If a senior has a hospital stay of at least three days and is eligible for rehabilitation, or skilled nursing, in order to improve enough to go home, Medicare will pay for part of that stay. Medicare pays for the first 20 days of the combined hospital and rehab stay. Days 21-100 are covered by Medicare but have a daily co-insurance that the patient is responsible for. In 2022, this is $194.50 per day. Days 101 and beyond are not covered by Medicare, and the patient must pay out of pocket, have long-term care insurance, or qualify for long-term care under Medi-Cal (California’s version of Medicaid).
Typically, the rehab center will issue a discharge notice at around the two-week mark. They prefer to have patients who are eligible for coverage under Medicare rather than risk not getting paid by patients who have to pay out of pocket. Private payment is not as guaranteed as a check coming from the government. Therefore, they are financially incentivized to discharge patients when their Medicare coverage is about to end.
However, skilled nursing rehabilitation facilities that accept Medicare or Medi-Cal are bound by very specific rules that they often defy and patients often do not understand. If the facility proposes to discharge a patient and the patient or their family accepts the discharge request, it is viewed as a voluntary discharge, and the patient has no recourse against the facility for the early discharge.
The facility may issue an involuntary discharge, but ONLY in the following circumstances:
- It is necessary for the patient’s welfare, and the patient’s needs cannot be met in the facility;
- The patient has improved such that they no longer need rehabilitation;
- The health of the residents in the facility would otherwise be endangered;
- The clinical or behavioral status of the patient endangers the safety of the residents in the facility;
- The patient has failed, after reasonable and appropriate notice, to pay, or to submit the necessary paperwork to have payment from a third party or benefit program; or
- The facility ceases to operate.
Free Reference Guide: A SKILLED NURSING FACILITY IS DISCHARGING YOUR LOVED ONE, NOW WHAT?
What happens when a family member or loved one is in a skilled nursing rehabilitation facility after a stay in the hospital, and the facility tells you that your loved one has to leave next week? What if there is no plan for after discharge, or do you think discharge is too soon? Download a FREE copy of our Reference Guide that discusses involuntary or inappropriate discharge and the next steps you should take.
In addition to needing one of the reasons above to initiate an involuntary discharge of a patient, skilled nursing facilities must provide a patient with written notice of the specific reason for discharge with instructions for appealing the decision with an independent agency. The facility must back up their decision with evidence, in writing, and including documentation from the patient’s physician, not only the facility’s physician.
The most important, and often the most neglected, requirement of a discharge from a skilled nursing rehabilitation facility is that the facility is required to provide a written post-discharge care plan for the patient in consultation with the patient’s family or legal representative.
The number one question we get from clients regarding nursing homes is, what happens if there is no plan for care at home? How can my family member be discharged? And the simple answer is that the facility is supposed to support the patient and family in having a discharge care plan; if they do not, they cannot involuntarily discharge the patient. The facility also cannot kick the patient out for non-payment if the patient is applying for Medi-Cal long-term care benefits and is waiting on a decision from the county on their benefit status. It is important to speak with your local Ombudsman about any issues with a skilled nursing facility, whether it be for rehabilitation or long-term care, or you can call your elder law attorney. For future reference, please find a link below for a free download of the discharge requirements for skilled nursing rehabilitation facilities.
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