A Medicare pilot program raises questions about care…

Posted on Posted in Long-Term Care, Medicare A & B, Medicare supplement, Patient Health, Uncategorized

In this September 2017 Washington Post article (link below), the writer shares the story about a Medicare pilot program after his 90 year old mother fell, and the resulting hospital and rehabilitation facility experience.

The writer legitimately questions whether the hospital and rehabilitation facility fast tracked his mother who, suffering from dementia, wasn’t progressing quickly enough to avoid Medicare CMS penalties.

When does Medicare cover skilled nursing facility costs?

  1. When the patient has been admitted to the skilled nursing facility as part of being discharged from another facility where they had been admitted as an in-patient, and
  2. That in-patient admission had been for a minimum three night / 72 hour stay, and
  3. The skilled nursing facility care is for continuing care treating the same condition. (In the mother’s case, the partial hip replacement,) and
  4. The skilled nursing facility reports progress in the patient’s condition. (This was the writer’s point; his mother’s dementia was making timely rehabilitation progress difficult.)

Once the patient’s condition is no longer progressing, Medicare concludes the rehabilitation has either concluded or reached its limit and skilled care is no longer necessary. And Medicare stops covering the daily bill. The writers point is: perhaps context matters.

The next phase is called custodial care and that’s often when long term care starts.

https://www.washingtonpost.com/national/health-science/when-his-elderly-mother-broke-her-hip-things-didnt-go-well/2017/09/15/e5339060-7317-11e7-9eac-d56bd5568db8_story.html?utm_term=.4aeaf6f1d353

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