To the editor:
My mom is 98 and lives at her home with some help. She is incredibly sharp, is easy to talk with, has a good sense of humor and doesn’t complain. Her mobility is limited to a walker and a wheelchair. Over the recent years she has been in short-term rehab five times. Each time she’s in the hospital for a few days prior to rehab. Medicare rates short-term rehab facilities with one to five stars. She has mostly been in five-star facilities but was in a three-star facility this past summer. At the three-star facility they gave her the wrong medication and hurt her leg moving her, resulting in extending her rehab by several weeks.
When it is time to be released from the hospital, the social workers at the hospital asks for or suggests rehab facilities. One needs to study the Medicare website to identify the five star facilities. If you have time, visit the facilities and talk with the facility directors.
There are eight five-star facilities in our area that are not-for-profit. I prefer the not-for-profit facilities because I believe they are less likely to cut corners. A great facility will employ directly the PT, OT, speech therapy, etc. providers. Other facilities outsource these providers and in my experience they are much less qualified, give short sessions and simply don’t care as much.
If there are no great facilities available upon hospital discharge, you have the right to challenge the hospital discharge and are automatically entitled to two additional hospital days paid by Medicare. During that time frame, there is a reasonable chance a bed may be available at a great rehab center.
If the rehab center determines the patient is not making sufficient progress, Medicare will no longer pay for rehab—private pay is $600 – $800 per day. You have the right to contest the decision to a Medicare outsourced third party who will decide quickly. We contested the decision and won three extensions. Our argument was mainly that 95+ year olds takes longer to recover.
One is entitled to up to 100 days in rehab paid by Medicare as long as the patient is progressing. Also, as long as there are 60 or more days between rehab stays, the clock resets and Medicare will pay.
I hope this is help to those with elderly parents.
Frank Pinto
Wellesley resident
