LO in skilled nursing. Rehab stay finished and they want us to move him. Our lawyer says not to: Says we will never get him anywhere better?

Look into having your dad put on hospice care in the facility. That would keep him there instead of going to the hospital and losing his bed.

“The lawyer says that the issue that might be problematic will be if he needs a hospital stay. The facility may have more leeway to say they won't accept him back after the hospitalization.”

With excellent care your father may not need to be hospitalized anytime soon. So why not keep him put until that happens? He will have had the benefit of this level care for as long as it lasts and then, if necessary, might have to relocate after a hospitalization.
I would plan on him having to relocate at that time.
You could be looking for an alternate place, perhaps get him on a waiting list for a more permanent home.
The plan could be that dad is there until next hospitalization and then see the status of things at that juncture. If the facility has successfully faded the heat from the wait list, they might be willing to continue on but if this is the legitimate out they need (and it’s legal) to free up dad’s bed, I would expect them to use it.

I would guess they very well understand the five rules for discharge.
They ran the risk when they opened up for rehab for patients not in the community. Those extra fees and income must have been factored in as an overall benefit to the facility and their patients.
To be licensed they have to follow the state laws but it sounds like your attorney knows that a hospitalization might be a deal breaker.
When my mom (on Medicare) went into a rehab, that had private pay only continuum of care, i believe we had to sign that she would be leaving after rehab. and it was understood that she would have not been accepted otherwise.
It sounds like the attorney has been advising you all the way, so hopefully he knows what the contract stipulates and if it’s enforceable.
Also the fact that the facility has indicated that there is a possibility that your dad could be “invited” to stay, seems to indicate that there are provisions for a person who has not bought in previously to remain, else why would they even discuss the possibility?
I wondered if they would come back and say that the daily rate is only offered for those who have joined the community earlier and present you with alternate higher fees required for those who are transitioning from rehab? Of course until they offer, you can’t consider.

I hope you let us know what happens. We learn from one another.

I guess this is more of a question rather than an answer - but will your fathers LTC insurance cover in-home care? Can he go home and have 24 hour caregivers and nursing visits at home? He owns his own home and appears to have assets to maintain the home. You could also hire an elder case manager to coordinate all of this.

”...most of the patients will be on Medicaid, paying almost nothing, while my dad will be paying for the full rate and still getting the same care. It would be difficult to deal with...”

Hmmmm

Kinda like the folks who paid the entrance fee and the monthly rent for however long being in the same LTC bed as your dad - who did not pay. Or worse - they lose that bed and remain paying rent while on the waiting list still - having lost the bed to your dad.

Hey, I won’t lie. If it were my dad, I’d do the exact same thing.

Just sayin’...

I just spoke with my daughter who has worked in rehab/longterm care facilities about this situation. She feels the lawyer is right. The facility cannot make u take him out. But, if you leave him there it may cost you more because Rehab beds are more money than LTC beds.

Helperson, did you tell the people at the facility that you'd like your father to stay there long term? I'm surprised they wouldn't accept him if he's paying the private room rate. Why wouldn't they agree to keep him? I read what you said your lawyer said and it makes perfect sense to me, it sounds like he knows what he's talking about. By the way though, if you do move him to another facility that takes Medicaid, you still could pay for a private room at that facility. Usually one wing is Medicaid and one wing is private pay.

The way I read this is the facility he is in now will not take Dad because

1. Rehab only is done here, once Medicare stops paying the patient is discharged.

2. For LTC they ONLY except those people in the Community who can pay privately.

So, your Dad can't stay. Your lawyer is wrong. Rehab beds are just that, beds for people needing rehab. I think what your lawyer is thinking is "unsafe discharge". Which no, the facility can't do but Dad has money to find another LTC facility. And in my opinion should. The facility has told you Dad cannot stay. Looks like they get no government funding since they do not except Medicaid. That may be why they don't, so they can pick and chose their residents. If they don't want to except Dad, they don't have to.

As said, there are nice LTC facilities that except a certain number of Medicaid recipients but there are also residents that private pay. Because they except Medicaid does not mean they are substandard. My daughter says staff is not made aware who is PP and who is on Medicaid. All residents are treated the same.

The way Medicaid works in NHs is that existing residents get "first dibs" when they become qualified for Medicaid and a Medicaid bed opens up. If no one "on the inside" needs that bed, then the facility starts calling people on the waiting list. It took almost 3 years for my MIL to get a call for the AL at our preferred facility, but by that time she needed LTC and they happened to have expanded Medicaid beds and she got in right away. I think that covid has changed the waiting list dynamics in many facilities in many states since most of its victims were in NHs (81% here in MN)...I suspect one would not have to wait long in many places anymore...a heartbreaking "silver lining".

I agree to have the lawyer speak to the SNF. I’m not sure he is correct. When you say “long term members of the community” take the non rehab designated rooms, do you know for certain if all these folks are private pay? What level of care are those people you refer to above? I’m curious. Is it an AL?

If they don’t take Medicaid & take Medicare for short term rehab I am thinking this specific facility hasn’t or didn’t want to acquire a CMS Provider number. They do not have to take the lower reimbursement rates offered by Medicaid/Medicare & charge what they like. The rules are different.

If the facility is consistently able to get private pay, kudos to them. That’s why it sounds like an AL not a SNF.

Interesting set up. I’m not familiar with a center being structured this way financially. I’m curious about what level of care the long term folks receive (AL, MC or Skilled nursing).

My Dad was on Medicaid, but his needs were so high (he kept trying to get out of bed and kept falling), the facility placed him in a private room near the nursing station so they could keep a better eye on him. They were truly wonderful. So it really depends on the facility, but the good ones will take care of their residents based on their needs regardless of how they are paying. The nursing staff take care of all the residents the same way, I don't think they think about how the facility is being paid.

I agree with Alva that I'm not sure your lawyer is an elder care attorney familiar with Medicaid. If your dad currently has enough funds to pay privately for LTC in a good facility (until it runs out), then the only issue is that he is "jumping the line" if there's a waiting list at that place. If they don't take Medicaid, I'm not sure I'd even consider that facility...you'd be shocked at how fast people's care funds run out and then Medicaid is the only thing left. If that happens to your dad, do you really want to be trying to get him into a new facility as a Medicaid recipient while he is ailing and under pressure to get out? There will most likely be a waiting list for the better places. My MIL is in a very nice facility after being on a Medicaid bed waiting list. She has to share a room but that's really the only difference we've been able to see at this point. In his current facility I think the can kick him out if his rehab is over and he hasn't been accepted as a resident. If he goes into a facility on private pay (one which does accept Medicaid), then his funds run out and he qualifies for Medicaid -- at that point they cannot kick him out, but if they don't have a Medicaid bed available you (or someone) will be stuck paying the difference for the private room until a Medicaid bed becomes available.

Skilled nursing facilities in general do not deal with chronic patients that will not improve. They are more for acute illness before it becomes chronic, for rehab and etc. I am not certain that the lawyer if correct. In fact I think that he is not. I think that the Social Workers at SNF when they have decided a patient cannot improve, can move a patient, esp now to wherever is able to accept new patients. But I don't know. I would have the Lawyer discuss this with the SNF. You have apparently been told that your father has to leave?
You are correct about the LTC insurance. Often they will ONLY pay when there is a full time RN on duty at the least. That is true at least of some policies. You will have to explore exactly what your Dad's insurance WILL pay for. These policies are often VERY expensive and seniors often do end up having to pay their own money because of restrictions of the policy.
Can't really advise you other than to get all the information you can from policy, and from SNF, and to wish you good luck.