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My father has been in a SNF since December first. Medicare pulled out after 20 days and we have been paying out of pocket since then, having had the second appeal just denied. Is it possible one nursing home might have different recommendations to Medicare re. amount of care required by resident than another? Does it make sense to get opinions from other facilities? Oh yes...my father ended up at this SNF after a hospital stay subsequent to a bad fall in AL where he was on 30 day notice for discharge because his needs were too great. They are certainly greater, now.

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I’d suggest you focus your time & energy on getting him approved for Medicaid and doing whatever needed to work with the atty have your mom as the CS - Community Spouse maximize her financial situation within Medicaid compliance. Medicaid will be the long term fix to paying his stay in the NH.

Medicare rehab benefit will be time limited to 100 days maximum even IF he was able to clearly show established measurements for “progress” within rehab.
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Thank you! Yes, there is a spouse who is, currently, living on her own. We have obtained an elder care lawyer who is helping us with “estate planning.” I have sent him a box of financial records to begin the Medicaid application process. I just can’t get over the seeming injustice of the claim that he only needs minimal assistance with daily living. He is blind, has Alzheimer’s, high fall risk, and a few chronic inflammatory/infectious diseases. We’ve only gotten a report back on the first appeal that says he does not require Skilled nursing. I went through the nursing and therapy charts and sent highlights to the appeal folks regarding events of high level of assistance and good prognosis for OT, PT. Still denied...
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A couple of things. Dad was in the SNF on "rehab" after a qualifying three day hospital stay, right? And he was discharged from Medicare paying for rehab because of lack of cooperation/lack of progress? Can/will Dad cooperate with therapy, or has he declined to the point where he can't/won't?

What I think you need to think about is applying for Medicaid; if dad has "countable" assets (money in the bank, CDs, stocks, etc) they are needed now to pay for his care. You can private pay for his care until he is under the asset limit for Medicaid.

The other question is what his income is; if he is over the income limit for Medicaid in his State, a Miller trust can be done, but this is something that you need an eldercare attorney to set up. Visiting a certified eldercare attorney RIGHT NOW is probably the best investment of dad's money that you can make. Is there a spouse in the picture as well?
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