Situation. "I want to help an elderly neighbor with a problem. Her husband is currently in a nursing home for physical therapy, learning to walk again. She would like to bring him home and hire someone to come to their house daily to administer his therapy. Where should I start looking for good reliable help?"

Reply. "We assume that your neighbor's husband is in a nursing home to recover after being hospitalized for a stroke, hip replacement, or another similar condition that caused him to temporarily lose his ability to walk. If this is the situation, Medicare is most probably paying virtually all of his expenses for the first 20 days of his stay, and then all but $114 a day for the remainder of his stay, up to a total of 100 days.

This Skilled Nursing Facility benefit is Medicare's preferred way to pay for the physical therapy needed to help someone recover. And, if your neighbor's husband has a Medicare Supplement insurance policy, even Medicare's $114 copayment is probably being paid by insurance. As a result, even though many people on Medicare would prefer to recover at home instead of in a Skilled Nursing Facility (that's Medicare's name for a nursing home that has met some additional medical requirements), most people simply cannot afford to pay for the needed care at home.

That said, a skilled nursing facility will generally discharge a patient before they are fully recovered. Medicare's preferred approach at that time is to provide skilled care (therapy) at home until the patient has recovered. But, if a patient leaves a Skilled Nursing Facility before he or she is discharged, Medicare's payment for home care may become an iffy issue. In other words, they may refuse to pay for your neighbor's husband's care because he "didn't follow their rules."

Regardless of whether your neighbor waits for her husband to be discharged, or takes him out of the facility prematurely, she must be very careful to hire the right home health agency to help her husband recover. Medicare will not pay for his care unless it is provided by a Medicare-certified agency. But, less than half of home health care agencies are certified. Care at home can be very expensive if you have to pay for it out of your own pocket."

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. ...