Question: My father was admitted to a skilled-care nursing facility in March after a series of strokes for rehabilitation. Within weeks, his Medicare ran out because he was not making improvement, and we helped Mom apply for Medicaid because their assets are limited.

But before he qualified for Medicaid, he developed other medical problems that required a six-day hospitalization last month. When the doctor released him to go back to the nursing home, we were told by the nursing home that his bed had been filled, and we would have to find another place for him. This was even though we had left all of his clothing, etc. in his room.

Not knowing any better, we picked up his belongings and took him home, which we now find was a mistake since our mother at age 83 is unable to care for him. My brother and I both work, and can’t afford sitters. Is there anything we can do?

Answer: Residents of nursing facilities who require hospital treatment during their stay count on being returned to the same room and bed they left after they are discharged. But whether that room and bed are available sometimes depends on the resident’s source of pay.

While The Nursing Home Reform Act provides residents who have qualified for Medicaid with what is called “Bed Hold and Readmission” rights, this federal law does not apply to Medicare.

In other words, nursing home residents who have qualified for Medicaid and leave a nursing facility for hospitalization or therapeutic reasons have the right to return for a certain period of time, and the facility must hold their bed for that certain period of time. However, should the period of hospitalization exceed the Medicaid bed hold period, and should the resident still require skilled or intermediate nursing services, by law, he or she is entitled to the first available bed in a semi-private room at the facility.

While the exact number of “bed reservation” days may vary from state to state, according to federal law, Medicaid will pay for up to 15 “bed reservation days” on behalf of hospitalized recipients and for not more than 21 days each year for temporary absences due to family outings, holidays, etc.

But once these bed hold payments have been made, the only way for a Medicaid resident to reserve his or her bed is for the family to do so at the daily rate set by Medicaid for that facility.
On the other hand, Medicare does not fund any bed reservation fees, meaning that if Medicare and private pay residents wish to protect their beds, either they or their families must foot the bill.

In the situation you describe, we have found that most nursing facilities will point out to the resident or family the need to pay to reserve the bed during a hospital stay.

Taking the NextStep: Had your father qualified for Medicaid before his hospitalization, we don’t believe that the six days he spent in the hospital would have exceeded the bed hold period, and Medicaid probably would have paid.

However, because he had not yet qualified and because Medicare would not pay (even if his care was still covered), your family should have been informed at the time of admission about bed hold policies in writing. And to be very fair to the facility, in the package you received at admission, we would be willing to bet that this process was explained.