Home for the Holidays

When I work with  seniors who are moving  from their own homes into memory care or assisted living facilities, their families often ask whether then can leave to attend family events and holiday celebrations.  While I frequently remind them that their parent’s new home is not a prison, there are some things to be aware of.

If  your family member is in a skilled nursing or rehab facility that is covered by Medicare, they will not lose their coverage if they leave to enjoy a holiday celebration.  The Medicare Benefit Policy Manual states that if someone in the facility is physically able to leave “for the purpose of attending a special religious service, holiday meal, family occasion, going on a car ride or for a trial visit home, [that] is not, by itself, evidence that  the individual no longer needs to be in a SNF for the receipt of required skilled care.”  If the patient is gone for more than one day, then the facility cannot bill Medicare, or the patient, for that day.  However, the facility can charge a “bed hold” fee to assure that the patient’s bed will be available when she returns.

While you should check the rules in your state, the same principal generally applies if the person lives in an assisted living, memory care or group home (sometimes called “board and care”) that is covered by Medicaid.  A short absence does not imply that the person no longer meets the medical criteria, but they need to continue to pay their “share of cost” to assure the availability of their bed.

One of the most rewarding parts of Life Care Planning is that I have the opportunity to help my clients and their families not only with the laws and regulations around their care needs, but (along with my Care Coordinator) with the psycho-social issues that are an equally important part of the decisions that they face.  The next (if not the first!) question to ask when thinking about having your older family members join you for holiday celebrations is whether it is in the patient’s best interest to leave what is now their home.  Disrupting their routine and moving the person to surroundings that may now seem unfamiliar could be as stressful and confusing as it was to move into the facility.  Even if someone does not have cognitive deficits that would cause them to become confused, they may be embarrassed about some of their physical needs and how they will be addressed away from professional staff.  It is important to talk with their care team to make sure that the visit is in their best interest, or if you should, instead, think about bringing the holiday to them.




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