A week prior to Thanksgiving, I met with a client whose husband was in a local nursing home for a rehabilitation stay following a fall resulting in hospitalization. The wife communicated that her husband wanted to come home for the day to spend Thanksgiving Day with his family, and would be devastated if he was unable to due so for health reasons.  The nursing home originally informed our client that her husband would lose his Medicare coverage for the rehabilitation stay if he went home for the day because it would be evidence that he no longer was in need of skilled nursing care.

The above scenario is likely to be played out this month at nursing homes throughout the US. Nursing home residents often want to participate in family gatherings but may worry they will lose Medicare coverage if they leave the nursing home to do so.  Nursing home residents and their families should not worry.

Nursing home residents may leave their facility for family events without losing their Medicare coverage. However, depending on the length of their absence, Medicare beneficiaries may be charged a “bed hold” fee by the skilled nursing facility (SNF).  It is true that Medicare coverage ends when a patient no longer is in need of skilled care.  However, section 30.7.3 of Chapter 8 of the Medicare Benefit Policy Manual states “absence for the purpose of attending a special religious service, holiday meal, family occasion, going on a care ride, or for a trial visit home, is not, by itself, evidence that the individual no longer needs to be in a SNF for the receipt of required skilled care.”

Furthermore, the regulations state it is “not appropriate’ for an SNF to tell a patient that leaving the facility will lead to a loss of Medicare coverage.

What about overnight absences? If the resident is gone overnight and returns to the facility the next day, Medicare will not pay the SNF for days when the patient is absent.  The SNF can charge the resident a “bed hold” fee for a temporary absence if the SNF informs the resident in advance of the option, the amount of the charge, and the resident affirmatively elects the bed hold charge.

In summary, there is no reason why residents cannot be taken out of the SNF for short periods, such as a day or two, to enjoy holiday gatherings without losing Medicare coverage as long as they are well enough and have the appropriate support they need while away.

By the way, our client, with the help of our office, was able to go home on Thanksgiving Day to spend it with family, and returned to the SNF under a Medicare covered stay.

We wish our clients, their families and our friends a joyous and fulfilling holiday season.

About Jerry

Jerold E. Rothkoff, a practicing New Jersey and Pennsylvania attorney, is the Principal of the Rothkoff Law Group, an elder care law firm. Jerry dedicates his practice to serving clients in the areas of life care planning, long-term care planning, Medicaid & VA benefits, and advocacy for the elderly and disabled. He is past President of the NJ Chapter of the National Academy of Elder Law Attorneys, former chair of the elder law section of the NJ State Bar Association, and past President of the Life Care Planning Law Firm Association. Jerry continues to be an outspoken advocate for the rights of the elderly and disabled. He writes for and gives presentations regularly to attorneys and other professionals about legal issues related to seniors and those with disabilities. Jerry’s community activities include the Twilight Wish Foundation, the Delaware Valley Stroke Council, the Alzheimer’s Association, as well as numerous other advocacy groups. When not in the office, Jerry spends time with his wife, Erica, and their five children, eighteen-year old identical twin girls, Liza and Julia, fifteen-year old fraternal twin boys, Evan and Gregory, and six-year old Aitan.

Leave a Reply