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Your elderly parent loves being invited to special family gatherings while taking a break from the nursing home. Yet, lately, they’ve been wanting reprieves more frequently. You totally understand their wishes, but you’re wondering if nursing home patients can have time away whenever they like.
Nursing home residents can’t leave a facility whenever they want. However, they can leave for the day or slightly longer if the doctor and the insurance provider approve the hiatus. In addition, the facility needs ample notice. Non-compliance can result in your parent losing their bed or insurance.
This post explains the insurance policies associated with taking vacation leaves from skilled nursing facilities. I’ll also discuss how to plan a smooth and safe leave of absence for your loved one.
Can People in Nursing Homes Come and Go As They Please?
Since nursing home patients need ongoing, consistent medical treatment, they can’t come and go as they please. Instead, you must plan several days ahead if you need your elderly parent to participate in an important family event.
As you know, nursing homes charge steep fees for a resident’s care. Thankfully, elderly patients over the age of 65 in the US have Medicare, Medicaid, or private insurance to pay the daily rate.
Yet, if your parent takes a leave of absence, the insurance may not pay the nursing home for the time spent away. Moreover, your loved one can lose their bed. Note that these penalties don’t apply to a transfer to another medical facility, such as a hospital.
All insurance providers have distinct rules about covering a holiday from a nursing home. Risks of injuries, medical issues, and infections (including COVID-19) that occur while the patient is outside can also complicate matters.
Therefore, it’s crucial to understand how various types of health insurance providers differ in their coverage of leaves of absence (LOAs) from a skilled nursing facility (SNF).
How Medicare and Medicaid Differ in SNF Coverage
These two government-funded insurance programs serve beneficiaries differently. Medicare is geared toward seniors needing short-term rehabilitation, such as after a stroke. Thus, if a Medicare-covered patient takes a “vacation” from an SNF, the insurer will question whether they still need to reside there.
On the other hand, Medicaid is for those requiring long-term care with a low income and limited resources. Both the federal and state governments finance Medicaid, and the state regulations vary widely for SNFs.
Medicare Policy on SNF Leaves of Absence
Medicare insurance only pays for skilled medical care or treatment rendered by a nurse or doctor. Thus, Medicare doesn’t favor extended holidays from an SNF. Still, the insurance program may cover several hours away for a special occasion.
Examples include the following:
- Family event
- Holiday meals
- Religious service
- Trial visit home
- Car rides
Such socialization opportunities constitute a “leave of absence” (LOA) eligible for an outside pass from an SNF. According to Medicare, a billable day starts at midnight and ends the following midnight.
So, an SNF can bill Medicare for an LOA if your loved one returns the same day by midnight. That’s because they received onsite treatment within a continuous 24-hour period. However, if your parent arrives back at the SNF after midnight, Medicare won’t pay for the previous day.
Here’s an example. Let’s say your loved one leaves the SNF for a special family event, staying with you overnight. Then, you bring them back to the facility at 11 am the next day. In this case, Medicare won’t cover the day your loved one departed the SNF.
SNF Bed-Hold Charge
Medicare only pays for inpatient care during a 24-hour watch. If your parent stays with you overnight, they’re off Medicare’s time clock. Therefore, the insurer won’t reimburse the SNF for that LOA. In that case, you must pay the facility to hold your loved one’s bed in their absence.
However, before your loved one takes their holiday, the SNF must give you written notice of its bed-hold policy and daily rate. The facility will ask for your signed consent. If the SNF neglects these legal requirements, it can’t charge you for reserving your loved one’s bed.
Medicaid Provision for SNF Therapeutic Leaves
Medicaid takes a more lenient stance on time away from an SNF. In fact, Medicaid uses the term “therapeutic leave.” Still, states vary markedly concerning the length of time Medicaid covers.
For example, in Colorado, Medicaid pays for 42 bed-hold days per calendar year. Meanwhile, in Georgia, Medicaid covers seven bed-hold days in a given year for therapeutic leave. However, Indiana nursing homes get no Medicaid reimbursements for bed holds. In some states, a resident’s family can reserve a bed by paying out-of-pocket.
If your parent has Medicaid, ask the insurer for your state’s bed-hold policy before planning a therapeutic leave. Be sure to get the rules in writing.
Even if a therapeutic leave lasts longer than the nursing home allows, your parent will still have a bed. It may not be in the same room, but they’ll get the first available bed upon readmission, per federal law.
Private Healthcare Insurance LOA Policies
If your parent has private medical insurance, call the provider for whether it pays for nursing home LOAs. Also, request the company’s policy in writing. With some insurance carriers, residents who go on an LOA will lose their coverage. By being fully informed, you’ll prevent this dire consequence.
How To Prepare for a Vacation Leave From a Nursing Home
To help ensure that your elderly parent can come and go without worries, you must carefully plan the vacation leave.
Make SNF Arrangements
First, get the consent of your parent’s doctor for interrupted skilled medical care. Next, ensure that your loved one’s insurance will cover your planned holiday.
Will your parent stay with you overnight or longer? If so, and they have Medicare, the insurer won’t reimburse the facility for its care provisions. Consequently, the SNF will charge you as compensation for reserving the bed. Thus, make sure you know the facility’s bed-hold rules and daily fee before requesting a nursing home pass.
Then, at least three days before the leave, speak to your parent’s charge nurse about your plans. This way, the staff has adequate time to prepare your loved one’s medications and home care instructions.
If your loved one has Medicaid, contact your state’s program to learn its SNF bed-hold policy. Hopefully, the insurance provider will cover your planned holiday. If not, you’ll need to reserve your parent’s bed by paying out-of-pocket.
On the other hand, if your loved one has private healthcare insurance, make sure the provider won’t drop the coverage if they take an SNF leave of absence. Request the company’s policy in writing.
Upgrade Your Home Safety
Is your home adapted for senior use? If not, consider making modifications and fostering your loved one’s comfort and safety. The following upgrades are inexpensive and easy to make. For high-quality products, follow the links.
Anchor any Household Rugs
Area rugs are a tripping hazard for seniors, and a fall can land your loved one in the hospital.
Uneven rugs can also be dangerous for elderly parents who use a cane or a wheelchair. If you can go without rugs in certain areas of your home, remove them temporarily.
Or do you need throw rugs to collect water, dirt, and mud? In that case, adhere the rugs to your floors with carpet tapes like the YYXLIFE Double-Sided Carpet Tape (available on Amazon). This product secures your rugs or carpets to prevent slips. It also works on various types of floor materials, such as wood, tiles, and concrete.
Ensure Ample Lighting for Your Loved One
Dim hallways and rooms can also provoke falls. Many elders can’t see well in low light. Thus, they’re at risk of bumping into furniture and other objects, throwing them off balance. Often, seniors fall at night while heading to the bathroom.
You can easily brighten dim hallways with night lights, like the GE LED Night Light (available on Amazon) with dawn-to-dusk sensors. This way, the light shuts off at sunrise, and at sunset, the fixture activates. Also, consider a plug-in brand with LED lighting, sparing you from replacing bulbs.
Facilitate Your Loved One’s Toilet Use
In modern homes, standard toilets are relatively low to the floor. For a senior with arthritic knees, sitting low can strain their knee joints. Moreover, it makes rising from the toilet difficult and possibly unsafe.
Consider getting a raised toilet seat, higher than the standard by 4 to 5 inches (10-12.5 cm), fitting over your existing toilet.
You can obtain a locking raised toilet seat with arms like the Carex Health Brands E-Z Lock Raised Toilet Seat (available on Amazon.com). It has a very comfortable design, suitable for seniors with sensitive skin and joints.
Make Showering Safer With Adaptive Equipment
While your loved one stays with you, they might need a shower. So, be prepared with a hand-held shower wand like the Moen Chrome 3.5-Inch Handheld Showerhead (available on Amazon), convenient for whoever bathes your loved one. It’s easy to install and ADA-compliant.
Does your parent have trouble with prolonged standing? In that case, get them a shower chair. If they don’t use a wheelchair, consider a shower chair with arms like the Medline Shower Chair Bath Seat (available on Amazon). It has slip-proof feet, making it safe for your elderly parent.
Or if your loved one needs a wheelchair, you can purchase a transfer bench, such as the Drive Medical 12011KD-1 Tub Transfer Bench (link to Amazon). This shower chair is broad, averaging 32 inches (81 cm) long. So, two legs sit outside your tub or shower stall, while the rest of the chair occupies the floor of your bath unit. This way, your parent can shift from the wheelchair seat onto the transfer bench.
Next, consider installing grab bars on the walls of your bath unit. While a device with suction cups is the simplest to attach, it’s not secure. A safer design is a grab bar you mount with a drill and screws, such as this Moen 12-Inch Bathroom Grab Bar (also on Amazon). Moreover, you can affix this type of rail to the walls around your toilet.
Easing Your Parent’s Nursing Home Re-Entry
You can easily imagine how challenging it must be for some elderly parents to go back to the nursing home after enjoying a vacation at home with loved ones. Therefore, it’s important to facilitate the return as smoothly as possible.
Plan a Heartfelt Talk Beforehand
Prepare for the resistance your parent could have to resuming nursing home life. For instance, they could “dig in their heels,” refusing to return. In that case, reassure your loved one that you understand how they feel. Admit that adapting to a nursing home is rough. Still, remind your parent that living at home isn’t safe or healthy for them.
Next, comfort your loved one by saying you’ll plan another outing soon. If there’s an upcoming family event or holiday they can attend, mention it specifically. If not, show your parent a calendar, pointing out when you’d like to bring them home again.
Affirm Your Support With Personal Gifts
Think of what will lift your parent’s spirits, conveying how much you love them. You can give them presents to keep them warm or entertained.
For example, with a talking picture frame, you can record a cheery message for your parent. With the Kwanwa Picture Frame (available on Amazon.com), you can speak for 20 seconds. Then, insert a picture into the heart-shaped window.
During your home visit, you may also encourage your parent to take a household item back to the facility.
Urge Joining Nursing Home Activities
Encourage your loved one’s participation in the facility’s recreational program. Typically, nursing homes offer movies, arts and crafts, sing-alongs, and games, such as bingo. If your parent has a particular faith, urge them to join the religious services held at the nursing home.
Is your loved one shy about making friends with their fellow residents? If so, speak with the charge nurse about accompanying your parent to a certain activity. This way, you can facilitate conversations between your parent and other seniors.
Schedule Weekly Visits With Your Parent
Canvass your family members, asking them to take turns seeing your loved one. Suggest that they bring a small gift for your parent each time. Examples are flowers, stuffed animals, or a healthy treat. This way, your loved one has a heartwarming reminder of being with a guest.
For an introverted person, weekends can be especially lonely at a nursing home. At that time, some of the professional staff may be off work, such as specialist doctors, physical therapists, and hairstylists. Consequently, residents are less busy with scheduled activities.
Try to arrange at least two visits per week from family members, including a weekend guest. Staying connected with your family will boost your parent’s outlook and self-worth.
What if your elderly parents want to leave a nursing home to live elsewhere? Although that’s completely possible, you should research living alternatives and make proper arrangements before they leave their current nursing home. Could an Elderly Parent Leave a Nursing Home?
Good To Go!
A nursing home resident can leave a facility with advance arrangements. If your parent has Medicare, it will cover an LOA if they return by midnight. For a longer stay, you must pay a bed-hold fee to the SNF.
If your parent has Medicaid, comply with the bed-hold policy for the state where your parent lives. Or if they have private insurance, make sure it covers LOAs.
Make plans at least three days before the leave, and clarify requirements and expectations with your parent’s doctor and charge nurse. Meanwhile, ready your home with safety equipment for your parent’s comfortable stay.
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