What the Nursing Home Won't Tell You

When you loved one goes into a Nursing Home, a.k.a. Skilled Nursing Facility (SNF) for rehabilitation, there some secrets you should know.  Entry into the skilled nursing facility usually follows three approved overnight stays in an acute care hospital.  Admission to the skilled nursing facility is often recommended after the hospital stay so a person can receive I.V. medications such as antibiotics, or various forms of therapy.   Not every older person needs to go to a nursing home for rehabilitation.  If an older person is going to a rehab for I.V. therapy such as antibiotics, there may not be an alternative since Medicare will not pay for I.V.’s at home.  This treatment can be very expensive unless the person has a secondary insurance policy (not a supplemental policy – another blog about that) that covers this service. The care at a rehab facility involves physical therapy, occupational therapy and speech/language therapy.  Care at home can often be a better option for many reasons.  Patients in rehab many spend a great deal of time in their rooms, other than the one to one and a half hours they actually get physical or occupational therapy.  This time spent in their room can be lonely and unproductive.  Older people may do better receiving these services in their own homes (if that is an option) or a family member’s home.  Family interaction, quality of and options for food, stimulation, and quality of care at home are all significant factors in how well an older person recuperates from an illness or injury.  An older person’s mood can deteriorate based on the original injury or the illness, and a rehab stay can cause their mood can deteriorate even further.  Older people who are experiencing any stage of dementia may see this disease progress quicker due to being out of their home environment. 

Another thing the nursing home will not tell you is that the Medicare insured patient has the first twenty days of rehab covered at 100% but only if they are making measurable progress towards their goals.  Many SNF’s will keep patients the full 20 days, when maybe the care in the SNF can be terminated and care continued at home by a home-based care agency.  If the Medicare insured patient has a secondary or supplemental insurance policy (separate blog) that pays the copayment for days 21-100 in the rehab, the facility will often keep them for as long as possible, up to and including the 100th day.  For all the reasons listed above, an older person may be better served by leaving the rehab as early as physically/medically possible and continuing their rehab at home with a home-based care agency.  The nursing home may not share this information with you because rehab patients are their “bread and butter”.