One of the most stressful calls a family can get from a nursing home or rehab facility sounds something like this:
“Medicare is ending Friday, so your mom is being discharged.”
The family immediately starts scrambling. Can Mom safely go home? Who will care for her? Does she need assisted living? Can she stay at the nursing home? How will we pay for it?
But there is an important question families should ask first:
Is Mom really being discharged — or is Medicare simply stopping payment for her rehab?
Those are two very different things.
Why This Matters
Many people enter a nursing home after a hospital stay for short-term rehabilitation. Medicare may pay for skilled nursing care and therapy while certain requirements are met.
Eventually, the facility may determine that Medicare coverage is ending.
When that happens, the resident generally receives a Notice of Medicare Non-Coverage, often called a NOMNC.
This notice is about payment. It tells the resident when Medicare expects to stop paying for skilled care.
It does not automatically mean the resident has to leave the nursing home.
That distinction can be very important.
A person may no longer qualify for Medicare-paid rehabilitation but still need nursing home care. If so, the next question becomes how that care will be paid for.
Depending on the circumstances, the answer might be private payment, long-term care insurance, or Medicaid.
A Real Nursing Home Discharge Is Different
Federal law gives nursing home residents important protections against improper transfers and discharges.
A nursing home generally cannot simply tell a resident, “Medicare stopped paying, so you have to leave.”
There are specific reasons a nursing home may legally transfer or discharge a resident. There are also notice requirements and appeal rights.
The notice should explain why the resident is being discharged, when the discharge will occur, where the resident is expected to go, and how the resident can appeal.
The Center for Medicare Advocacy is a great resource for appeals, and you can find more information by clicking here.
So if someone tells you that Mom is “being discharged Friday,” ask to see the actual written notice.
You may discover that what the facility is calling a “discharge” is really just a notice that Medicare will no longer pay for rehabilitation.
Medicare Ending Does Not Mean Care Is No Longer Needed
This is another common misunderstanding.
Medicare may stop paying for skilled rehabilitation even though a person is still unable to safely live at home.
For example, Mom may still need help getting out of bed, using the bathroom, managing medications, or walking safely. She may have dementia, confusion, a high risk of falling, or need supervision throughout the day and night.
Dad may be 85 years old himself and physically unable to provide that level of care.
Ending Medicare coverage does not make those problems disappear.
That is why families need to separate two questions:
Will Medicare continue paying?
and
Where can Mom safely receive the care she still needs?
The answers may be very different.
Medicaid May Be Part of the Solution
If someone needs to remain in a nursing home after Medicare rehabilitation ends, this is often the point where long-term care Medicaid planning becomes important.
Many families assume Medicaid is only for people who have very little money.
That is not necessarily true.
Michigan Medicaid helps many middle-class families pay the enormous cost of long-term nursing home care. There are detailed rules involving assets, income, spouses, gifts, transfers, the family home, and other property.
Good planning can sometimes protect significant assets while still helping a loved one qualify for benefits.
Timing matters, though.
Waiting until the facility says Mom must leave can make an already stressful situation much harder.
Be Careful About an Unsafe Trip Home
Most people would rather be home than in a nursing home. And most families would love to bring Mom or Dad home.
But wanting someone home and being able to safely care for that person at home are two different things.
Before agreeing to a discharge home, ask practical questions.
Can your loved one get in and out of bed safely? Use the bathroom? Walk without falling? Remember medications? Be left alone? Navigate stairs? Manage confusion or wandering?
And perhaps most importantly:
Who is actually going to provide the care?
A discharge plan that depends on an elderly spouse or adult child providing round-the-clock care may not be a realistic plan at all.
Simple Lesson
The end of Medicare rehab coverage does not necessarily mean it is time to pack the bags.
Understanding the difference between Medicare payment and a true nursing home discharge can give families valuable time to make better decisions about care, Medicaid, and the safest place for a loved one to live.
Action Step
If a nursing home or rehab facility tells you that your loved one is being discharged, ask for the notice in writing.
Find out whether it is simply a Notice of Medicare Non-Coverage or an actual transfer or discharge notice.
And before agreeing to bring your loved one home, make sure the plan is truly safe and realistic.
If long-term nursing home care may be necessary, this is also a good time to talk with an experienced Michigan elder law attorney about Medicaid planning and your options.
If this topic raises questions for you or your family, feel free to call (517) 548-7400 or contact us online: https://www.michiganestateplans.com/contact-us
