Here are helpful hints when trying to understand how many days Medicare will cover while in a rehab or skilled nursing facility.
Coming from working in the rehab or skilled nursing facility (SNF) world for quite some time, the phrase “Medicare covers 100 days in the SNF/rehab”, is one we would hear almost daily, from patients and their families.
Patients and families are under the impression when they are in rehab/SNF, they’re entitled to 100 covered days by Medicare; plain and simple.
I can understand why this can be confusing. But boy did we have to explain this often. Let me try to clear this up for you.
Yes, Medicare will cover up to 100 days per year in skilled care, skilled, is the key word here. But there are guidelines that must be followed throughout your stay in a facility for therapy and nursing care. There are some more complicated layers like wellness periods that we won’t get into here.
Meeting Medicare Guidelines
The bottom line is you must continue to require the skill of a nurse and/or therapist in this setting for something that a therapist and/or nurse cannot provide in the home with home health services.
Following are examples of criteria that must be met in order to meet the guidelines to continue your stay:
- Therapy cannot be safely provided in the home due to the amount of assistance needed.
- You require nursing care for a wound(s) that has orders for daily treatments
- You require IV medications and don’t have someone at home who can manage them
- You must be making functional and medical progress toward reasonable goals set by your healthcare provider based on their assessments. You cannot stay in a facility and receive the same care day after day without improvements in your condition.
Ask yourself:
What is preventing you from going home? Can the care you need be provided at home instead of in the rehab/SNF setting? If these necessary skills can be provided at home or are not deemed as a skilled service, meaning someone at home can do it, then you no longer meet the criteria for a qualifying stay. This is not the end of the world and is not the end of your therapy and nursing journey. Many things can be treated with home health therapy and nursing and you can do this in your own home, which puts you at less risk for coming in contact with illnesses of others in the facility.
So, do you have a benefit of 100 days by Medicare? Yes, you do as long as you meet the criteria. Each facility meets on at least a weekly basis to look at their patients to determine if you are still meeting the criteria and if not, you will need to transition to home with continued services as necessary.
To learn more about different alternative living options, go to my article, “Time to Get Moving and Shaking.”
