How to Manage Your Loved One’s Discharge to a Rehabilitation Center

If your loved one can benefit by short term rehabilitative therapy such as physical therapy, occupational therapy (for activities of daily living) or speech therapy, they can receive care via a short-term stay in a rehabilitation hospital or a skilled nursing facility.

General Discharge Planning

This article discusses discharge from a hospital to an inpatient rehabilitation center.

Before reading this article, read our general article about “How to Manage Your Loved One’s Discharge from a Hospital or Rehabilitation Center” which explains how to:

Meet your discharge planning team
Meet with the health care team to learn diagnoses and treatment plan
Understand the next level of care
Clarify insurance options and other financial plans
Choose the next care setting and providers
Attend the discharge meeting
Arrange transportation to the next level of care
Ensure a smooth transition to the next level of care

Managing a Discharge to an Inpatient Rehabilitation Center

The United Hospital Fund, via its Next Step in Care* program, publishes a family caregiver’s guide to “Short-Term Rehab Services in an Inpatient Setting.” Among the topics addressed in the guide are:

Going from hospital to rehab
Paying for rehab services (including Medicare coverage requirements and clarification about the “continued improvement” rule)

Inpatient Rehabilitation Settings

Inpatient rehabilitation settings include:

Acute rehabilitation hospital (intensive therapy)
- Note: patients who can walk independently without standby assistance most likely will not meet guidelines for an inpatient acute rehab stay.
- Patients do not need to stay in the hospital for 3 nights to qualify for Medicare coverage of an acute rehabilitation stay.
- Patients need 2 out of 3 disciplines to qualify for an acute stay: Occupational therapy, Physical therapy and/or Speech therapy.
Skilled Nursing Facility / Subacute rehabilitation facility; this includes rehabilitation facilities housed inside continuing care retirement communities

Clarify Insurance Coverage and Other Financial Options

Determine your loved one’s insurance coverage for the services they will need:

Medicare requirements for coverage of care in a skilled nursing facility is addressed later in this article.
Your loved one may have additional insurance to pay for deductibles, coinsurance, and other costs. Check your loved one’s own insurance for their specific coverage.
Contact your loved one’s insurance professional for guidance. If they don’t have one, consider engaging one now.
If your loved one has long term care insurance, this is a good time to review coverage and options
Some required services may not be covered by insurance. Meet with your financial planner to discuss options.

Choose the Inpatient Rehabilitation Center

By law, hospitals must give patients a choice of the provider they will use for their rehabilitation, home health care, hospice, etc. Many hospitals own such services, however your loved one may benefit from using a different provider.

You can help your loved one choose a provider and work with the discharge planner and the provider to set up that referral and transition.

Discharge planners often choose providers based on availability. By arranging discharges in advance with the provider, you may be able to arrange a more orderly discharge to your loved one’s provider of choice.

Things to consider when choosing a provider:

Location - proximity to your loved one’s home and their loved ones
A facility your loved one has used and is comfortable with
Insurance coverage

The National Institute of Health US National Library of Medicine provides guidance on Choosing a Rehabilitation Facility.

The Center for Medicare Advocacy recommends these ways to choose skilled nursing facility.

Medicare provides comparisons between providers: Inpatient Rehabilitation Facility Compare

To arrange for discharge to a particular facility, contact the admissions personnel at that facility to determine whether they have a bed available. (You can do this yourself - you do not need to work through the hospital discharge planner.) If the discharge planner says there is not a bed at your preferred facility, call the facility yourself to make sure.

If the admissions person at the rehabilitation facility confirms they can receive your loved one, contact the discharge planner at the hospital, communicate which facility your loved one has chosen, tell the discharge planner that the receiving facility has agreed, and ask the discharge planner to communicate discharge instructions to the facility.

Confirm with the rehabilitation facility that they have received the referral from the hospital and the discharge is arranged.

Medicare Coverage of Skilled Nursing Facility Care

Be sure to determine your loved one’s insurance coverage of their stay in a skilled nursing facility (SNF). Medicare coverage of a skilled nursing facility stay depends on several factors, which are detailed below.

Costs of Skilled Nursing Facility Care Under Original Medicare

As of March of 2019, you pay the following (Check Medicare.gov for current costs):

Days 1–20: $0 for each benefit period .
Days 21–100: $170.50 coinsurance per day of each benefit period.
Days 101 and beyond: all costs.

Requirements for Medicare Coverage of a Skilled Nursing Facility

Medicare Part A (Hospital Insurance) covers skilled nursing care provided in a SNF in certain conditions for a limited time (on a short-term basis) if all of these conditions are met.

1. You have Medicare Part A* (Hospital Insurance) and have days left in your benefit period available to use.

A benefit period begins the day you’re admitted as an inpatient in a hospital or SNF. (See “Important note” below regarding outpatient and observation status.)
The benefit period ends when you haven’t gotten any inpatient hospital care (or skilled care in a SNF) for 60 days in a row.
If you go into a hospital or a SNF after one benefit period has ended, a new benefit period begins.
You must pay the inpatient hospital deductible for each benefit period. There’s no limit to the number of benefit periods.

2. You have a qualifying hospital stay.

This means an inpatient hospital stay of 3 consecutive days or more, starting with the day the hospital admits you as an inpatient, but not including the day you leave the Hospital.

Important Note
Time you’re being observed in a hospital or in an emergency room before you’re admitted doesn’t count toward the 3-day qualifying inpatient hospital stay. You may be classified as “outpatient” or “observation status” even if you spend the night in the hospital, so it is critical to verify that you have spent three days in the hospital under an inpatient classification. Otherwise, Medicare will not pay for your skilled nursing stay. See our article on “Hospital Observation Status”.

You must enter the SNF within a short period of time (generally 30 days) of leaving the hospital. After you leave the SNF, if you re-enter the same or another SNF within 30 days, you may not need another qualifying 3-day hospital stay to get additional SNF benefits. This is also true if you stop getting skilled care while in the SNF and then start getting skilled care again within 30 days.

3. Your doctor has ordered the inpatient services you need for SNF care, which require the skills of professional personnel like registered nurses, licensed practical nurses, physical therapists, occupational therapists, speech-language pathologists, or audiologists, and are furnished by, or under the supervision of, these skilled personnel.

4. You get the required skilled care on a daily basis and the services must be ones that can only be provided in a SNF on an inpatient basis. If you’re in a SNF for skilled therapy services only, and these services aren’t available at the SNF 7 days a week, your care is considered dailycare even if the therapy services are offered just 5 or 6 days a week.

5. You need these skilled services for:

An ongoing condition that was also treated during your qualifying 3-day inpatient hospital stay (even if it wasn’t the reason you were admitted to the hospital.)
A new condition that started while you were getting SNF care for the ongoing condition. For example, if you’re in a SNF because you broke your hip and then have a stroke, Medicare may cover therapy services for the stroke, even if you no longer need therapy for your hip.

6. The skilled services must be reasonable and necessary for the diagnosis or treatment of your condition.

7. You get these skilled services in a Medicare-certified SNF.

How Care is There can Help:

If you are a long distance caregiver or already busy with career and family responsibilities, you may not be able to coordinate your loved one’s discharge to an inpatient rehabilitation center. Care is There can help. We can:

Be your family’s contact with the discharge planning team
Clarify insurance options and other financial plans
Help you and your love one choose their inpatient rehabilitation provider
Attend the discharge meeting on your behalf
Arrange transportation to the rehabilitation center
Ensure a smooth transition into the rehabilitation center
Keep you informed

Also, read our article about Managing a Stay in a Rehabilitation Center.

Resources for Inpatient Rehabilitation

* The United Hospital Fund requires the posting of this disclaimer when linking to their website: “The United Hospital Fund is not responsible for information or advice provided by others, including information on websites that link to Next Step in Care and on third party sites to which the Next Step in Care links. Please direct any questions to nextstepincare@uhfnyc.org.”

Next Steps

Can’t be with your loved one to manage their discharge from the hospital to a rehabilitation center? We can help!

Contact Care is There today for a free consultation!

Central Virginia: 434.326.5323
Toll Free: 800.434.1633
Email: Info@CareisThere.com