Most of the time people don’t choose to go into a nursing home or skilled nursing facility, so it’s no wonder why they are often caught off guard figuring out how the system works and knowing what their responsibilities are. In light of this common predicament, we wanted to release a post to guide families through the complexities that arise during and after their loved one’s stay at a skilled nursing facility.
Know If and How Long A Stay Is Covered
Usually a hospital stay precedes a stay at a skilled nursing facility. When this is the case, your hospital social worker will notify you if your loved one’s insurance will cover his or her stay at the skilled nursing facility. While at the skilled nursing facility, it’s important you make the effort to meet with the social worker. He or she will schedule regular care plan meetings with you. During these meetings you will learn about your loved one’s progress and if the center’s team expects the insurer to continue coverage.
Sometimes an insurer will cease covering a patient’s stay at a skilled nursing facility. That’s because either the patient has run out of covered days or has recovered to a point that he or she no longer needs the center’s services. Patients may appeal the insurer’s decision, but from our experience it is very rare for patients to win their cases. The downside of not winning is the patient is liable for the bill accrued during the trial, which can sometimes take weeks.
Have the skilled nursing facility review your loved one’s prescriptions and write new prescriptions when necessary. The center can call in the prescriptions to your local pharmacy, but it’s likely you will have to hand deliver any prescriptions for narcotics. Discuss with the social worker and the nurse what you need to do at your last care plan meeting.
Whether the patient is being discharged home or someplace else, request a list of the current prescriptions and their corresponding instructions.
Make sure the center has ordered the proper medical devices for your loved one. Some common examples of medical devices that we see centers ordering for patients are walkers, wheelchairs, hoyer lifts, and hospital beds. Granted, each of these medical devices must be warranted in order for the center to order them. It’s important that you ask your social worker if he or she would recommend any medical devices. Trust their answers, the social workers are just as interested in keeping your loved one safe as you are. As a result, they will give you their honest opinion about what your loved one should and shouldn’t require.
The unfortunate reality is that insurance does not cover transportation from a skilled nursing facility back to the community. You will be responsible for organizing transportation from the center upon discharge. The most popular transportation options are you, a taxi, or a hired caregiver.
Primary Care Physician Appointment
While many centers have their own primary care physicians, it’s not guaranteed that he or she will assess your loved one during his or her stay. Ensuring that your loved one sees his or her primary care physician at the end of his or her stay or directly after is very helpful. During this visit, the physician should review, yes again, the patient’s prescriptions and write any the center wasn’t willing to write or missed. Additionally, the physician may sign off on home health services if the center did approve the patient for home health. We’ve seen it many times--a patient was written an order for home health, such as physical therapy, but he or she couldn’t get it because he or she hadn’t seen a primary care physician in over a month.
Prior to discharge, either ask the social worker for an in-house primary care physician to visit your loved one or make an appointment yourself. Scheduling an appointment does not require that much effort from you, but it will potentially save you a lot of hassle down the road.
Find a Safe Environment
Often patients who leave a skilled nursing facility aren’t 100%, which means they still require care after their stay. It’s important you have a plan to care for your loved one. You, a family member, a hired caregiver, or an assisted living community are caregiving options. Whatever option you choose, consider the needs of the patient and your resources, including time and money.
While there is a lot to do prior to a discharge from a skilled nursing facility, there are many resources available to help you make this transition as smooth as possible. If you have any questions, please feel free to contact us and we will help you choose the best path forward.
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