Many seniors do well while living at home without being in a residential senior setting. They are fairly self-sufficient and are not yet plagued with age-related memory loss. Sometimes the only things they now need assistance with would be the heavy duties such as taking care of the lawn and garden, or deep cleaning the home.
Even so, there may be times when a slip and fall could result in a broken hip which would necessitate surgery. After several days in the hospital, they are released but in no condition to care for themselves or their basic needs. This is where Medicare Part A kicks in if you have it, but there are some conditions you need to be aware of before you qualify for a skilled nursing facility.
1. Medicare Part A Benefit Days
One thing to be aware of is that Medicare will not cover extended, long-term stays in a skilled nursing facility. However, Medicare Part A will cover a skilled nursing facility for post op care for any unused remaining days. In general, Medicare will kick in if the following conditions are met which limit your stay to 60 days. It begins upon admittance to the facility and ends 60 days later. If you should need a longer stay than that, you would need supplemental insurance or be able to pay out of pocket.
2. Qualifying Hospital Stay
This is the first condition which must be met, other than having Medicare Part A. You must have been admitted to a hospital for a period not less than three days. This is referred to as a “qualifying hospital stay” after which the next condition must be met.
3. Doctor Recommendation
Another very important qualification would be admittance to a skilled nursing facility on a doctor recommendation. If they feel this would provide you with the post-op care you need, then they will write the referral. It is imperative that the care provided would be at a skilled nursing facility that meet certain criteria. Any doctors, nurses and therapists must have a direct certification in the type of care you need. For example, after a broken hip and perhaps a hip replacement surgery, you will need physical therapy to get back on your feet and walking securely.
4. Facility Medicare Certified
Finally, not all facilities are Medicare certified. Medicare will only pay for skilled nursing facilities that are certified within the system and no exceptions are allowed. This is where your doctor or the hospital social worker or patient advocate can help you find a qualified facility. If it’s something you’ve never had need of before, it may take some research to get into a facility covered by Medicare with the services you need.
If you are not ready to be released from the short-term post op care at the nursing facility where you are getting cared for, you must be able to pay out of pocket or have a supplemental insurance coverage for the remaining days. Most cities have Medicare certified skilled nursing facilities, so it should be no problem finding one. If not, neighboring communities may be an option.
