Can Medicare prevent me from hiring a companion for a resident in a nursing home?

Tigger 20 asked...

Do the Medicare guidelines prevent a family member from employing a companion for a resident in a nursing home who is receiving skilled therapy and nursing services by that home? The family would be paying for this companion who is not a certified nursing assistant to sit by the bedside only.

Expert Answer

Medicare is not likely to know or care if you hire a private companion to sit with your relative while he or she is in a skilled nursing facility. However, the nursing facility itself might not permit it. Medicare nursing home coverage is provided only in a skilled nursing facility and only for a patient who needs daily skilled nursing care or rehabilitation while recovering from an injury, illness, or surgery. Your relative's need for daily skilled care, as prescribed by the treating physician and confirmed by the nursing facility and Medicare, is what determines Medicare coverage. The fact that you or other family members, or someone you hire, spends hours at your relative's bedside in the nursing facility, providing company and some extra comfort, is of no concern of Medicare.

Instead, the problem may come from the nursing facility or from your relative's physician. The nursing facility may have rules that limit or forbid outside paid aides, or may have strict time limits on visiting by anyone. Or, in the specific case of your relative, the nursing facility or your relative's doctor may believe that the assistance provided by the aide is not in the best interest of your relative's recovery. So, before you hire anyone to spend time with your relative, speak directly with the nursing facility to find out its general rules about outside aides, and to determine whether there are any specific restrictions regarding your relative in particular. Check also with your relative's treating physician -- if the nursing facility's rules permit it at all, the doctor might be a help in persuading the nursing facility to allow a paid commpanion in your relative's specific case.