Most seniors and their families spend a lot of time planning how to stay out of the nursing home. Those perceptions of nursing homes are often tainted by old stereotypes. Although Nursing Homes still provide long-term care, they also provide effective short term rehabilitation services for seniors recovering from extended illness or injury. Nursing Home rehab can actually be a short stop on the road back home after illness.
100 days of coverage? Not necessarily
Nursing Home used to be known for a slower pace of therapy, which was helpful for seniors recovering from illness. In recent years therapy in the nursing home has become more aggressive measuring progress on a daily basis rather than the weekly measure they used before. This change in approach has dramtically reduced the length of stay for those receiving therapy in the nursing home.
The common misunderstanding among seniors and families is that they get 100 days of Medicare coverage as long as they are receiving therapy. While Medicare does provide for 100 days of coverage it does not mean that the patient will actually receive that amount. The patient will only be covered as long as they are showing “progress” toward therapy goals.
Who determines progress?
Nursing Home therapists will tell you that it is Medicare that determines whether a patient is making progress. While this is true, much of how that decision is made depends on how the therapist documents therapy treatments.
Medicare determines progress through regulation and precedent with the facility they are dealing with. There is not some room where someone from Medicare waits to review daily therapy notes. Instead a therapist estimates coverages based on how Medicare has approved billing in the past. The notes are only reviewed during random audit or if the patient appeals the coverage decision.
Directed Therapy Goals
Because the process for determining progress is highly subjective, it is vital to make sure the therapist understands your personal goals. If the senior is returning home, the therapist should understand what abilities and skill the senior will need in order to remain safe. For example, if the senior has limited support at home they may need to be strong while standing in order to use the bathroom safely. If responsible for preparing their own meals, they may need to work on adaptations to make that task easier.
By directing the therapist to focus on practical outcomes, rather than a focus on general goals like walking distance, a patient can help define progress as it relates their patient-centered treatment plan. This will improve your therapy outcome and get the most coverage out of your nursing home rehab stay.