Can Medicare deny future coverage for similar issues if Mom signs herself out of a nursing home?

2 answers | Last updated: Dec 06, 2010
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Caring.com User - Joseph L.  Matthews
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Joseph L. Matthews is a Caring.com senior editor, an attorney, and the author of Long-Term Care: How to Plan & Pay for It...
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The fact that your mother's doctors or the nursing home are not ”signing her out" to leave the nursing home serves two purposes. One, they are formally letting your mother See also:
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(and you) know that in their opinion she is not ready to go home, or that going home would be medically worse for her than staying in the nursing home. Two, they are protecting themselves against a claim of liability from your mother or her family if your mother checks out of the facility and then her condition becomes worse. But not being signed out by the doctors does not make your mother a prisoner in the nursing home -- no competent adult can be forced to accept unwanted care (unless the doctors used state law to keep your mother in the facility for a short time if they believed she was a danger to herself or others; if they wanted to extend such an involuntary confinement, they would have to go to court to do so). So, if your mother decides to leave the nursing home before her doctor discharges her, she has the right to do so.

If she does check out of the nursing home, this will NOT cause Medicare to deny coverage of future care for your mother's alcoholism or related problems. Medicare covers medically necessary and reasonable care at the time someone needs it, regardless of whether that person has refused the same or different care for the same illness in the past. Every patient has a right to refuse treatment or care, and it doesn't matter (for purposes of Medicare coverage) that such a choice may turn out not to eliminate the need for treatment in the future, or that it may mean the need for future treatment will be more extensive.

One thing you and your mother should be aware of, however, is that her decision might affect what kind of care Medicare or her doctors will consider reasonable in the future. Medicare or her doctors might decide that some types of treatment for her alcoholism -- certain kinds of therapy, for example -- are not appropriate for her if she is at home and seriously relapses, whereas such treatment might be approved if she were staying in a stable, controlled environment such as in a nursing home. These kinds of things are extremely hard to predict, however, and in general your mother will continue to receive Medicare coverage regardless of where she is staying.

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An anonymous caregiver said...

Joseph Matthews answer is an excellent response. But the questionner must also realize that her mother is an addict, and should there be one little slip up in her sobriety, she will again, lie, lie, lie. The trust can only be built slowly, and you cannot take what they say at face value for a long time. You will need to verify everything they say.

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