Nursing Home Patients Need To Know Rights Before They Are Kicked Out

A new report warns nursing home patients that they have the right to appeal Medicare discontinuance prior to being kicked out of a nursing home for lack of Medicare coverage. In one case, a woman's Medicare coverage was running out, and in mid-February, her nursing home told her she would have to leave. She had multiple health issues, including a pressure sore on her tailbone and congestive heart failure. The woman did not know that she had a right to appeal Medicare’s denial. She was discharged to her daughter’s one-bedroom apartment and lasted there only a week before being rushed by ambulance back to a hospital with fluid retention in her lungs. She died in another nursing home in late June at age 65. He daughter said, “To me, you don’t send a sick person home who shouldn’t be home and can’t do anything for themselves. It’s crazy, and I’m stuck picking up the pieces.”

Advocates for nursing home patients say this case illustrates a growing problem. Medicare — public insurance for the elderly and disabled — covers most of the costs of skilled nursing for up to 100 days after a hospital stay. But many patients do not realize that, when Medicare coverage stops, they have other options. Many nursing homes do not inform patients of these different options. “What they say is, ‘Medicare has stopped paying, so you’re going home tomorrow,’ ” said Mark Davis, long-term care ombudsman at the Center for Advocacy for the Rights and Interests of the Elderly (CARIE) in Philadelphia. Patients have the right to appeal termination of coverage, and they also have the option of paying out of pocket or applying for Medicaid, which reimburses facilities at a fraction of their rates. Davis said his agency had received eight complaints, including the case above. For more about this issue, please read the story.


Robert W. Carter, Jr. is a Virginia attorney whose law practice is dedicated to protecting the rights of the victims of nursing home and assisted living neglect and abuse in Richmond, Roanoke, Norfolk, Lynchburg, Danville, Charlottesville, and across Virginia.




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