Can't we admit my grandma with a broken hip where she'll get medical care instead of a nursing home?

1 answer | Last updated: Oct 03, 2016
Skle1978 asked...

My 97 grandmother is living with my brother. She wandered last night without her walker, fell and broke her hip. Now the hospital wants to ship her off to a long term care facility (not even 12 hours after her fall). They say that this will not be covered because she needs to be in physical therapy for it to be covered, but she can't start PT until her hip heals. Can't we admit her somewhere for actual medical care that will be covered by medicare rather than having her sit in a nursing home that is doing nothing to care for her break??

Expert Answers

Kay Paggi, GCM, LPC, CGC, MA, is in private practice as a geriatric care manager and is on the advisory board for the Emeritus Program at Richland College. She has worked with seniors for nearly 20 years as a licensed professional counselor, certified gerontological counselor, and certified geriatric care manager.

I've never heard of a hospital discharging a patient before they are ready for rehab. There are lots of uncertainties now among Medicare providers that due to proposed cuts, they will not be paid for services rendered. This hospital may be afraid that they will not be paid for your grandmother's stay.

I recommend that you contact Medicare immediately, 1-800-MEDICARE and ask about your grandmother's benefits. Second, speak to a hospital representative, such as an official in the discharge department, and ask if this is legal. Third, talk to someone at the rehab facility where your grandmother will be taken. Find out how long she will be there before they can begin therapy and apply for Medicare reimbursement.