How many days does Medicare (a,b,c,d) cover rehab in a SNF?
My mother, who has Alzheimer’s, suffered a stroke on 01/23. On 01/29, she was transferred to a SNF for rehab. On 02/05, I had to call the social service office with concerns of neglect and emotional abuse of my mother. On 02/12, I called the head director regarding ongoing concerns of Mom not getting the proper (if any) rehab.
She seemed to be getting worse every time I visit. They have her in a wheelchair when she can walk with a walker. I received 3-4 phone calls yesterday (02/21) from different people at the facility saying Mom's last day of coverage was 02/20. They were demanding I get her out of the facility, even though I explained I didn’t have home health services set up yet, mainly due to her insurance (Humana) slow-walking the situation.
I looked up Medicare and rehab services, which states they cover 60+ days of rehab. I think they are retaliating because of my complaints. The director said he stopped her rehab because she wasn't progressing, even though it had only been 20 days.
Can I move my mother to a facility that will not neglect or abuse her? Thanks for any help.
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Let me give you a few examples. SNF is usually ordered when the patient needs nursing care. Sometimes that is IV antibiotics for severe UTI. Sometimes that is further workup on mental health and attempts to medicate. Sometimes that is for healing of a bedsore or other wound, or post op surgical wound.
1) For example: Let us say that "Irma" goes to SNF for wound care. She may be "allotted" a maximum number of days, BUT should the wound heel in three days, then she is discharges with no longer a need.
2) Example number two is Irving who comes to SNF for evaluation of psychotropics. He is allotted x-number of days. But if medication "A" works well; he will be discharge before that.
3) Next example is Louise who enters for rehab walking and balance issues, but from day one it is clear that Louise is lost and cannot be oriented enough to cooperate with any PT or OT work. Care conferences suggest she cannot progress in this rehab. She will be discharged to facility.
So the number of days POSSIBLE under Medicaid and Medicare is allotted by what you see online or in the 2025 handbook (free from Medicare). BUT, the individual must qualify in the care and must be able to progress in the care.
You will have discharge planning and social workers at this facility. They know the patient you are speaking about and are aware of the history. If you are the POA you should be participating in conferences and communicating with the social workers at the facility. Be certain that you never sign as the responsible party if you are not POA. You don't want any bills coming to YOU, but rather only to your Mom, who likely doesn't have the wherewithall to pay them, anyway. They will ruin her credit, but credit isn't something she needs at this point. Also, do not accept her home to an unsafe situation. If she needs placement then insist upon that, even if it is temporary. The words "UNSAFE DISCHARGE" and that you will not accept her home where she is unsafe but will have her transported back to Hospital early readmission.
Now, early on in your communication you say: "On 02/05 i had to call the social service office with concerns of neglect and emotional abuse of my mother".
I would need a whole lot more on that accusation to touch it. First of all I don't even have a clue who is being accused of abusing your mom.
I wish you the best ongoing. You will have to sort all this out with the facility admin and social workers and discharge planners. A polite and cooperative approach will get you the bees with the most honey.
Good luck.
With a history of Alzheimer’s and now CVA, it’s quite possible that 20 days was enough opportunity for the therapists to be able to determine if she was able to cooperate and start meeting some goals. Unless things have changed drastically, the therapists would be rooting for your mom and trying whatever they could to help her progress. Also, I don’t know any hospital or rehab that would allow someone with an acute stroke/dementia to walk unassisted. It’s a liability issue. The rehab my husband was in two years ago didn’t even want me to transfer him from wheelchair to bed when we were both capable.
I’m sorry that you and your mom are in this position. I would be working with the facility social worker to explore options. It is their job to help you plan for discharge.
She can potentially stay in the facility (if they have space) if she pays out of pocket by day but she would be considered SNF and not rehab.
The abuse and neglect as Alvadeer mentioned would need additional information before we could weigh in.
The wheelchair - in a rehab, unless they feel safe putting your loved one in a chair, it is going to be the wheelchair or the bed.
Until they are back to baseline in most cases they do not want patients ambulating on their own. It is a fall risk. Typically they start out with PT or OT ONLY. Then they move to assistance of the CNAs and Nurses. Ambulating with no assistance with a walker in less than a couple of weeks would be unusual.
As gently as I can say this - it is very easy to get a perception of abuse and neglect in a facility - if the only person you talk to is someone who has dementia and ALZ and they are sharing their opinions and points of view. If you have WITNESSED the abuse and neglect - that's another story entirely. And I'm not saying that we should disregard what our loved ones tell us - but use the "trust but verify" method - because people with dementia and ALZ have very skewed thought processes, and even sometimes delusions and hallucinations.
If you listened only to my FIL - he was abused and neglected in EVERY SINGLE rehab and SNF he ever set foot in. But he had severe time dilation and would claim that they left him in his room for DAYS with no food, in his waste and they REFUSED to help him. That was categorically untrue. But his sister (in another state) believed him and tried to involve the Ombudsman, who quickly realized what the reality was.
His sister believed until the day he passed that he was abused and neglected in the SNF. I can promise you that he wasn't.
So more details on what has occurred would be helpful.
So Mom has made her 20days of 100% Medicare will pay. She can continue to be in rehab but she pays the other 50%. You can claim "unsafe discharge" if nothing is in place at her home.
Not that you were not in your rights but they want her out because you complained. You could have her transferred to another facility but the days don't start over, they just continue and she will be paying that 50%.
If your Mom has Alzheimers, she probably can't do Rehab anyway. She needs to be able to follow directions and remember her exercises. I may ask her doctor, when she is home, for an in home evaluation. She can do therapy in her home. If that can be set up, an aide is usually provided for bathing 2 or 3x a week. This is usually paid by Medicare.
Only thing is if the patient is not cooperating in the OT and PT sessions, then based on reports those terms might change. You can file exemption, however the maximum days may not change.
They kept my mom for only 30 days. She had Medicare and an advantage plan. My mom cried and claimed the nurses didn't like her, I never walked in on anything suspicious. They offered a psychiatric evaluation for my mom. My mom was never able to walk. The combination of her dementia and peripheral artery disease caused a rapid decline. Once the SNF tells you they have to discharge, she needs to be placed elsewhere. My mom's SNF went from free coverage to it will be $9,000 a month. I immediately placed her near me, sold her house to help pay for her stay. Your mom needs to be somewhere safe. Dementia will cause your mom to become a danger to herself.
Medicare doesn't cover C or D coverage, D is a supplemental and C is considered an advantage plan, you can purchase a supplemental that covers what Medicare doesn't.
I would encourage you to contact the insurance company and ask for help, I found them to be awesome when I had any questions about my dad's coverage.