Admitting yourself or someone you love to a nursing home for rehabilitation is sometimes something that we have to do and not what we want to. As you age the risk increases for a health accident even if you are healthy. Unfortunately not all of the care we need can be provided in the hospital or at a rehabilitation specialty center. Some of us will need to go to a skilled unit in a nursing home. Understanding your insurance benefits for a medical health care accident must be a priority even if it is for a short rehabilitation stay.
One of the most frustrating events for individuals facing rehabilitation is not understanding how and what their insurance is going to pay for. Read and understand your insurance policy thoroughly. If you don’t understand call your agent or customer service center to get the answers you need about your coverage and keep up on any future changes. Understanding your insurance benefits and your rights will get you the services you require for your rehabilitation stay.
Nursing home skilled units want to be assured that the necessary steps will be taken to assure that they will be paid. Many people don’t understand this but it is the rehabilitation services that generate the income that keep nursing homes financially afloat. Nursing homes are most familiar with Original Medicare, Medicare Advantage Plans, Medicare Managed Care Plans, Medicare Preferred Provider Organization Plans, Medicare Private Fee-for-Service Plans, Medicare Specialty Plans, federal employee health program, military health program and railroad retirement programs. If your patient has one of these your they will be highly considered once the payer source is verified. If the nursing home cannot verify the payer sources and coverage immediately they may ask for a deposit.
The nursing home or the rehabilitation center will then look to see if they will be able to provide the needed therapies. Secondly, they check to see that they will make a profit from providing the patient the services they need. That means that everything the patient needs in the way of treatments and therapy must be covered by your insurance. Thirdly, they attempt to get an understanding of the patient’s cognitive status and psycho/social-well-being to see that they are appropriate for their facility unless they have a contract with the discharging hospital. Keep in mind that not all nursing homes are adapted to serve all types of patients.
Once the nursing home determines that they will accept your patient the hospital makes the necessary arrangements for the patient to get to the nursing home.
Finally your patient is at the skilled unit of nursing home. The patient or the patient’s representative will meet with the nursing homes admissions representative to complete the admission paper work.
The admission paper work into a skilled nursing home for rehabilitation can take near up to an hour to complete. The responsible party whether it is you the patient, your spouse an adult child, someone will have to sign all of the paper work. The representative of the nursing home more than likely is not going to read the whole contract to you but they will paraphrase each section of the contract.
You will feel that you are signing your life away but you are not. Long term care facilities are very regulated therefore they have several release forms, program acknowledgement forms, HIPAA forms, assignment forms, permission forms to bill insurance and more that must be signed at admission. It will take 2 to 5 hours to read all the material they give you.
All of these forms are standard for admission into most all nursing home rehabilitation units. You may not have time to read all of the forms during the admission process so be sure that you get a copy of the contract and all the forms that you signed. Be sure to read them as soon as you can. If you have any questions ask them to explain. If they can’t or won’t explain contact the faculty ombudsman for assistance.
The facility’s Ombudsman is a volunteer with your state’s Agency On Aging. The facility Ombudsman is not paid by the facility. The Ombudsman is your patient advocate and they can help you with many issues.
On the first day you should expect the nursing staff to assess patient and the patient needs and preferences. The therapists from the rehabilitation will come to screen your needs for treatments so that they can obtain orders to begin your treatments. Other nursing home disciplines will also visit in the next 24 hours to find out what the patient’s goals and preferences are while they are in the facility. Just as soon as the patient is admitted to the facility discharge planning will begin.
Believe it or not you will find most of the nursing home staff very likable and you will find many friendships in a nursing home among staff, other residents and their families.
