Home for the Holidays?

By Wesley E. Wright and Molly Dear Abshire, as published in the Houston Chronicle Senior Living Section on December 22, 2011.

During the holiday season, many have loved ones recuperating in rehabilitation facilities or residing in long-term care homes. Decisions have to be made about how to handle holiday festivities.

In order to make the holidays special, activity directors for the nursing home often plan seasonal activities for residents and encourage families to participate. The Nursing Home Reform Act says that facilities are to be as homelike as possible, so celebrations such as these should be encouraged. It is caring and supportive for families to participate in the planned activities, especially for loved ones who cannot leave due to physical or mental limitations.

For those who are temporarily recuperating in rehabilitation facilities over the holidays and who are physically and mentally able, they may wonder if it is possible to leave the facility and enjoy the holidays at home without losing their skilled nursing benefits under Medicare. If the patient is well enough to leave the facility temporarily without harming his or her health or physical recovery, then it is possible to spend the holiday at home. If the patient chooses to leave their facility for a brief respite, it is important to know how the how the Medicare rules affect their skilled nursing benefits.

First, it is true that Medicare benefits stop when a patient has reached the point of no longer benefiting from care in the skilled nursing facility (SNF). Yet, Section 30.73 of Chapter 8 of the Medicare Benefit Policy Manual says that "an outside pass or short leave of absence for the purpose of attending a special religious service, holiday meal, family occasion, going on a car ride, or for a trial visit home, is not, by itself evidence that the individual no longer needs to be in a skilled nursing facility for the receipt of required skilled care."

Second, care in a skilled nursing facility is based on 24-hour periods that run from midnight to midnight. Therefore, if a patient leaves the facility for just a few hours but returns before midnight, it is as if they have been there all day and there is no loss of Medicare benefits.

However, Texas is a large state and sometimes the facility where the loved one is receiving care is a long way from home. What happens if the patient has to be away from the facility overnight to reunite with family over the holidays? In the instance of overnight absences, Medicare will not pay the SNF for days when the patient is absent from the facility at midnight, nor will the patient be charged by Medicare for the cost of the day away either. Be aware that the facility may charge the patient a fee to hold the bed to compensate for the loss of income if the bed is held empty, ready for the patient's return.

There are other factors to consider when determining how to handle the holidays when your loved one is receiving SNF benefits. The patient's mental and physical ability to tolerate a trip should be considered as well as whether the place where they are visiting can handle physical impediments such as a wheelchair. It is best to consider the opinion of your loved one's physician and therapists in making a decision to spend time away from the facility and the care it provides.

For loved ones residing in long-term care facilities on Medicaid benefits, the specific rules regarding absences from the facility differ. For instance, a Medicaid resident may leave the facility for up to three days and nights without an interruption in benefits. A day is counted midnight to midnight just as with Medicare benefits.

Thus, there is no reason why loved ones cannot be taken out of the facility for a family festivity over the holidays that they would enjoy as long as they are well enough and have the appropriate support they need while away.