Caregiver Tip of the Month

Skilled nursing facilities (also known as rehab facilities and rehab hospitals) sometimes discharge senior patients before they have recovered enough to be sent home. Often, it's a matter of economics – Medicare provides only a fixed amount of money to pay for a patient's medical condition. Just like hospitals, if the skilled nursing facility can discharge a patient before it spends the entire pot of money, it keeps the difference. But, just like hospitals, federal law protects recovering patients from being discharged too soon. But sometimes hospitals and skilled nursing facilities need to be reminded of this fact.

(To see what you need to know when your loved one is a Medicare hospital patient, go to the Caregiver Reminder at the end of this newsletter.)

With regard to skilled nursing and other rehab facilities, the following information was taken directly from Medicare's latest consumer booklet on skilled nursing facilities. The rights described apply to ALL Medicare beneficiaries, regardless of whether they participate in Medicare's original plan, or under an HMO licensed to provide coverage to Medicare beneficiaries.

"At a minimum, Federal law specifies that a SNF (Skilled Nursing Facility) resident’s rights include:

Protection Against Unfair Transfer or Discharge:

You cannot be sent to another SNF, or made to leave the SNF unless:

• It is necessary for the welfare, health, or safety of you or others,
• Your health has declined to the point that the SNF cannot meet your care needs,
• Your health has improved to the point that SNF care is no longer necessary,
• You do not pay for the services you are responsible for, or
• The SNF closes.

Except in emergencies, SNFs must give a 30-day written notice of their plan to discharge or transfer you.

If you have a problem at the SNF (Skilled Nursing Facility), talk to the staff involved. For example, if you have a problem with your care, talk to the nurse or Certified Nurse Assistant (CNA). The staff may not know there is a problem unless you tell them. If the problem is not resolved, ask to talk with the supervisor, the social worker, the Director of Nursing, or your doctor.

The facility must have a grievance procedure for complaints. If your problem is not resolved, follow the facility's grievance procedure. You may also want to bring the problem to the resident or family council. The SNF must post the name, address, and telephone number of state advocacy groups, such as the State Survey and Certification Agency, the State Licensure Office, the State Ombudsman Program, the Protection and Advocacy Network, and the Medicaid Fraud Control Unit.

If you feel you need outside help to resolve your problem, call the Long-Term Care Ombudsman or State Survey Agency for your area."

To see the complete booklet, click on Medicare Publications, then type "skilled nursing facility" (without the quotes) in the Search by Keyword box and click GO. The next page should be for Medicare's booklet, "Medicare Coverage of Skilled Nursing Facility Care" - 10153 which you can read online by converting it to html, or download in PDF format for later viewing after saving it to your hard drive.

Our visitors ask ...

Q. Is there a income limit on being eligible for treatment under Medicare for someone at home? Is it possible that someone could receive too much money from retirement benefits to qualify for Medicare services?

A. There is no upper income limit. In other words, Medicare provides the same home health care benefits regardless of income. (But, as explained in our November 2004 issue, many low income seniors can receive financial assistance for prescription drugs.)

Daily Living Solutions

— products for seniors —

As we grow older, it often becomes difficult to use many everyday products because of arthritis and other conditions. If you or a loved one needs a little help – or a lot – we've selected a group of practical and affordable solutions from our affiliated merchants to help overcome those limitations.

Whether you are looking for yourself, or to help an elderly senior continue living in their own home, you'll find a wide variety of supplies and accessories – raised toilet seats, safety rails, incontinence supplies, large-handle eating utensils, pain relief, diabetic supplies, pill splitters and crushers, big-button telephones, canes, walkers, rollators, wheelchairs – and much more.

Everything is sorted into convenient categories in our Solutions for Seniors section.

Caregiver Tip #2

— Where is the Living Will? —

As much as you may wish otherwise, if you've just taken your mother to the hospital emergency room, it is not enough to say, "I have my mother's Power of Attorney* and she has a Living Will. But I don't have it with me. It must be at her house – or in her safe deposit box – or with her attorney." While it may seem unfair, health care directives have absolutely no value unless they can be shown to medical personnel when and where they are needed.

*Power of Attorney for Health Care – A written legal document in which one person (the principal) appoints another person to make health care decisions on behalf of the principal in the event the principal becomes incapacitated (the document defines incapacitation). This instrument can contain instructions about specific medical treatment that should be applied or withheld. While its purpose remains essentially the same from state-to-state, the name of this document can vary; for example, in Florida it is called an Appointment of Health Care Surrogate. (Note: This document must not be confused with what most people call a Power of Attorney; that document usually confers only financial responsibility and has nothing to do with health care.)

The solution? Make copies – plenty of copies – along with medical information such as current medications and allergies, and doctors' names and phone numbers. Then, put a set in an envelope on your loved one's refrigerator where emergency personnel can readily find it. Put another set in your car's glove compartment. Keep a set a work. If you have to travel to see your loved one, keep a set in the suitcase you usually use. On your next visit to your loved one's primary care physician and all of his or her specialists, give a set to each one of them. And, give a set to everyone in your family who might be involved with your loved one's health care. Bottom line – you cannot have too many copies. Make extras and share them.

Today's technology also provides new ways to make advance directives available anytime and anywhere. They can be posted on an Internet site and the Internet address and access instructions carried in a wallet, purse or in the envelope on the refrigerator door. Wherever your loved one may be, wherever their Power of Attorney (Surrogate) is located, whenever their documents are needed, they will be waiting and available.

You should, however, be cautious of providing access only through technology driven systems. These documents should be available for use by low and no tech people, as well as high tech users. The refrigerator door is still the most universally accepted place for first response personnel to look for emergency information; therefore, it is the first and most important place to keep a set.

The LifeLedger Online Services from Elder Issues will assist you and your loved one in using all the options from no tech to high tech. Don't choose one option; choose them all for the peace of mind you both want – to get your loved one's advance directives into the right hands when and where they are needed. For more information, including details about their 7-day free trial, click here.

Recommended Reading and Videos

Many excellent books and videos can help guide you through the caregiving process. For our recommendations, including a brief description of each one, click here.

Caregiver Reminder

What you need to know when your loved one
is a Medicare hospital patient

If you are looking for assisted living, home health care, skilled nursing or a nursing home, it's usually because of a medical crisis involving a loved one. You're probably in a time crunch – decisions have to be made quickly. The hospital may have said that your loved one will be discharged tomorrow. They've given you a list of rehab facilities, and it's up to you to pick one. But, how do you know which one is best? Are some better than others?

If you're in this situation – take a deep breath – relax a little – and read the next paragraph. You might make a better decision as a result.

Medicare has special rules to keep patients from being discharged from the hospital too soon. In spite of what the hospital may have said, your loved one cannot be discharged until 3 days after the hospital gives you a form called a Notice of Noncoverage. If they have not given you the Notice, insist that they do. (You won't get into trouble by insisting, and neither will your loved one.) This will give you additional time to find the rehab facility that's best for your loved one.

Hospitals discharge their Medicare patients quicker and sicker that ever before. In 1968, patients age 65 and older stayed in the hospital an average of 14.2 days. By 1982, that was down to 10.1 days. Now it only 6.4 days.

Why? Medicare is under constant pressure from Congress to cut expenses. Now, Medicare benefits pay a hospital the same fixed fee for each patient with a particular medical condition – even if one patient's condition is more severe than another's. If a patient stays too long, the hospital has to pay the extra costs out of its own pocket. But, the shorter a patient stays, the more money the hospital gets to keep.

How bad has the situation become? According to The Wall Street Journal, "Nearly one in five people admitted to hospitals with broken hips are discharged before all of their vital signs are stable ... . Those patients are far more likely to die or be readmitted to the hospital within two months."

To protect you, Medicare guarantees you certain rights if you think you are being asked to leave the hospital too soon. Unfortunately, these rights are given to you along with all the other papers a hospital makes you sign when you are admitted. So, they are usually lost in the shuffle, with most people never realizing how important they are. Hospitals sometimes take advantage of that fact. ...

The material on this site is for informational purposes only, and is intended as a supplement, not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider. More