Getting old isn’t easy or cheap. Nursing homes can be very expensive; sometimes in the ballpark of $7,000 a month. Eventually you will reach the point where it’s time to check a loved one (or yourself) into a nursing home. For most families in America that’s a scary number to look at as a monthly bill. But there are government programs in place to help with the cost, and even make it no cost to house a loved one in a nursing facility.
If you qualify with a recent hospitalization, Medicare will cover a nursing home stay for up to 100 days. After that, Medicaid can kick in if you qualify until the care offered by the skilled nursing facility is no longer medically necessary. This can be great news for those who qualify but it may not always be happily ever after.
Nursing homes are for-profit businesses. They are primarily concerned with their bottom line and maximizing how much they’re making off a resident. So let’s go back to the two government programs mentioned earlier. Medicare can reimburse facilities more than $1,000 a day. When the coverage is switched to Medicaid that coverage can drop to an average of $219 a day. That’s a big difference, and nursing homes know this.
When this reimbursement level changes nursing homes may try to push you or your loved one out to make room for new residents that they can bill Medicare for instead of Medicaid. NBC News recently published an article discussing this exact issue. (https://nbcnews.to/34zbdOe). In the article, which focused on California, it talks about how nursing homes will even dump you residents they don’t want any more on the side of the road. These are people who cannot care for themselves. If they’re lucky the nursing home will put them up in a motel for a couple of days instead of putting them directly on the street. This isn’t allowed, and the nursing homes hope they can play off the fact that people don’t know this.
There are a limited amount of circumstances when a nursing home can remove a resident from a facility. Some of these include: if the resident’s health improves sufficiently, if the resident’s presence in the facility puts others in danger, if the resident’s needs cannot be met by the facility, if the resident stops paying and has not applied for Medicare or Medicaid, or if the facility closes. Even then, federal law requires nursing homes to give a 30 day notice in writing to the resident and work on a transition plan with the resident. These safeguards are in place to protect the resident, but sometimes the nursing homes don’t follow them or share the existence of them with the resident or the resident’s family.
Being faced with this situation can be extremely stressful, and with all the federal and state laws and regulations out there it can be confusing to know where to even start with it all. The nursing home already has the specialized knowledge because it’s part of their business practice. You don’t have to be alone though when dealing with the nursing home. You can reach out to a nursing home abuse lawyer who knows the law and regulations, and knows how to advocate for residents to make sure they receive the care they deserve.
