Can a nursing home refuse? Yes. They can refuse for lots of reasons.
Medicare Insurance Provider? Like a Medicare HMO? If the patient meets the criteria (usually that they have had so many nights inpatient at hospital) and the insurance isn't willing to cover it, appeal it or file a grievance. Ask what home help they are going to provide. Remind them it is more cost effective to have the patient get the treatment at a SNF than to go home to early and wind up back in the hospital.
Worst case, if the patient is sent home and is still sick or gets worse, send them back to the hospital.
Boy, the healthcare system is really ridiculous, isn't it. Yes, you'd hate to use hospitals for everything, but if that's what it takes, I vote for that route. Is there a supervisor or advisory board you can talk to at the insurance provider?? Or, write a stern letter so it's in writing....you never know.
I'm learning a ton about Nursing Homes right now. Most are truly run "efficient" businesses. Many are now focussing on "Rehabilitation Services". Hence, when they do this, Medicare pays for the first 100 days of care, when that is finished the nursing home can let that person go. Go where???? #1. HOME or #2. INTO THEIR NURSING HOME or #3. INTO ANOTHER NURSING HOME---assuming the patient has $$$$$. Most Nursing homes in my area are limiting the number of Medicaid beds, hence...again focussing on those folks whom can "self-pay", folks whom will provide the nursing home with a PROFIT. The nursing homes seem to be screening their patients completely, and I truly don't believe there is any re-course for us. They are businesses.
