Moving from the hospital to a skilled nursing facility is hard. The move happens fast and you don’t have a lot of time to process all that will change once you get to your new medical facility building. The transition from one to the other doesn’t have to be shocking. Learn what to expect and how to handle to transition…
Today we’re going to talk about something serious.
Imagine this scenario:
You’re in your yard working in the garden. You reach over to grab a the handle of your trowel, then… you wake up in the hospital. What the heck!!!
It’s a short story that happens every single day. (At least some version of it does)
Passing out, falling, broken arm or leg, heart attack, stroke, aneurism, etc… These are all things that can land you in the hospital suddenly and for an extended amount of time.
Whatever the reason, the next step is often to rehab program at a skilled nursing facility or a sub-acute rehab hospital before home. Home is often days, weeks or months away.
What You Got at the Hospital -> for a typical short term stay
- Around the clock care for all of your wants and needs
- Plenty of nurses on staff
- On site pharmacy and doctors
- Shorts bursts of therapy
- Fairly tolerable food
- Scanning equipment (PET, CAT, EEG, MRI, X-ray)
- Volunteers- plenty of volunteers!
What You Get at a Skilled Nursing Facility
- Around the clock care for your needs…and maybe some of your wants.
- Limited nursing staff
- Extensive lengths of therapy- between 1 to 3 hours typically on a daily basis.
- Slightly better food
- All scanning equipment and prescriptions have to be scheduled or ordered and aren’t immediate
- Doctors most likely are NOT on staff and are NOT in the building daily. Many use contracted MDs to come in once or twice a week.
- When doctors are in the building they are seeing A LOT of patients in a few hours.
The Number One Question. “Do I Have To Go To Therapy Today?”
Well… Technically no. But you really should.
Just know that if you don’t, you will most likely be responsible for the bill at the end of it. Insurance changes so much that it’s difficult to say this is a steadfast rule.
Insurance dictates how much therapy you’ll get before you have to pay out of pocket. Depending on your plan, that is typically anywhere from 20 to 100 days. Some charge a co-pay from the beginning. Some don’t.
The catch. If you don’t follow their rules, insurance companies will probably deny your claim. It happens all the time.
They need a reason to pay out. That reason is the need for rehabilitation. In their eyes, if you didn’t need it, you would be home already. So why should they pay for a stay in a facility if you don’t need it? You have to think like an auditor would.
It also changes your status in their system from a rehab patient to a non skilled patient. All that means is, you get only nursing services and not the full treatment. Usually, this also means a room change and you have to go from a nice private room to a shared room or even change hall types.
Hall types are not usually a big deal for rehab hospitals, but it’s a HUGE deal in skilled nursing facilities.
So what does this mean for you? It means you’ll either have to leave before you’re ready and pay for all of the therapy services you’ve already used or you’ll have to change insurance types and start the treatment cycle all over again. Which means discharging from therapy and then getting re-evaluated.
Either way, it’s a big hassle and could be costly.
Think of Going to Therapy as a Part Time Job.
It pays for your stay.
Simply participating in therapy can save you thousands of dollars. That means actually participating though. Not just showing up.
When you participate you have the best chance of reaching or even exceeding your goals before you go home. AND, you won’t have to worry as much about claims denials.
What questions do you have about Skilled Nursing Facilities?
Let me know in either the comments below or through email in my contact me form.
More to come soon on this topic.
North Carolina, USA
What kind of care would a Veteran receive in a skilled nursing and rehab facility which is under a VA Contract?
It would be dependent on what kind of care was deemed necessary by the evaluating therapists and doctors on staff.
Typically, someone would come in from the hospital with orders for care then they would get evaluated for their current condition. Different insurances will stipulate the amount and length of treatment that is allowable based on their current level of need found on that eval. Sometimes it can dictate how much it is willing to pay for. This is where the difference in cost comes in since they may not pay for everything that is wanted/ needed. For instance, a person may want to stay in the facility and get therapy or nursing for a full month, but insurance could pull funding after 3 weeks if they deem the patient is too high level to need that sort of care. Or they may a monetary cap on how much they are willing to pay and the family could be responsible for the rest of the costs.
The best place to ask this question would be at the specific facility that you or your family member may be going to. They would be able to give you a cost breakdown and what the VA is currently willing to provide care for.