Can the Nursing Home Send Mom Home?

When a family member needs long-term care in a nursing home, her family is often distraught—distraught because mom is failing mentally and physically, distraught because the family is unable to provide the care mom needs, distraught because the family is concerned no nursing home will care for mom and mom will end up in a “government run” facility.  In this article, I want to address this last issue.

Most frequently, the way a family member ends up in a nursing home is as follows:  Mom, who is in her 80’s or 90’s, has a traumatic health issue in her home—perhaps she falls and breaks a hip.  Mom is brought to a hospital where she has surgery for her broken hip.  After the surgery, mom stays in the hospital for several days, being observed and participating in acute rehabilitation.

The hospital then discharges mom to a rehabilitation (or rehab) center.  And here is one of the first misconceptions that family members have.  Most every rehab center in New Jersey is really a nursing home.  Most rehab centers are sub-acute rehabilitation facilities.  Those sub-acute facilities are subsections of nursing facilities, that is, nursing homes.  In other words, when most people say that mom is in “rehab,” mom is really a resident of a nursing home; she is simply receiving sub-acute rehabilitation services in the nursing home.  (Acute rehabilitative services are typically provided in a hospital, though there are a few stand-alone rehabilitative facilities in New Jersey.  The vast majority of rehab occurs in sub-acute facilities, that is, in nursing homes.)

At this point in time, the family (and mom) may believe that mom will be returning home, and in most cases, mom will be returning home.  But, if mom does not return home and needs to “find a nursing home,” then mom needs to look no further than the room in which she currently lives.  Mom is in a nursing home.

When mom is in this situation, she is often scared and anxious.  Her family is often scared and anxious.  But what makes mom and her family the most vulnerable is the fact that they lack knowledge as to how the long-term care system works.  As I say, most people believe that mom is in a “rehab center,” not a nursing home; they fail to understand that mom is already the resident of a nursing home at the time she is receiving rehabilitative services.

If a person is not receiving rehab services in a nursing home, then she is receiving custodial care (long-term care) services in the nursing home.  Medicare pays for rehab services.  Medicaid or the family pays for long-term, custodial care.  Nursing homes like to provide rehab services because Medicare’s reimbursement rate is high.  Medicaid pays nursing homes far less than Medicare, and family payment is always in question; in the back of the facility’s mind is the question—Does mom or the family have the necessary assets to pay the facility?

For this reason, when rehab is concluded, nursing homes want to discharge the resident, and here is where the mistruths and misconceptions often come into play.  The nursing home staff is not personally invested in mom’s plight.  The nursing home staff have a great deal of knowledge as to how the system works.  The family is fully invested in mom’s plight and is, therefore, anxious and has little to no knowledge of the system.

“We have no Medicaid beds,” the facility will tell the family.  The truth is, in most every nursing home in New Jersey, every bed in the facility is dual certified Medicare and Medicaid eligibility.  Mom is already in a Medicaid bed.  “We have a waiting list,” the facility will say.  Once again, mom is already in a Medicaid bed.

“You have to take mom home and you have to provide care to her,” the facility will say.  The facility is actually obligated to care for mom and cannot relieve themselves of that obligation unless the facility is approved by the State to discharge mom, which requires the facility to come up with a comprehensive discharge plan.  The discharge plan cannot be that the family will care for mom because the facility has no obligation whatsoever (other than a moral obligation) to care for mom (or to pay for mom’s care).  In my twenty-five years of practicing elder law, I have never once seen a nursing home get approval from the state for such a discharge plan.

Know your rights.  Consult with a Certified Elder Law Attorney if your mom needs care.  Do not put yourself in a situation where you do not know the facts.