My private patient discharged from a SNF to his apartment at…

Hi there,

It sounds like the level of care needed is, in fact, skilled nursing. I don't see why the patient can't be transferred back to a skilled nursing facility unless the family is unwilling to use their father's money to pay for his care. If that is the reason they do not want to have him stay at a skilled nursing facility, then adult protective services can become involved to determine, and implement, the level of care he needs.

Medicare will only pay for a certain amount of rehab time. When that runs out, the patient will then have to use their own funds to pay for nursing home care (just as he uses his own funds to pay for assisted living). IF his private funds run out, as they do for many people in nursing homes, then medicaid picks up the total bill.

I suspect there aren't any doors being closed here that prevent this patient from going back to skilled nursing unless the family is closing them themselves. His funds, whatever they may be, are really his, and not his family's, and should be used to provide the level of care he needs. The famliy will never be required to pay out of their own pockets for their father's care; the money used would be his and his alone. If he has no money, then nursing homes will apply for medicaid for him, which will pay for his care. Again, if the family is unwilling to move him to the level of care he needs, then adult protective services should become involved. They will assess his ability to make his own decisions and will assess the kind of care he needs to keep him safe. Sometimes the courts appoint guardians to make sure the patient gets the care he needs.

Please write back if I haven't addressed your concerns or you have more questions. Thanks.