home care through a Visiting Nursing Association under Medicare Part B. They are very strict with the benefit however, and he must be home bound, with the need for assistance with ADL's (activities of daily living) to qualify for rehab, a social worker, a nurse, and possibly a HHA.

In addition, within 30 days, if he has a problem, medically or functionally, he should be able to return to the rehab facility if needed under Medicare guidelines. The nurse in the visiting nurse association will be the one to recommend this if needed. Talk with the social worker or discharge planner to get this going. Good luck.
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As a nurse, I can tell you an abdominal bleed is nothing to fool around with and his regular doctor who knows him well should be directing his care. Doesn't he make rehab calls? I don't know of anyone who "likes" being in a rehab facility or hospital, but give it time. Consult the attending physician and see why he is still there. No one can deny claims for Medicare except Medicare. A CNA does not have the authority to tell you that anyway. Home health is only paid for by Medicare if it is "medically necessary". Unless you are a skilled nurse or higher, do you really want to risk your husband's life if something untoward happens?
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I would talk to a medicaid worker about my case.
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