Nursing homes are a vital part of adult healthcare and rehabilitation. Most often, patients transition from the hospital to a nursing facility following a surgery to repair a broken bone or there has been some type of major surgery that requires 24 hour nursing care and physical therapy. Nursing homes will assist residents with feeding, bathing, dressing and help getting in and out of bed by providing skilled nursing care. Each resident has a licensed physician that supervises their care plan which can include speech, occupational and physical therapy. Almost all nursing homes have these services available in house to the residents who qualify. 

There are two types of nursing home placements, short- term and long-term. Most people do not know that nursing homes have become an increasingly effective place that can be utilized as a rehabilitation facility. Most often this is a short stay until the individual has recuperated. It is a convenient respite for families because they may not be equipped to deal with the health care needs their loved one has. The long term-stay is basically permanent placement until the end of life.

For residents, transitioning to a skilled facility can be difficult so they offer a variety of amenities and conveniences designed to enhance comfort, and improve convalescence and recovery. Such as, a beauty/barber shop, shopping excursions, crafts and most now have a luxury spa bath. Today, there is a movement underway designed to lift the negative stigma surrounding nursing home placement by embracing the idea that the residents have a right to live in an environment that they can call home.

Nursing home stays have a number of payor sources. Medicare, Medicaid, VA benefits, private pay resources and certain insurances including some long term care and life insurances. Each payment source has their own criteria of what, when and how they will pay. It's important to note, that Medicare will not pay for an indefinite stay. To qualify, individuals must have had a full 3 days in-patient hospital admission. Their doctor must also state that rehabilitation is needed at the nursing facility. Medicare will then pay for the first 20 days for each benefit period. From 20 to 100 days it is $157.50 of co-insurance per day during each benefit period. The continued stay of 101 days or longer, is usually paid for by Medicaid if the resident is qualified, the VA if the facility is contracted, private pay or perhaps an insurance plan.

When there is no longer a need for the nursing facility and the individual is well enough to go home, the Medicare benefits coverage may be affected depending on how long the break in nursing home lasts. If the break is more than 30 days, there must be another 3 day admissions stay in a hospital to qualify for additional nursing home benefits. When the break in skilled care has been longer than 60 days, it ends the current benefit period and renews the Medicare nursing home benefits, meaning maximum coverage available would be up to 100 days of benefits.

As the population ages, more and more families will be faced with the possibility of nursing home placement. Everyone should be aware of the healthcare services available to make an informed choice on what needs are best for them. If you would like more information on this topic please contact us