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Preparing for Geriatric Patient’s Move Home

Author: Helen Dennis, Specialist on Aging

Question: My father is on Medicare and is about to be released from a nursing home and rehabilitation center.  He’s recovering from near death and suffers from diabetes, kidney failure, heart disease and depression.  He lives with his 72-year old brother.  What do we need to have in place when he returns home?  I am afraid he will be “kicked out” before we have his home ready. 

Answer: Your question is both pragmatic and caring.  Let’s begin with Medicare and its relationship to (occasional) discharge decisions.  Note your father’s recommended discharge date.  There might be a connection between that date and who is paying the bill.

The Medicare payment policy is germane.   The first 20 days of nursing-home care in a Medicare certified facility is covered. The next 80 days are a shared cost with Medicare.  (Charges for private-duty nurses, the first three pints of blood and personal conveniences such as a barber, a beautician, personal laundry, and a private telephone are not included.)  For those 80 days in 2009 the individual pays $133.50 a day; Medicare pays the balance.  Medicare will not over more than 100 days of continuous nursing home care.

If your father has spent less than 100 days in the nursing home, and disagrees with the facility’s decision that he does not need to stay longer, he can appeal their decision.  This can be done by phone, but must occur before the noticed termination date. Response to an informal appeal usually takes about one day.  If he is turned down, he can file a formal appeal which must be decided within 72 hours.

Should that second appeal be denied, Medicare will not cover your father’s continued nursing home care costs. Most nursing homes charge patients who have used up their Medicare coverage much more per diem than the Medicare rate. However, if your father can afford to pay, he can probably stay at the facility for as long as he’d like.

Now to your father’s home. What is required is an assessment of your father’s needs and a review of his home environment.  Ask his doctor to order a physical therapy evaluation and home care, if needed.  Medicare will likely cover these costs.

Another option is to engage a professional geriatric care manager.  These professionals provide assessments and solutions; screen, arrange for and monitor home-care services; offer counsel and support; and act as a liaison to family members.  To find one near you go to

The following problems and interventions are suggested by the Family and Consumer Sciences¸ Agrilife Extension of Texas A & M University. The interventions described are only suggestions.  A complete assessment of the individual is still the best beginning step:

Problems in the Bedroom:

  • Lighting: Have a bedside light, a night light, a flashlight that attaches to a walker or cane, and remote-controlled switches.
  • Low bed: Install leg extensions or blocks, use a second mattress or provide an adjustable hospital bed.
  • Slippery floor: Use nonskid wax or avoid using wax; provide rubber-soled footwear.
  • Distance from bathroom: Provide a bedside commode or urinal.
  • Clock visibility: Obtain a large-faced clock radio, provide a Braille alarm clock or talking alarm clock.

Problems in the bathroom:

  • Getting off the toilet: Provide a raised seat, side bars and grab bars.
  • Getting in and out of the tub: Install grab bars, a bath bench, a handheld shower nozzle and a rubber mat.  Consider a hydraulic lift bath seat.
  • Slipper or wet floors: Use nonskid rugs or mats.
  • Dizziness standing at the sink: Provide a stool to sit on.

Consider discussing changes with you father so he doesn’t feel they are imposed upon him.  Ideally, engage him in making some of the decisions.  There are many other tips that can solve and prevent problems while encouraging the greatest amount of independence and comfort.

© Helen Dennis 2010, all rights reserved.

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