Medicare and Post-Hospital Care

Eligibility requirements for Medicare-funded post-hospital services

When Rosanne Iacarella, RN Case Manager at Newton Wellesley Hospital in Massachusetts, is asked what patients and their families don't know about post-hospital care, she replies that eligibility for Medicare funding of skilled nursing care only begins if a patient has spent at least three nights in a hospital.

If Medicare eligibility requirements are met, it will fund up to 100 days of nursing care. However, the care facility must document that the patient is making "functional, daily improvement," Iacarella says, otherwise Medicare won't cover it. If the patient is well enough to receive nursing care at home, Medicare may fund Visiting Nurses' care, but only for as long as it can be documented that the patient is making gains for each visit and has not reached a plateau. Families should review Medicare eligibility requirements as soon as they can, in order to prepare for caring for an elderly parent.

Check The Official U.S. Government Site for People with Medicare for more details.

Custodial care

If a patient is not expected to get better but nevertheless needs care, unfortunately Medicare will not pay. This kind of care, often called custodial care, may be given in Assisted Living facilities, in which patients live independently but may need help with taking medications or certain other tasks, such as receiving oxygen or bathing. Or the custodial care may be given in nursing homes, where the patient receives more constant care. Nursing homes can cost up to $75,000 a year. In addition, they often require an upfront down payment of $15,000, a sum which many families, Iacarella says, are not prepared to pay.

Medicaid as an alternative

If patients need skilled nursing care after spending two or less nights in the hospital, or are not expected to get better, then they must fund this care themselves. Often, families in this situation must then consider a spend-down of assets in order to qualify for Medicaid, as opposed to Medicare. To qualify for Medicaid, a person must only have minimal assets, which usually means that if there is a family home, it must be sold or perhaps gifted -- although that must have been done at least five years before the person applies for Medicaid. Each state has different requirements for Medicaid, so check out your individual state's requirements.

State-subsidized services may include

• Adult day care
• Help with chores
• Companionship
• Help with shopping for groceries and with laundry
• Home-delivered meals
• Home health services
• Help with cleaning
• Nutrition counseling
• Assistance with such tasks as getting dressed, taking a bath or with other personal care needs
• Devising a personal emergency response system
• Respite care
• Transportation

It's important to know the rules so that you can anticipate what funding you can receive for post-hospital care from Medicare. Check with your local Council on Aging for other possible sources of funding.

Helpful links

The Official U.S. Government Site for People with Medicare for more details.

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Ronnie Friedland is an editor at Care.com. She has co-edited three books on parenting and interfaith family life.