Edith, Sandy's mother, spent a several days in the hospital after her stroke. The therapists then recommended that Edith move to a skilled nursing facility for more therapy. Edith was improving, but she needed more rehabilitation.

Edith had a good secondary insurance policy, so Sandy wasn't worried about her mother's rehabilitation being covered. She knew Medicare would cover up to a maximum of 100 days of inpatient therapy. When the rehab center said they were ready to send Edith home, Sandy advocated tirelessly for her mother to be allowed to continue therapy. Sandy ultimately convinced the
center to keep Edith several more weeks.

A little more than nine weeks after what would have been her original rehabilitation discharge date Edith had a set-back when she fell at the rehab center. She suffered a hairline fracture of her hip and went back to the hospital for a few days.

Even though this second time in the hospital was for a brand new medical problem Edith hadn't been out of the hospital and rehab for 60 consecutive days, so her re-hospitalization was considered to be a continuation of her first stay. After this second hospital stay Edith could probably have gone directly home, but Sandy again advocated strongly for what she thought her mother needed, and Edith returned to the rehab center for more physical therapy.

She is still unstable when she walks and needs to be watched closely so she doesn't fall again. She has now used up almost of her 100 maximum allowable rehabilitation days. She is still in her first Hospital Benefit Period because she has not been out of the hospital or rehabilitation facility for at least 60 consecutive days.

Now some hard decisions have to be made. Edith could stay on in the skilled nursing center for another week or two to take advantage of all the therapy she can get. That might make all the difference in preventing another fall. But that would also use up all of Edith's remaining rehabilitation days. Or, she could go home and begin working on the 60 days she has to remain out of a
medical facility. She could try to re-set her eligibility clock at home and keep those few remaining days available, just in case.

Whatever Sandy decides for her mother, they will be taking a gamble.

Until Sandy finally called me she didn't completely understand that her mother's "clock" hadn't been re-set for up to 100 new days with the second hospital stay. It's unfortunate, but many hospitals and skilled nursing facilities don't do a very good job of explaining this to families until the days have been all but exhausted. And not understanding how the Medicare system really works can have serious consequences for both the patient and the family.

How Medicare Benefit Periods Affect
Medicare Rehabilitation Days

When it comes to the hospital (Medicare Part A), Medicare works by "Benefit Periods" rather than on an annual basis like most health insurance. After a hospitalization the patient must stay out of the hospital or other Medicare facility (like a rehabilitation or skilled nursing facility) for at least 60 consecutive days in order to re-set the clock and earn eligibility for a new Benefit Period.

If the patient goes back to the hospital within 60 days of being discharged from a Medicare facility (hospital or skilled nursing/rehabilitation), it is considered to be part of the first hospital period, even if it is for a new medical problem. This has serious consequences for allowable rehabilitation days, as we saw with Edith. The second time she came out of the hospital, rather than starting fresh with another 100 potential days, as Sandy thought, she picked up her rehabilitation days where she left off.

When she has used up all of her allotted days, any additional skilled care Edith needs outside of the hospital will have to be paid out of her own pocket until she has been out of the Medicare inpatient system for at least 60 days.

So when Sandy thought she was helping her mother by pushing to extend her stay in the rehab facility, she was using precious rehabilitation days that she could possibly have saved. Edith could have been out of the "system" for more than 60 days when she fell, and she could have had a new Benefit Period. I really fault the rehab staff for not making this clear to Sandy, but here we are.
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Wisdom doesn't necessarily come with age. Sometimes age just shows up all by itself.

- Tom Wilson
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Mother's Day is May 8. Have you panicked yet? Do you have a wonderful idea for something your mother will love, doesn't already have, won't take up too much space or have to be dusted, doesn't cost an arm and a leg and that you won't have to drive all over town trying to find?

No? Didn't think so. Me, too.

Make a quick visit to the Gold Violin http://www.goldviolin.com This delicious web store has quite a selection of affordable, interesting, unique and fun things that will appeal to our older loved ones. You can search and sort by price, among other things. I love that.

They have things that will appeal to both men and women, so get two birds with one stone and shop for Dad's Day, too.

Their shipping charges are a little inflated, I think. But when you consider you save bundles of time and gas money as well as sales tax you probably come out ahead.

I'm not on their payroll, and they don't know I'm sending you. Again, Gold Violin at http://www.goldviolin.com

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Elder CareTip

How long has it been since you really looked at the front of your older person's home? If it's a house - single or multiple family - take a slow cruise past the front next time you visit. Can you see the house number easily from the street? Numbers painted on the curb fade over time, and you can't see them if there is a car parked in front of them. Numbers on the side of the building can fade or become obscured by foliage that has grown up. Numbers on the door are often too small to be easily read from the street.

Put yourself in the shoes of emergency personnel and freshen up your home I.D. Make sure the house number reflects light at night and that there is good color contrast against the house during the day. Make them bigger than you think they need to be so anyone can read them from the street.

You can also buy portable flashers to put in a front window or on the front stoop to further alert emergency personnel that they have the right address. But the house number comes first.
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If you've got an Elder CareTip you'd like to share, please send it to
mailto:molly@eldercareteam.com with the subject line "care tip."

Let me know if I can use your name. Or if you'd rather have me leave your name off, that's OK, too.

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Fear grows in darkness; if you
think there's a bogeyman around, turn on the light.
- Dorothy Thompson
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That's it for now. Don't keep us a secret. If you know other people who should be reading this too, then do them and us a favor by telling them about Elder CareTips(TM). Just send them this link:
http://eldercareteam.com/resources/newsletter.htm

Until next time -

Molly

Do you know why you should count the wheelchairs in the dining room of any assisted living residence you might be considering? The answer is on page 60 of the newly-released print edition of The Insider's Guide To Assisted Living, now available here and on Amazon.com. Read it before you look and you'll probably know more than the manager.

©2005 Molly Shomer, All Rights Reserved. You are free to use material from Elder CareTips: Mastering The Eldercare Maze™ as long as you include complete attribution, including live web site link and email link. I would appreciate it if you would let me know where the material will appear.

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The Eldercare Team
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email: info@eldercareteam.com
©2005
Advanced Professional Member
National Association of Professional Geriatric Care Managers