My husband is in a skilled nursing facility that is out of the area. He has a traumatic brain injury from falling down the stairs, is on a feeding tube implanted in his stomach, and has a tracheostomy with supplemental oxygen. He is bed bound, unable to walk, sit or stand. Once the Medicare 100 day period is up the facility will send him home regardless of what state he is in. We can’t afford to pay to keep him in a facility which is where he should be for his own safety.
how do I get Medicare Home Health Care benefits for him?
From what I read above, he had an accident and is in a facility not near your home. On what basis is Medicare currently paying for his caring? Is is classified as rehabilitation?
I can't imagine that he will qualify for 100 days of rehab; the patient has to be making progress and actively participating in therapy in order for Medicare to pay for rehab.
Have you spoke to the social worker at the facility about his prognosis and a long term plan? Have you had a care meeting the the rehab team?
Have you considered, not in any particular order, Hospice, for him to become a long term care resident at another facility closer to home, applying for Medicaid on his behalf, consulting with an eldercare attorney to see about a division of assets so he can qualify for Medicaid and so you can NOT be impoverished?
I mean no disrespect or harshness with these questions; more information will help us give you better guidance.
This does not sound like Rehab. Rehab does not do skilled nursing, as far as I know. A Trach is skilled Nursing and when my daughter worked in NHs there were very few that would take on trach care. Like said, if your husband shows no sign of progress, Medicare will discharge him. Medicare only pays 100% the first 20 days. The 21st to 100 they only pay 50%. The other 50% is paid by the patient or insurance which may pay all or partial. If those 80 days are private pay, based on $150 a day (what Mom paid 6 yrs ago) thats $12,000.
I would call the finance office at the facility and make sure Medicare is covering his care. They should also know how the 80 days at 50% is being paid.
Medicare home health is usually easy enough to get but in your husbands case there are at least two issues.
The home bound care is only for when “intermittent” skilled nursing is needed. It sounds like your hubs needs 24/7 skilled nursing.
Even should he qualify for home health care, it would be for very limited care. He would only get one nurse visit a week and perhaps three cna visits for bathing. This works as a great support for some folks but your DH sounds beyond that being enough help for you on your own.
Hospice at home could provide more help and he would most likely qualify but not that much more help. He truly needs 24/7 help it sounds like.
‘But back to your original question, ask his primary to write an order and they will explain what is available. You could also google home health agencies in your area and call them or look on Medicare.gov home health agencies. They will advise you that you need a doctors order but you can discuss his condition and see what they suggest. Most will tell you right away what they can and can’t provide.
My information is from my experience with original Medicare. If he is on one of the advantage plans, you will need to call the one he is on as there are very many of them and each has their own guidelines.
Truly if I were in your position I would seek the services of a certified elder attorney in order to protect you from losing your income and assets. If it takes both your incomes to pay your bills, Medicaid will even divert a portion of DH income to you to keep you from being impoverished. Good luck with this and let us know how it goes.