Mary set her phone down on the table and frowned.
Her husband, Herb, studied her. “What’s wrong?”
“I don’t think we can bring Mom home for Christmas. The nursing home said if we remove her from the premises, we have to pay a fee to hold her bed. Otherwise, they can give the bed away to someone else.”
“What? That makes no sense. You’ve taken her out on day trips. How is this any different?”
“Apparently, Medicare won’t reimburse them for the bed if she doesn’t sleep in it on a daily basis. So they have no reason to save the bed if they aren’t drawing a check. Either we pay the money they lose out on or they can give the bed to someone else. And the administrator says they have a waiting list.” She sighed. “She said there were many just waiting to take that bed.”
Fred poured himself a cup of coffee and took a long sip. “Well, they are a business. And like any business, they want to make money. But seriously, who wants to move into a nursing home over the holidays? Maybe we can we just skip paying the fee and get her back before they give it to someone else? Take our chances?”
Mary shook her head. “Mom is happy there. If we lost her bed because we didn’t pay the required fee, we would have to start all over again. It took us six months to get her into this place and if there is a shortage of rooms in quality nursing home facilities—as the newspaper claims—God knows what will happen. We can’t take that chance.”
Fred frowned. “Sounds like it may be too much trouble to bring her over here for Christmas. Maybe we should just leave her at the nursing home. Visit her for an hour or so, then come home for our family dinner.”
Mary glared at him. “And leave her alone during the holidays? I don’t think so. No one should be separated from their families during the holidays. That’s what the holidays are for. Family.”
Fred shrugged. “Then we just may have to write the nursing home a check.”
In California, nursing home residents may fall under Medicare or Medi-Cal rules, depending on which organization reimburses the facility for their care. While the rules between the two programs differ, both permit short absences from a facility.
According to the Medicare Policy Manual, nursing homes will be paid for days when a resident takes an “outside pass or short leave of absence for the purpose of attending a special religious service, holiday meal, family occasion, going on a car ride, or trial visit home.” However, the resident must return by midnight. If a resident is gone overnight and returns the next day (called a “leave of absence”) Medicare will not reimburse the facility and the facility may bill the resident to hold the bed during their absence.
Medicare requires that nursing care facilities inform residents of the need to make bed-hold payments prior to taking a leave of absence. However, residents should also clarify the daily rate that must be paid. In some nursing homes, it can get expensive.
The leave policy for Medi-Cal nursing home residents is much more lenient. Under Medi-Cal, a resident can take a leave of absence of up to 18 days a year without penalty, as long as the leave is in accordance with the resident’s plan of care. In addition, a resident may take up to 12 additional days of leave per year, in increments of no more than two consecutive days, when:
- The additional leave is in accordance with the resident’s care plan,
- The additional leave will further their physical and mental well-being, and,
- At least five days of inpatient care is provided between each approved leave of absence.
Prior to removing a resident from a nursing home for any reason, it is important to inform the nursing home of the date, length, and reason for the absence. Then verify whether the absence is authorized under either Medicare or Medi-Cal rules, and whether the resident must make financial arrangements to hold their bed. In addition, pre-planning permits you to arrange for wheelchair or other special transport if needed.
With a little advance planning, arrangements can be made for nursing home residents to join their families in celebration of the holidays. However, it is important to take appropriate steps to ensure that those residents have a bed to return to.