Medicare Rehab Time Clock Reset When Hospitalized Again

Well-nigh of the states take for granted that nosotros tin can get out of bed in the morning and exercise all the things necessary to head out and face our day. Y'all know… the elementary everyday things like moving around our house, showering, getting dressed and eating breakfast. I might exist a little foggy most mornings only I don't retrieve about whether I'll face an enormous claiming in measuring out the coffee or pouring the milk. The point is the routine is only that…routine.

Merely if your parent is frail, you know that at that place'southward nothing routine about these activities — that for them, doing even the simplest things just can't be taken for granted anymore.

The mobility and performance that's essential to independence and safety of a sudden becomes a big effort. And, Daughterhood actually happens when we have to get involved in helping our parents do the things that they can no longer do by themselves. This is when their lives and ours get hard.

That's why, from a daughter'southward perspective, you want to be super invested in anything that can help maintain or restore your parents' ability to handle daily tasks independently and to get around on their own.

And the nigh useful tools in the independence toolbox for older adults are the three therapies:
concrete, occupational, and speech communication/language. These therapies, working together, tin help your parent continue doing all the usual things they normally practice – or help them go back to doing these things later on an blow or surgery.

Read: A Go-To Guide for Agreement Your Parents' Rehabilitation

Unfortunately, the Medicare rules around how and where your parent can get therapy are incredibly COMPLICATED! As office of our series on therapy and functioning at home, I'grand going to boil information technology downwardly for you here.

The affair to remember is that Medicare pays for therapy through four main service pathways. 2 of these pathways are for post-hospital care only and the other 2 are available regardless of whether your parent has recently been in a infirmary.

Here'southward how each pathway works.

Therapy in a Skilled Nursing Facility

What many people don't realize is that most nursing homes do double duty as places where people live when they can't take care of themselves anymore AND every bit facilities for short-term rehabilitation therapy following a hospitalization. These days, the majority of frail older adults who need intensive rehabilitation therapy subsequently a infirmary stay receive information technology in a nursing home – referred to as a "skilled nursing facility" – where they'll stay for nearly three weeks before going abode.

Medicare-covered skilled nursing facility care may provide any or all types of therapy besides as the nursing and other clinical intendance your parent might need earlier going home. It's pretty typical for an older adult who has had knee or hip replacement, or is recovering from a hip fracture, to receive therapy in a skilled nursing facility following hospitalization.

Read: The 3 Surprising Medicare Benefits You lot MUST Know Well-nigh

If your mom or dad spends more than three nights as an inpatient in a regular hospital, and has a need for skilled care, Medicare will encompass 100% of the costs for the first twenty days of care in a skilled nursing facility. After 20 days, in that location'southward a 20% copayment that tin be covered by Medigap, Medicaid or out of pocket.

It's important to note that Medicare pays skilled nursing facilities by the day, like a hotel, which ways that most facilities aren't in a big hurry to discharge your parent. And, the more therapy your parent gets, the more money per day the facility gets. I've had quite a few people tell me that they feel their parents are getting Likewise much therapy and that's entirely possible. Remember, it's well within your rights to question how much is beingness provided.

Therapy in an Inpatient Rehabilitation Facility

In some cases, your parent may be discharged to something chosen an "inpatient rehabilitation facility" which – from a girl'south perspective — could easily seem indistinguishable from a skilled nursing facility.

Even so, inpatient rehab is usually a more intense place than a skilled nursing facility. These facilities are licensed and paid as hospitals and tin be swell for a younger person who'southward recovering from an automobile accident or a traumatic brain injury (retrieve Gabby Giffords).

For the purposes of Medicare coverage rules, all of the normal hospital copayments and deductibles employ here. These facilities become paid a lump sum for the whole stay just like regular hospitals.. So, in contrast to the skilled nursing facilities, they're going to be working a lot harder to discharge your parent rapidly.

If you ask me whether your parent should exist in an inpatient rehab facility or a skilled nursing facility, I'd accept to honestly say that, for well-nigh frail older adults, a really good skilled nursing facility is a less expensive and more advisable identify for recovering from a hospital stay.

But, what makes all this even more complicated is that quality varies tremendously between and across both types of facilities. And, sadly, much of the fourth dimension the hospital'south making a decision that has very little to do with what's best for your mom or dad and everything to do with getting them out of their hair as quickly as possible.

Read: 5 Rubber-Commencement Strategies for Your Parent's Infirmary Discharge

Therapy from a Dwelling Wellness Agency

At some point, either right after a hospitalization or later a stint in the skilled nursing facility, your mom or dad is going home…..nevertheless needing therapy and nursing care but too frail to get out of the firm easily. In this case, Medicare will pay for a limited amount of "home health" care, which is really mostly rehabilitation therapy at home.

I retrieve one of the best things most "abode wellness" care is the opportunity to have an occupational therapist on site helping your parent relearn how to interact with his or her abode environment. Home health is not restricted to post-hospital intendance and is available anytime as long as your parent meets the adequately strict criteria for needing information technology.

To qualify for the do good though, a doctor must certify your parent needs it… AND, that doctor must actually have seen your parent, in person, sometime inside the last 90 days to verify the need for home health.

You tin see the irony here… that your parent has to exist and so delicate that it's not reasonable to expect him or her to leave the house and yet, somehow has to go to the doc to get certified for needing home health. Argh.

Watch: Daughterhood Voices – When Answers Are Difficult to Find

Only, one time you get your parent certified, there are no copayments or deductibles. And then that's something!

Outpatient Therapy

If your parent has Medicare Part A (infirmary) coverage, which about people take, or if your parent is enrolled in a Medicare Reward programme, all of the 3 pathways mentioned to a higher place are available to you.

If your parent has Medicare Part B (or is enrolled in a Medicare Reward wellness plan), he or she may also authorize for outpatient therapy services, which are very similar to the therapy you lot and I are familiar with – where you go to a therapy center and work with a therapist.

Considering this is Role B, if your parent is traditional Medicare Part B (every bit opposed to a Medicare Reward program), in that location's a 20 percent copayment and the Medicare Part B deductible applies. That's pretty straightforward.

What's non straightforward is that there are limits to how much therapy'due south reimbursable under the Part B outpatient therapy benefit. Generally, your parent can go $one,960 worth of combined physical therapy and speech/language therapy and $ane,960 worth of occupational therapy without whatsoever problems or questions. And if the therapist tin can substantiate an ongoing need, your parent may authorize for some other $i,740 worth of therapy in each category through something called an "exceptions process." But that's not guaranteed.

Phew. Who idea this all up?

Therapy When Your Parent Lives in Assisted Living or a Nursing Domicile

Things tin go pretty murky when your parent is living long-term in assisted living or a nursing domicile – in terms of the service category nether which Medicare will pay for therapy. I've created the handy little table below – just so you know what's what when your mom or dad lives somewhere other than a typical home.

Bottom line: This is a huge mess. Medicare is a conglomeration of benefits tacked on and revised piecemeal over fourth dimension, with more of an heart towards cost control than what volition work best for the families who have to navigate it. Then, best of luck because you'll demand it and let me know your experiences in the comments department!

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Source: https://www.daughterhood.org/medicare-therapy-rules-made-easy/

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