Prospective clients often visit the firm and begin their explanation of their circumstances with a recitation of the course of admission, treatment, and transfer to the rehabilitation unit of a senior living facility. They then express confusion over the fact that when Dad was admitted, they were told that he had up 100 days of Medicare rehabilitation benefits. Then, the story continues, just a couple of days ago they were told that Dad is being discharged at the end of the week unless we would like to arrange for him to stay on in long term care, for which, they want a check right away. The family is worried and confused, and wondering if the facility really understands what challenges they are facing. No one has $5,000 a month extra for care and Dad’s social security doesn’t cover half of the cost.
The genesis of this problem is found in the history of Medicare and how the rehabilitation benefit fits into the scheme. Medicare was founded as a part of the great social safety net. It provided access to hospitals for millions of seniors who had no health insurance past retirement and could not afford descent care. Soon after roll out, it became apparent that simply providing acute care in a hospital would not suffice because, simply, it takes longer to get back on your feet as you age. So, the rehabilitation benefit was added with the purpose of helping people to transition out of care, helping people to go home.
There are effectively three limits on these benefits. The first is 100 days. The second is therapeutic endpoints, the third is refusal to participate in therapy. The first one is budgetary. The government has only provided for up to 100 days of these benefits (per cause). The last two go to the heart of the deal, if one cannot get any better, or refuses to try to get better, the purpose of the program is frustrated and benefits must end. The facility does not want to bet against the patient at admission, so there is often a sense of surprise when it comes time to discharge Dad before his time is used up. It’s a product of history.