Nursing home skilled units want to be assured that necessary steps will be taken to assure that they will be paid. Nursing homes are most familiar with Original Medicare, Medicare Advantage Plans, Medicare Managed Care Plans, Medicare Preferred Provider Organization Plans, Medicare Private Fee-for-Service Plans, Medicare Specialty Plans, federal employee health program, military health program and railroad retirement programs. If your patient has one of these, they will be highly considered once that payer source is verified.

Medicare Part A is primary source of insurance that will pay for a skilled nursing home stay. Medicare pays 100% of day 1 through day 20 and from day 21 up to day 100 Medicare will pay everything less $114.00 per day co-pay as long as resident is making progress towards their rehabilitation goals.

If, Medicare is managed through a HMO (Health Management Organization) it usually pays 100% of rehabilitation stay. The HMO determines length of stay by assessments provided to them by nursing home rehabilitation staff and level of independence required where resident will reside after their rehabilitation stay. The HMO utilizes a Nurse Case Manager and a Medical Director who is a physician to make this determination.

Secondary insurances with Medicare Supplemental Coverage will usually pay $114.00 per day co-pay from day 21 through day 30 up to day 100 depending upon tier level of insurance plan and some tiers will some times pay up to 120 days. It is important for you to know what your insurance will cover.

Near end of your or your loved ones hospital stay, you will be contacted by Discharge Planner or Case Manager of hospital to discuss alternatives of continued care. You or your loved one may no longer meet criteria for a hospital stay. Once a patient is stable they must be moved towards a lower level of care.

The Interdisciplinary Care Team of hospital will assess needs of patient’s care based on acuteness of care and monitoring required for patient, patient’s rehabilitation potential, ability of patient or their family’s ability to care for patient and nature of home environment that supports patient. In all cases, goal is to establish a safe discharge plan that meets needs of patient.

For aged and for people with multiple disease progressions recommendation maybe for patient to be admitted to a long-term care facility (nursing home) that provides skilled nursing and rehabilitation. The hospital Discharge Planner usually provides a list of nursing homes that they are contracted with or provide reliable service for you to tour and select. The discharge planner will not choose for you.

I recommend that you take time to see at least three nursing homes for following reasons: