Will my grandmother lose Medicare benefits if she is checked out of a rehab center without a doctor's approval?

Rrdeon asked...

My grandmother is 92 and she fell and broke her hip June 24. She was placed in a Health and Rehabilitation Center. She is not doing well. She will not eat and only wants to go home. My mother has medical power of attorney and has made arrangements to take her home to live with her. The facility that she is in is telling my mother that she can bring her home without the doctor recommending and signing off on it but that if he doesn't recommend it my grandmother cannot get any help from Medicare for such things as a hospital bed, etc. My mother is very upset and is afraid my grandmother is going to get dehydrated and is starving herself. Does my mother have a legal right to take my grandmother TODAY? Is it true that Medicare benefits stop if she does?

Expert Answer

It sounds like the facility is badly overstating the case -- Medicare benefits will not stop. Your grandmother has every right to leave the facility if she wants to, and your mother has a legal right to check her out of the facility and take her home (assuming she has a properly executed power of attorney from your grandmother). The real question is, what happens next?

The facility people might be trying to say that for your grandmother to receive Medicare coverage for any medical carehome health care, or medical equipment (like a hospital bed) and supplies, while she's living at home, a doctor must determine that the care or equipment is "medically necessary" and must give a prescription for it. Your grandmother's doctor might not agree with the decision to take your grandmother home, but the doctor can't stop providing proper, medically necessary care for your grandmother just because the doctor thinks your grandmother would be better off in the facility. If your grandmother is determined to stay at home, the doctor should prescribe all appropriate medical care and equipment to care for her there. And if the doctor properly prescribes something for your grandmother which Medicare normally covers, Medicare won't refuse coverage just because she could be in a nursing facility instead.

The key thing in this situation is to convince your grandmother's doctor of how important it is for your grandmother to be at home, and then to get his cooperation in getting the most Medicare coverage possible for her care there. Even with the doctor cooperating, though, Medicare coverage for home health care is limited both in terms of how often a home health care nurse or aide will visit, and how long the visits will continue. Because of these rules, your mother and other family members may have to do a tremendous amount of caregiving for your grandmother on your own (which may be why the doctor thinks a facility is a better place).