My mother is now on private pay after a stint in the hospital and the 21 days Medicare payed for upon release to rehab in the nursing home she will spend the rest of her life in if we can afford it still after a few years. She has exhausted her LTC policy after 7 years in AL facilities
She is 90, immobile and on oxygen. Her secondary insurance said they would pay for the balance of days to arrive at 100 days in a Medicare facility which she is in. However the NH is categorizing her care as custodial which seems to be exempt for payment.
We don't understand how this is strictly custodial. She must be lifted from the bed to a lounge or wheelchair. She is on oxygen which obviously has to be administored to her at varying levels due to present need which changes. She is completely assisted with bathing and toileting.. She is receiving PT in her room in her bed or wheelchair. Medicare is presently covering that. When we asked what would categorize skilled nursing we were told something of a surgical nature. I am fairly certain surgical procedures are not conducted within the NH.
We feel that it might be easier for the NH to categorize it this way in order to receive payment. We have a meeting with them next week. Other than this question are there others I should be asking of them. Their cost is $295.00 per day which seems on the high side for the area we are in. The costs of oxygen seem to be additional. I know they will not accept Medicaid for the future if she is still alive after the spend downs.
Do you mean if I found a place that would eventually accept Medicaid should she be approved that the whole facility would be a better experience pre and post Medicaid eligibility?
My understanding is that she is in this facility for rehab after her hospital stay, is that right? Of course hospital to rehab and then another move is going to be confusing, but unless she is imminently nearing the end of her life she needs to find a permanent placement somewhere. No doubt her previous home would be best, but would her AL even accept her back with her current needs? If she outlives her money you will be forced to move her anyway, and the choice of places will be more limited.
We were told that after 2 years of private pay, if she needed to tranfer to Medicaid, there would be no change in her shared room or her services.
In other words, once you get her in to a place like that, there is no need to move her again.
When we looked for rehabs after the hip surgery, we ONLY looked at places that would accept Medicaid after private pay, which was explained to us by the great discharge planning folks at the hospital.