Will Medicare cut off if you refuse rehab in a Nursing Home?

Thanks everyone for you thoughtful and helpful input. I read through lots of the Medicare literature, and I can navigate the information with some patience. I also have been talking with mom's case manager of sorts from the SNL, and she has been extremely helpful! I strongly advise anyone in this type of situation to hook yourself up with those in the know, especially because caring is what they do for a living and these types of situations, while new to us, are not to them. If you don't like the person you are talking to, find another. It takes being a little assertive, but we are the customers, and if the informational person is not a good fit for you, you have a right to find another. For those in this thread who may not be familiar with Medicare, freqflyer provided a good starting place.

Thankfully, my mom is not only of sound mind, but also in no pain. She continues to amaze my brother and I of her pain tolerance. She takes only Tylenol to relieve any pain. She is not just being tough, she just has a high pain threshold. She likes the SNF she is in and her PT, so I think we are good for the most part about being cooperative and working towards her goals set forth in her Care Plan. It is important to know and be a part of this plan if possible, because it dictates when Medicare will stop paying. If she doesn't make progress, either because she has plateaued out or refuses to do therapy, she is discharged or must pay out of pocket for additional time in the SNF. If you are working with a good SNF, they will individualize the plan and modify it along the way.

We are also of good fortune in that my mom lives in a house worth A LOT of money, and this house will cover her health needs for many years if she is willing to work with us to (1) take out a home equity loan, or (2) sell the house. She can't live there alone, and even though she has the money, can't afford 24/7 help.  The house is not safe, and if she chooses to return, she will fall again. It is not a matter of will she fall, but when will she fall. But it is her choice, and all we can do is provide the reality of going back there. She will be back in the hospital and most likely for something worse than a broken rib cage and collapsed lung. We let her know this outcome is not what we want for her, and also the reality that these hospital stays are also very very hard on us. I think it is important to let our loved ones know that we are all in the situation together. We are doing all we can to find the best choices in a "it is what it is" situation. Acceptance of that reality is a huge step in moving forward, keeping in mind accepting does not mean you have to like the reality, but have to deal with it nonetheless. None of this is easy, but like is not easy.

We looked at a apartments for both independent and assisted living in the SNF we choose, and we think she can be very happy there. In fact, it would be freeing in many ways, socially and without burdens of paying bills, etc., because she has been in many ways stuck and home bound in her current home.

We had the tough talk with her last night expected lots of resistance, but she surprised us in saying she liked the idea of staying at the retirement community. We don't know if this positive reaction will stay positive, but it is good start.

We talked with her letting her know from the get go that we love her deeply and want what is best for her and us. This change while understandable tough, could be a positive change for her. For our situation, gentle but honest has been the best way to go. We'll see how things play out in the days to come.

What makes me truly sad is most people are not in our enviable position of her having the means to live in relative comfort for many years given the value of her house which she owns (no mortgage). My brother and I would have NO means to pay, are both sending kids to college next year, and can't take her into our homes because we have full time jobs. If not for her house, we would all be SOL, and I imagine the majority of people in this country are without the means to get through this. That is truly sad, and maybe a situation that while accepting, can also determine is unacceptable if it can be changed through an active role in being a part in pushing our elected officials in the political process towards ways we see our positive and not moving backwards. We can all differ on what we want to push for, but must understand that we need push should we want to bring about change. Sorry to digress into the political arena, but for me, it play an important role in all this stuff, and we are not powerless.

Anyway, thanks to all.

Rehab in a SNF and being in a SNF for care are two different things.

bigsispjt

Not all Social Workers are as you described.

You can refuse care just make sure a doctor signs off. No one can make u go to rehab. I agree, see about home therapy.

freqflyer said it all. Listen to her.

Actually, I've heard so many nightmares about Medicare are not covering anything that you may actually be best just to ditch Medicare altogether and get some form of alternate supplemental insurance. There are supplemental insurance is out there that supplement were Medicare leaves off off. Apparently the rumor I heard about the government running out of money must be right to some degree, especially if Medicare seems to be going broke from what I've heard. They obviously don't have enough money to cover much and I personally would never have it. I would never recommend Medicare to anyone and those who have it I would highly recommend just go ahead and ditch it because they're obviously broke

If she leaves againstmedical advice I think but I'm not sure that Medicare will not pay for her stay and you better check that out just call Medicare and although it sounds like she's not going to be able to function and Leslie we were in the hospital for two months

If she leaves againstmedical advice I think but I'm not sure that Medicare will not pay for her stay and you better check that out just call Medicare and although it sounds like she's not going to be able to function and Leslie we were in the hospital for two months

When my father was in the nursing home after having been in the hospital, they attempted physical therapy with him. However, the therapists gave up after a few attempts because he was, in their words, simply unable to do anything, which was true. We learned that Medicare will only continue paying the 20 days/80 days if the patient is progressing, so he lost this. After my mother had been in the hospital and returned to the nursing home, they attempted therapy with to get her strength back up (she had been in the hospital for an unrelated reason), but because one of her legs hurt so much when trying to walk using a walker (both femurs had broken spontaneously due to severe osteoporosis a few years earlier at different times, and she had metal rods installed in each leg), she refused further therapy and effectively resigned herself to being bedridden (which, of course, she still is after 3 years). Medicare quit paying for her nursing care, but I didn't have to heart to tell her she essentially threw $16K out the window by quitting--maybe if this had been explained to her earlier, it would have given her a bit more incentive to try--but I'm not the one having the painful leg so perhaps this would have been cruel to suggest!

Of course, you will check with the facility to be sure, however, when my mother was in a skilled nursing facility after leaving the hospital, they said she would have to demonstrate progress. Get the social worker involved immediately, if you haven't already. These people are angels and can help you navigate the system and also keep check on your mother's mental state to avoid depression. Know you are not alone, though days can get overwhelming.

When you are of "sound mind" you can refuse treatment from any medical provider. I just took my husband out of a SNF because of poor treatment and I refused all medications they wanted to give him. Of course I'm the "sound mind" acting on his behalf.

Frankly, I don't blame your mom though I've terribly sorry that she has to go through this. I disagree with lying to your mom since she's cognitively sound. She will not lose all of her Medicare benefits and she likely knows that. However, she will likely lose her place in the facility if she refuses the treatment. She can apply for private pay admission.

She sounds as if she may be ready for hospice care, though a doctor would need to decide if she qualifies. Since she still has a good mind, she has a right to decide what she wants. She may want to go home, but Medicare will cover hospice care there or in a nursing home if she needs to go into the facility (this would be private pay). If she improves under hospice she can go off the program.

Listen to what your mom wants. This is her life and she is in a very miserable condition. Her mental capacity is sound but her body is not. She'll know where she wants to go from here.

My best to your both. This is very hard.
Carol

Will she agree to have in-home OT, PT and Visiting Nurses? Will she comply with their recommendations for exercise?

Before she leaves the SNF, arrange to have the OT assess her home for safety. Discuss with discharge planning who will be at home to assist. If she is planning on going home alone, you can indicate strongly that you will NOT be moving in to care for her.

In any event, feel free to TELL her that she will lose ALL her Medicare benefits if she leaves prematurely. Sometimes you gotta do what you gotta do to keep Mom safe, if not happy.

OmaFeef, I found this for you https://www.medicare.gov/coverage/skilled-nursing-facility-care.html ;  it says  "If you refuse your daily skilled care or therapy, you may lose your Medicare SNF coverage".

Also "If you stop getting skilled care in the SNF, or leave the SNF altogether, your SNF coverage may be affected depending on how long your break in SNF care lasts."

"If your break in skilled care lasts more than 30 days, you need a new 3-day hospital stay to qualify for additional SNF care.   The new hospital stay doesn’t need to be for the same condition that you were treated for during your previous stay."