My brother is severely disabled and has been living in the same nursing home for 10 years. He was recently hospitalized and after 10 days the nursing home contacted me (his DPOA) and told me they could no longer hold his bed unless I paid the full daily price (he is on Medicaid) and signed the guaranteed hold. The nursing home is under new management with a new administrator. Last year my brother was hospitalized for over a month and the nursing home did not try to "kick him out". What recourse do we have? He will soon be discharged from the hospital.
What is going on is that Medicaid pays a daily reimbursement rate for their room & board. If they are NOT there for over a certain amount of nights, then Medicaid has to suspend payment as there is no eligibility to pay; no butt in bed no $. Apparently for you all, it's 10 days. I know for my MIL old NH in New Orleans, they could not "sign out" for more than 72 hours or Medicaid would be suspended.
When I moved from NH #1 to NH #2, they stressed that mom needed to be "moved in" by 10:30 AM, so that must be the time required for payment for the day. Kinda like schools get reimbursed for the # of students who are butts in seats by 9:00 as I can remember waiting with lots of other parents till the magic bell of 9:15 to take them out early, this school gave out a sheet on all this so parents could plan accordingly.
Now the Medicaid reimbursement rate will likely be lower than the daily private pay rate. Like in TX the daily r & b is slightly under $ 145.00 day (which is low), private pay rate is likely double or triple that. See if the NH will be OK with you paying the Medicaid rate that they are not being paid - at least it will be lower.
Also speak clearly with the floor nurse @ the hospital he is at as to what they think the future looks like. Are they waiting for good labs to come back, before he is discharged? Or is more likely he is there for a few weeks. Try to do this first, so you have an idea of just how long / how much $$ you might need.
The one bright spot in all this, is that when he gets discharged from the hospital, since it is a hospital discharge from a 3 day stay, MediCARE will be paying for his first 21 days. Medicare pay out is much, much higher day rate than Medicaid will ever pay. So that will help make the NH happier for their bottom line. If he can do any rehab, then Medicare will pay either 80% or 70% of his stay up to 100 days if he is "progressing" in his care. If he is on Medicaid, then Medicaid covers the 20% or 30% that Medicare does not pay. The hospital may be able to give you some insight as to that possibility too.
The facilities do a piss poor amount of explaining how this all works. They think family know the minutia of the rules. One issue I have is that if your family member is on Medicaid, you NEVER get a bill. Well at least that's the case for me on my mom's NH account. The statements are all about what you owe for your copay or SOC/Share of cost. So you don't' really have an idea of just what the huge costs are without a lot of work to get.
Good luck and let us know what you can negotiate.
They can be located by state @
theconsumervoice/get_help
Maybe this might help your situation. I hope so.
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Financing-and-Reimbursement/LTC-Ombudsman-Programs.html
That being said, I believe that this is common practice today. I, too, was asked if I wanted to hold the bed. I did not. Do you have the original papers you signed when he was first admitted? I wonder if you could be grandfathered in under those terms and conditions that you or someone originally signed?
This seems to be the business model today. I know when I had my attorney look over the contract I signed for the rehab facility, she said that was in just about all facilities today.
These facilities are run like a business. They have so many Medicaid beds and people are waiting for that bed.
I feel awful you are going through this, but lots of good advice above.
And this is why we're all here. To kind of see that others are going through the garbage we're all going through. It needs to be fixed somehow, but we all know how that's going.
Call or email your state representative. You can find them under state representatives (look up your state). At least it's another thing you can do. The bottom line is still money. And like the saying goes (and it seems to be true lately) "Money is the root of all evil". We need it. Some crave it. And some make way too much of it. And I'm a conservative! (God, I can't believe I just wrote that!)
Whether they are non-profit or for-profit, they are businesses and must cover their expenses with revenue whether that revenue comes from Medicaid, private pay or any other source.
That said, 'bablou' makes a good suggestion. Ask the nursing home how full they are. If they have plenty of beds, you can probably release his and be pretty sure one will be available when he's discharged from the hospital. Be sure you let them know he intends to come back.
As others have mentioned, the fact that your brother is disabled (and not merely 'old') may put him in a position to take advantage of other programs that may help out in this situation.
The previous administrator where your brother was in the nursing home while he was hospitalized for over a month evidently was not following the industry wide practice of charging residents to have their rooms held while they are in the hospital. This probably explains why the nursing home has a new administrator. That is someone probably noticed that the nursing home was loosing money. Sorry,that is what it comes down to in the nursing home industry. They are for profit. I don't know if non-profit nursing homes are run differently, but I expect they may be.
For example, I found an article from April 2011 saying that in Georgian Medicaid will pay a nursing home for up to 7 days to hold the room while the Medicaid recipient is in the hospital.
My own state, NC, does not have such a policy. The policy varies according to what each state decides to do.
I also found a site from 2012 that listed the Medicaid Bed Hold Policy by State.
http://www.ltcombudsman.org/sites/default/files/norc/state-bedhold-chart-oct2012.pdf
What state are you in?
I don't know if knowing this information will help you and your brother now or not. Frankly, when the nursing home contacted you, the person who did or the social worker should have said something about your state's Medicaid Bed Hold Policy since he is a Medicaid recipient.
http://www.ltcombudsman.org/about-ombudsmen
It all depends where you live as to what's available. It's very disconcerting to have to scramble like this all the time especially when we're all caring/worrying about our loved ones, that's stressful enough.
Then, of course, we need to look at the other aspect, our 'loved ones' are just another number because the numbers are starting to rise. Nobody knows exactly what to do with this and one would have thought government would have prepared given they've been warned (at least since I was studying this) for years that this was going to happen!
Annoying and stressful when it need not be!
That's why I recommended contacting a state representative just so it could be documented that people are having problems. If more people did this (of coursed they don't care) perhaps we'd have more of a voice in this. We all need to email them so they know there is a problem. I just don't believe they'know' this yet.
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