Move from hospice to facility

[Anonymous]

MIL started hospice 2 weeks ago, (diagnosed with pulmonary fibrosis and has severe memory issues)but has also fallen twice when the nurse was not there. Hospice is working on finding her a facility and assigning a social worker. They are moving her out to a facility, since she was approved for hospice would she also be covered for care in a facility? I am trying to support my husband and his sister who are navigating this but also don't want to step on any toes. MIL worked for the gov and has great insurance on top of Medicare B. Any hints or tips would be greatly appreciated (they are in PA)

[Anonymous]

By facility...do you mean in patient hospice or skilled nursing? Skilled nursing is not covered by medicare or health insurance except for a limited time after a hospital stay. It is covered by Medicaid if there are very few assets. In patient hospice is covred by medicaire but that is usual for people on their very last days.

[Anonymous]

If she goes into a nursing home, hospice goes into the facility for support.

[Anonymous]

If she is currently in home hospice, they don’t provide caregiving - a nurse will regularly visit to maintain comfort care and pain management but if the patient needs hands-on caregiving and the family cannot provide it, they must hire a private duty aide.

If a patient’s death is imminent and they meet the criteria for inpatient hospice for management of clinical needs (for comfort care, not curative treatment), then they can be moved to the hospice facility (for example, Montgomery Hospice has an inpatient facility).

If a patient’s needs cannot be managed at home, sometimes they move to a nursing home/LTC (long-term care) facility where they can continue to receive hospice care but the LTC is usually is usually private pay. Even if it’s following a hospitalization, Medicare will not cover the cost of rehab and hospice at the same time; if a patient goes to rehab with hospice, they must pay privately for the rehab.

[Anonymous]

The government insurance would likely pay for hospice - both at home and in an inpatient hospice facility. Insurance will pay for rehab if there is a “skilled need” but they won’t pay for rehab and hospice services at the same time; the family would need to pay privately for the rehab if the patient is receiving hospice care there. There is no insurance besides LTC Medicaid that pays for long-term care/nursing home. Sometimes a LTC facility will accept a patient for rehab with the idea that after their rehab benefits run out, they will transition to one of their LTC beds but that is a complicated financial process that is worked out between the family and the facility’s financial office. Usually there is a period of private pay/spending down assets before LTC Medicaid kicks in, but that takes time.

Just to add, it may be that your family members are looking for a private pay assisted living facility where their loved one can receive home hospice; there are a variety of them with different fees and placement agencies like “A Place for Mom” can help with that (or the hospice social worker may have expertise in this area). There are also places that have “respite care” beds (like some Sunrises) but again, it’s private pay.

[Anonymous]

Anonymous wrote:The government insurance would likely pay for hospice - both at home and in an inpatient hospice facility. Insurance will pay for rehab if there is a “skilled need” but they won’t pay for rehab and hospice services at the same time; the family would need to pay privately for the rehab if the patient is receiving hospice care there. There is no insurance besides LTC Medicaid that pays for long-term care/nursing home. Sometimes a LTC facility will accept a patient for rehab with the idea that after their rehab benefits run out, they will transition to one of their LTC beds but that is a complicated financial process that is worked out between the family and the facility’s financial office. Usually there is a period of private pay/spending down assets before LTC Medicaid kicks in, but that takes time.

Just to add, it may be that your family members are looking for a private pay assisted living facility where their loved one can receive home hospice; there are a variety of them with different fees and placement agencies like “A Place for Mom” can help with that (or the hospice social worker may have expertise in this area). There are also places that have “respite care” beds (like some Sunrises) but again, it’s private pay.

Do you mean Medicaid? If not, what is the government insurance program you are referring to?

[Anonymous]

Anonymous wrote:

Anonymous wrote:The government insurance would likely pay for hospice - both at home and in an inpatient hospice facility. Insurance will pay for rehab if there is a “skilled need” but they won’t pay for rehab and hospice services at the same time; the family would need to pay privately for the rehab if the patient is receiving hospice care there. There is no insurance besides LTC Medicaid that pays for long-term care/nursing home. Sometimes a LTC facility will accept a patient for rehab with the idea that after their rehab benefits run out, they will transition to one of their LTC beds but that is a complicated financial process that is worked out between the family and the facility’s financial office. Usually there is a period of private pay/spending down assets before LTC Medicaid kicks in, but that takes time.

Just to add, it may be that your family members are looking for a private pay assisted living facility where their loved one can receive home hospice; there are a variety of them with different fees and placement agencies like “A Place for Mom” can help with that (or the hospice social worker may have expertise in this area). There are also places that have “respite care” beds (like some Sunrises) but again, it’s private pay.

Do you mean Medicaid? If not, what is the government insurance program you are referring to?

Medicare pays for hospice.

[Anonymous]

Anonymous wrote:

Anonymous wrote:The government insurance would likely pay for hospice - both at home and in an inpatient hospice facility. Insurance will pay for rehab if there is a “skilled need” but they won’t pay for rehab and hospice services at the same time; the family would need to pay privately for the rehab if the patient is receiving hospice care there. There is no insurance besides LTC Medicaid that pays for long-term care/nursing home. Sometimes a LTC facility will accept a patient for rehab with the idea that after their rehab benefits run out, they will transition to one of their LTC beds but that is a complicated financial process that is worked out between the family and the facility’s financial office. Usually there is a period of private pay/spending down assets before LTC Medicaid kicks in, but that takes time.

Just to add, it may be that your family members are looking for a private pay assisted living facility where their loved one can receive home hospice; there are a variety of them with different fees and placement agencies like “A Place for Mom” can help with that (or the hospice social worker may have expertise in this area). There are also places that have “respite care” beds (like some Sunrises) but again, it’s private pay.

Do you mean Medicaid? If not, what is the government insurance program you are referring to?

Sorry, I meant the federal insurance plan PP referred to (like BC).

[Anonymous]

If she was in the hospital and declined there and it is within the 30 day window, you could call rehabs to see if she could do a stay there (max 20 days for 100% Medicare coverage) to regain what she lost in the hospital. To do the full 20 days, she has to be maintaining/responsive to stay. Can she follow directions and participate in OT/PT/speech?

She MUST be disenrolled from hospice before entering rehab, because as others have mentioned, you can't be on hospice and rehab at the same time. But hospice isn't a one way street. Patients can go off/on it.

Rehabs aren't designed for supervision/safety like a memory care place might be so keep that in mind. You might need to be there or hire a nurse to keep her safe. Also hospices allow a bit more restriction than rehabs (no restrictions), so I would ask for a bed alarm/rails to keep her safe. Rehab would just be a way to buy time to plan next steps, and if the rehab place has memory care then you can transition there after. Rehabs with memory care are more open to taking more severe patients than a strict rehab who won't take anyone with advanced dementia. Once she gets in memory care, you can renroll in hospice again or not. FYI memory care would be private pay if she has assets.

If she was a federal worker, check to see if she has a long term care policy with Federal Long Term Care Insurance. That would really help you!

What other insurance does she have? If she has Tricare for Life it can extend coverage once Medicare stops paying. But it won't cover unskilled nursing, either (help with activities of daily living).