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

2 answers | Last updated: Oct 13, 2016
A fellow caregiver asked...

My mother is an alcoholic. She had health issued due to her drinking and depression in May of 2010. Her nutrient levels were rock bottem, she was seeing double and having difficulty walking. After a couple of days in the hospital, Medicare said her tests were fine and that she needed to leave the hospital, but since she was still having trouble walking, she was sent to the local nursing home for some rehab. After a couple of weeks there she passed whatever was required by Medicare. My sister (who now has nothing to do with my mother or her care) painted an awful picture of my mother and her home. She described her home as looking like an "alcoholic version of hoarders". I have since seen the show and my mothers home was not nearly as bad as these homes. But she told everyone that she didn't want her to go home and at the time I agreed with her. After 4 months now, my mother feels good and is on medication. But the doctor's are dragging their feet on signing her out of the nursing home. Claiming their afraid that she will go home, drink and not take care of herself. She disagrees and has said "please, let me try". If she signs herself out against medical advice will she loose any Medicare coverage or if she does relapse and need medical attention due to alcohol abuse will she still be covered. If she continues to see her therapist, would that be considered extended care. She has done everything the doctor's have asked of her while in the nursing home, so is it really against medical advice? I would like to see her out of the nursing home, given a chance and save any life savings that is left (since she is private pay at the nursing home). Doesn't everyone deserve a chance?

Expert Answers

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 (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.

Community Answers

A fellow caregiver answered...

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.