The holiday season is all about family, joy, and coming together. It’s a time to reconnect with loved ones, enjoy special meals, and make lasting memories. But if you or someone you care about is in a Medicare-covered nursing home, you might wonder: Can you leave the nursing home to spend the holidays with family? Here’s what you need to know.
How does Medicare cover nursing home stays
Medicare helps cover the costs of various healthcare needs, including short-term stays in skilled nursing facilities (SNFs). If you’ve been hospitalized and need follow-up care, Medicare Part A might cover your stay in a nursing home. This coverage includes things like daily skilled nursing care, physical therapy, and other rehab services.
However, there are limits to how long Medicare will cover these stays. Here’s what you need to know about eligibility and coverage:
- Eligibility: To get Medicare coverage for a nursing home stay, you generally need to have been in the hospital for at least three days before moving to the nursing home.
- Care Requirements: To be covered, the skilled nursing care or therapy services you receive must be deemed necessary and provided by skilled professionals.
- Coverage Duration: Medicare covers up to 100 days of skilled nursing care per benefit period. The first 20 days are covered in full, but after that, there’s a daily co-payment required for days 21 through 100.
Leaving your nursing home: what you need to know
Medicare Coverage and Absences:
Medicare coverage for skilled nursing facility care is typically strict about temporary absences. This might not be a problem if your family lives close to the facility you’re staying at and can pick you up and drop you back on the same day.
If you leave the nursing home for more than 24 hours, however, Medicare might view it as a discharge from the facility and stop covering your stay. Depending on the length of your absence and your health needs, this can involve formal re-admission, and it might lead to additional out-of-pocket costs if a new benefit period is required or if there is a lapse in coverage.
Discharge and Re-Admission:
When you return to the nursing home, the facility might need to reassess your condition to determine if you still qualify for Medicare coverage. This reassessment could delay your care or result in changes to the type and level of care provided.
Additionally, if your absence was considered a discharge and you’re required to start a new benefit period, it could impact the number of covered days under Medicare.
Communication with Your Facility:
Before leaving, it’s important to have a clear and open conversation with your nursing home’s administration to avoid complications and ensure that your holiday visit does not negatively impact your care.
Ask about their specific policies regarding temporary absences and get written confirmation of how a holiday visit might affect your coverage and stay. Additionally, make sure you understand any required paperwork or procedures you need to complete before leaving and upon returning.
Alternative Arrangements:
If a temporary leave from the nursing home is not feasible due to Medicare restrictions, consider alternative ways to stay connected with family during the holidays. Many facilities offer special holiday activities or events that can bring the holiday spirit to residents. Additionally, facilities often have large and comfortable family rooms where the family can cook and serve a meal together and visit, just like at home.
There are also virtual visit options such as Zoom video calls or Facetime, which can be as easy as having a family member visit with an iPad and connect with the rest of the family without leaving the facility. Check with your facility’s social services or activities coordinator to explore these options.
The top 7 questions we get about leaving a nursing home for the holidays
- How do I find out if my nursing home treats a temporary leave as a discharge? To get a clear answer, just ask your nursing home directly. Check with the administration about their policy on temporary absences and how it affects Medicare coverage. It’s a good idea to get this information in writing so you have a record of their policies and any agreements.
- How can I find out if my nursing home’s policies are stricter or more lenient compared to others? Nursing home policies can vary, so it’s worth comparing your facility’s rules with others if you can. You might also want to chat with a Medicare advisor or insurance professional who can offer insights into different facilities’ practices and help you understand your options.
- What if I need medical care while I’m away from the nursing home? If you need medical attention during your absence, make sure to arrange it ahead of time. You might need temporary care at your family’s home or local medical services. Keep your nursing home and family informed about your plans to ensure everything goes smoothly and you get the care you need.
- What should I know about the financial side of taking a temporary leave? There could be extra costs if you have to restart your benefit period or if your coverage lapses. Before you leave, ask about any potential charges and how to manage them. A financial advisor or your nursing home’s billing department can help you understand what to expect.
- Can I appeal if Medicare changes my coverage because of a temporary leave? Absolutely! If Medicare’s decision impacts your coverage, you can appeal it. Reach out to Medicare directly or get help from an insurance advisor to understand the appeal process, gather the necessary documentation, and make your case.
- Are there any exceptions to the usual rules for temporary absences? While the general rules apply, there might be exceptions based on specific situations or facility policies. It’s important to discuss your particular case with your nursing home administration and Medicare representatives to see if any special considerations apply to you.
- Where can I find more information about Medicare coverage and policies? For Medicare-related questions, detailed information and support, call the Medicare hotline at 1-800-MEDICARE (1-800-633-4227). You can also speak with a Medicare expert here at Guided Solutions — we’d be happy to help you out. If you prefer to speak in person, you can call the number of your nearest Medicare office.
We hope you feel the joy of the holiday season
Spending the holidays with family is something we all look forward to, but if you’re in a Medicare-covered nursing home, it’s important to understand how taking a break might affect your stay.
Medicare has some limits on temporary absences, but with a bit of planning and a chat with your nursing home, you can make sure everything goes smoothly. This way, you can focus on enjoying the season with your loved ones without any surprises.
If you have questions about Medicare coverage and nursing home stays, contact the online Medicare experts at Guided Solutions. We’re happy to help as much as we can!
Happy Holidays!