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Can a Nursing Home Resident Attend a Holiday Gathering at Home during a Medicare-Covered Stay?

Can an older adult leave the nursing home for a holiday gathering during a Medicare-covered stay?

Have you ever wanted to bring an elderly loved one in a skilled nursing facility to a family gathering during the holidays? If your loved one is in the facility during Medicare-covered stay, have you made that request and then been told that taking your loved one away from the facility might put their Medicare benefits in jeopardy?

This is an important issue to discuss this time of year. A recent article on the blog of Rothkoff Law Group, a Life Care Planning Law Firm in Philadelphia, addressed this topic.

According to the article, a week prior to Thanksgiving, one of the firm’s employees met with a client whose husband was in a local nursing home for a rehabilitation stay following a fall that resulted in hospitalization. The wife communicated that her husband wanted to come home to spend Thanksgiving Day with his family and would be devastated if he was unable to do so for health reasons.

Then, the wife heard something from the nursing home representative that surprised her. She was told that her husband would lose his Medicare coverage for the rehabilitation stay if he went home for the day because it would be evidence that he no longer was in need of skilled nursing care.

As the article states, this scenario is likely to be played out this month at nursing homes throughout the country. Nursing home residents often want to participate in family gatherings but may worry they will lose Medicare coverage if they leave the nursing home to do so.

Is this true?

Fortunately, as the author of the article explains, nursing home residents and their families have no cause for worry. Nursing home residents may leave their facility for family events without losing their Medicare coverage.

There is a catch. Depending on the length of their absence, Medicare beneficiaries may be charged a “bed hold” fee by the skilled nursing facility (SNF).

While it is true that Medicare coverage ends when a patient is no longer in need of skilled care, the Medicare Benefit Policy Manual addresses situations like the one described in the article. The manual states, “absence for the purpose of attending a special religious service, holiday meal, family occasion, going on a car ride, or for a trial visit home, is not, by itself, evidence that the individual no longer needs to be in a SNF for the receipt of required skilled care.”

Was the nursing home wrong for telling the wife that Medicare would no longer cover her husband’s stay if he went to the family’s Thanksgiving dinner?

Yes! The regulations state it is “not appropriate” for a skilled nursing facility to tell a patient that leaving the facility will lead to a loss of Medicare coverage.

What if the family gathering requires an overnight stay away from the nursing home? If the resident is gone overnight and returns to the facility the next day, Medicare will not pay the skilled nursing facility for days when the patient is absent. The nursing home can charge the resident a “bed hold” fee for a temporary absence if the facility informs the resident in advance of the option, the amount of the charge, and the resident affirmatively elects the bed hold charge.

As the author of this article explains, there is no reason why residents cannot be taken out of a skilled nursing facility for short periods, such as a day or two, to enjoy holiday gatherings without losing Medicare coverage—as long as they are well enough and have the appropriate support they need while away.

In case you were wondering, thanks to the assistance of Rothkoff Law Group, the husband was able to go home on Thanksgiving Day to spend it with family. After the event was over, he returned to the skilled nursing facility to resume his Medicare-covered stay.

Read the original article here.


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