Question: Over the past three years, my mother has been in and out of the hospital for treatment of a series of strokes after which she is sent to a nursing home for rehabilitation. In each instance, her Medicare insurance has covered the first 20 days. On one occasion, when she stayed for more than 20 days, her Medicare and supplement covered all of the costs. I am concerned that if she continues to be hospitalized, she will run out of lifetime nursing home days and the facility will require a deposit. Is there any way to prevent this from happening?

Answer: There is no such thing as “lifetime nursing home days” under Medicare – at least not yet. Generally speaking, your mother would pay nothing for the first 20 days of what are referred to as “covered services” each time she becomes ill. After the expiration of 20 days, assuming she still needs skilled care, her coinsurance will continue to pay for each additional day which is covered under Medicare up to an additional maximum of 80 days. Without a Medicare Supplemental policy, your mother would be paying $97.00 per day for days 21 through 100 during each benefit period. After 100 days, your mother would be totally responsible for the full cost of her care.

Regarding your question about deposits, it is illegal for skilled nursing facilities to require a patient to make a deposit or other payment as a condition of admission unless the services clearly will not be covered under Medicare.

Question: My father was discharged from the hospital directly home after his stroke without rehabilitation other than that which was given in the hospital during his eight-day stay and some in-home services now. I thought that he would be sent to another facility for rehabilitation under Medicare. Can I do anything about this as I think he needs more rehabilitation?

Answer: Whether or not a patient is sent to a nursing facility for rehabilitation depends on whether or not the physician certifies that inpatient rehabilitation services are reasonable and medically necessary. Should these services be needed, but not available at a skilled nursing facility or on an outpatient basis, your father would be entitled to rehabilitation on an inpatient hospital basis under certain circumstances.

All issues you now raise should have been raised during the discharge planning process before your father left the hospital. While discharge planning should begin when a patient enters the hospital, in many instances, such as yours, the family does not understand the importance of getting involved. Here, it appears to us that some rehabilitation was provided to your father in the hospital setting and some continues to be provided at home on an out-patient basis at home. There are no rules about how many hours per day of therapy should be given.

And even if your father is receiving rehabilitation, he must meet the “restoration potential” test, meaning that he must show progress to the extent that there is an ``….expectation that the patient's condition will improve significantly in a reasonable (and generally predictable) period of time.'' We suggest that you contact your father’s physician to get your answers.


Taking the NexStep: Because discharge planning is so important, yet so misunderstood, a practical videotape called “Discharge Planning” has been produced in association with South Carolina ETV. Available with an accompanying booklet for $15.95, this program can help you and your family understand and deal with the complicated issues. If you send a check payable to “Discharge Planning Video” in care of us, we will make sure you receive it.