Loved ones are often quite confused when a family member requires nursing home care. For them, the event is both new and unique, and for them, it is.  But from a broader perspective, a person’s need for nursing home care and their entrance into a nursing home follow a very common pattern.  Knowing these patterns can prove helpful and will make you feel less adrift if you find yourself in this situation.

For many elderly individuals, the need for long-term care begins with a trip to the hospital, perhaps after a fall in their home. They will stay in the hospital for several days, then they will be discharged to a “rehabilitation center.”  The rehabilitation or rehab center is really a nursing home.  Technically it is called a sub-acute care facility.

Most nursing homes have both a rehabilitation section and a long-term custodial care section. The long-term section is what most people would call a nursing home, but if you didn’t know which section of the nursing home was which, you would be unable to distinguish the rehabilitation section from the custodial care section.

It is important to be discharged from the hospital to a nursing home where you might want your family member to stay if he requires long-term custodial care. Getting your foot into the door of the nursing home where you want your family member to stay is important.  Nursing homes want rehabilitation patients.  For the elderly and disabled, Medicare covers rehabilitation services.

Medicare’s reimbursement rate to nursing homes is quite good, so nursing homes like to take patients who require rehabilitation. Nursing homes also like to receive referrals from hospitals, so they are eager to accept referrals from hospitals for rehabilitative services.

After your family member has entered the nursing home for rehab, you may discover that your loved one does not have the ability to return home. The staff of the nursing home might tell you that you need to look for a long-term care facility that can care for your family member.  They might tell you that all of their Medicaid beds are full and that they have a waiting list for long term care beds.

Despite what the staff of the nursing home might tell you about “not having a Medicaid bed,” in New Jersey, most every bed in every nursing home is dual certified for Medicare and Medicaid coverage. This means that rehabilitation services will be covered (by Medicare) and custodial care could be covered (by Medicaid).

Once your family member enters the rehab center, he is already in a Medicaid bed, and the facility cannot discharge him for lack of a bed. Even if the bed weren’t Medicaid-certified, the nursing home, not the family, must find a facility that will accept the patient as a long-term resident, and the facility cannot discharge your family member until they find a facility that will accept him.  The facility tries to make this your burden, but the reality is, the burden is theirs, not yours.

Finally, the staff of the nursing home might tell you that if your family member is going to stay in their facility and if he is going to apply for Medicaid, then you have to use the company they recommend to help you apply for Medicaid benefits. The owners of these Medicaid application companies are often related in some manner to the owners of the nursing homes and are very loyal to the owners of the nursing homes.  The companies often charge more than an attorney would charge, yet the companies cannot provide the same level of services that an attorney can provide because there are certain services that constitute the practice of law and only attorneys can provide those services.  The truth is, you have the right to apply for Medicaid on your own or to hire whomever you wish to hire to help you file your application for Medicaid benefits.