Minor health matter can begin path to long-term care - Elizabethtown News Enterprise

Although everyone recognizes the need for nursing homes, most people are unclear on how an individual goes from full health to needing long-term care.

A typical case that ends with an individual needing long-term care often begins with a seemingly simple medical problem. This may be a minor fall, a diagnosis of a new health condition or even a change in levels of social interaction.

In some cases, the individual may spend some time in rehab or even in long-term care. In many cases, family members simply begin to notice signs of declining health. At some point in the future, the individual once again needs hospitalization for a more significant fall or for stabilization of another condition. That hospitalization may last several days or even weeks.

Often at this point, social workers employed by the hospital will begin talking with the family about additional assistance through in-patient rehabilitation services. Instead of simply returning home in declining health, the individual may have a chance to rebuild some self-care skills. Upon discharge from the hospital, the patient can be transferred directly to a rehab facility.

Because nursing homes often serve as both rehab and long-term care facilities, people generally are confused as to which insurance will cover which services.

As long as the individual is considered a rehab patient, health insurance may pay all or part of the cost of in-patient rehab. Generally, after a qualifying hospital stay, Medicare will cover up to 20 days in full with up to an additional 80 days of partial pay. The share Medicare does not cover may be covered by a Supplemental Insurance or Tricare for Life, if the patient has the additional insurance available.

When Medicare determines that the individual has hit a âplateau,â meaning that the individual is unlikely to continue to progress with additional therapy, Medicare will give notice of intent to terminate payment for services. The notice often is abrupt, given within days of the final payment date. Families may appeal to Medicare, but even successful appeals often only return a short period of additional days.

When the rehab nearing the end, the facility will talk to the family about options for ongoing care. Regular health insurance will not cover the cost of a long-term bed.

Families should speak with an elder law attorney in order to determine the most cost-effective way to pay for long-term care. A collaborative approach between the attorney and the nursing home usually will result in the best outcome for all parties.

Cynthia Griffin is an elder law and estate planning attorney at Burnett and Griffin PLLC in Elizabethtown. She can be reached at cynthia@bcglawcenter.com.