Readmission Into Nursing Home after a Hospital Stay

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Has your loved one been taken from a nursing home and hospitalized? If they are eligible for Medicaid, they are entitled to certain bed-holding rights. It is important to understand the rights allowed to Medicaid-eligible nursing home residents so that they can claim those rights, as they are needed. One of these rights is to be readmitted to a nursing home after a stay in a hospital.

When a nursing home resident is hospitalized, the nursing home generally is required by state law to hold the bed for a week or two, if the resident chooses to hold the bed. If the resident is paying privately, they will pay for the bed hold privately. If the resident is Medicaid-eligible, Medicaid will generally cover the costs of the bed hold. Because Medicaid generally pays lower rates than the private rate or Medicare rate, Medicaid-eligible residents may be seen as less desirable to finance-conscious nursing homes. The Nursing Home Reform Law establishes a readmission right for Medicaid-eligible residents so that they don’t just get dropped from the nursing home to attempt to find another one. This law states that a Medicaid-eligible resident has the right to the next available Medicaid-certified bed, regardless of their length of stay in the hospital, even if it is longer than the bed-hold period. A bed is not considered available, though if the hospitalized resident and the proposed roommate are not the same gender.

Since the nursing home has a vacancy anyway since the resident was hospitalized it should not be a huge inconvenience for them to readmit the resident, though they may act like it is. If the nursing home is being difficult and claims not to have a vacancy at that time, the Medicaid-eligible resident should continue to be persistent. If the nursing home thinks that the resident will continue to check on the vacancy of a bed in the nursing home, they are more likely to attempt to readmit as soon as possible. If the nursing home indicates that they have no intention of readmitting the resident, the resident should make a complaint to the state inspection agency and consult with a knowledgeable attorney.

If your loved one is Medicaid-eligible and is attempting to get readmitted to their nursing home after being hospitalized, it can be disheartening and stressful. If the nursing home is not following through with the regulations set in place for Medicaid-eligible residents, contact the Dan Pruitt Law Firm today.

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