How long is Medicare likely to cover post-stroke rehab?
I realize coverage differs according to many factors, but just wondering if anyone might have some thoughts. My mother has Medicare/Oxford in NY State. She is almost on day 21 of being in sub-acute rehab after a stroke. Last week, we met with her "team" and the SW said she would probably be discharged at the end of June. She explained that Medicare covers 21 days at 100 percent, but then we'll have a co-pay of $142/day and then it costs $500 a day out of pocket. But today, her PT told me she is going to ask for a longer session per day with my mom (55 min vs 30 min) because she shows a lot of promise. We had a cryptic conversation over my mom's wheelchair in which I asked if that meant a longer stay and if Medicare would cover it plus extra PT time. The PT said she was going to look into it and was prepared to appeal if necessary. I'm completely confused about how this all works! My main concerns are: How long can she stay there and how much will everything cost? I left a message for the SW to get clarity on everything, but I haven't heard back from her yet.
It appears that your mother just suffered this stroke recently and you are in the beginning stages.
Having consistent and ongoing therapy will (most likely) result in a better outcome for all. My mother had a stroke 6 years ago and we still get PT/OT/SP covered by Medicare. The trick is to A: Never give up B: Get educated C: Find someone who KNOWS the Rules, Guidelines/ and how the system works. (see links below). You would be amazed at how many professionals either don’t understand the rules or don’t want to (or know how to) “play the Medicare game”. My experience is this. Mom suffered stroke. Went to sub-acute rehab. She made decent progress during the 21 day period and then the administrator explained they would be discharging her. I had an “off the record” discussion with one of her OT’s who told me to “not follow the sheep” , meaning don’t accept the admins word that discharge was a Medicare rule. Since the Therapies were showing progress , Specifically, “ATTAINING GOALS”, the Therapists put in for exceptions to Medicare which were approved. If the staff mentions “Plateauing” that’s your first clue that discharge is the next step. Ask what “goals” your mom has reached and if they can chart a NEW GOAL. Without going into a great detail, Continue to define NEW Goals – Hint: Start with Small, attainable goals , that way you can Up the goal when they mention Plateauing. If you start with too hard of a goal, you have nowhere to go from there. Also, Ask now about Home Therapy. Immediately upon my mom’s discharge (to her own home) , we had therapists come to the home 2-3 times a week. (Medicare also covers limited in home care such as nurses visits , Durable equipment , etc.) Learn the terms & phrases that these Home Care Providers need to hear such as : My mom needs help with “ADL’s” (Activities of Daily Living).
NOW, Get in touch with Advocates [ AgingCare.com is a good start ] , Stroke.org Medicare Ombudsman https://www.medicare.gov/claims-and-appeals/medicare-rights/get-help/ombudsman.html
https://www.medicare.gov/Pubs/pdf/11173.pdf
I wish you and your mother continued success, improvement and good health.
All the best, David W.
I get that Medicare only covers X amount of time in rehab and that SNH is a business. I don't quite get how much say I have in trying to challenge Medicare and the SNH if they seem to be kicking my mom out. If they discontinue OT and PT services, then what? My mom's speech/language therapist has already stopped providing services because she says my mom has recovered a lot in that department, which is true. Another issue is that my mom is resistant to all of it. She'll do the PT and OT, but she's not exactly the most compliant person. How much does that figure into all of this?