Paying for Personal Care in PA: Stuck Between a Rock and a Hard Place

Personal Care Homes (PCH) and Assisted Living Residences (ALR) are housing options typically for older adults that provide hands-on care with activities of daily living such as bathing, dressing, grooming and offer three meals a day, activities and medication monitoring. The average annual cost of a personal care home or assisted living in Pennsylvania is $41,400¹. While some older Pennsylvanians are fortunate enough to pay privately for these services, a much larger percentage simply cannot. Either way, many of those who need these levels of care are often mistaken on how it will get paid for. Many seniors and/or their families think that Medicare or Medicaid (aka Medical Assistance) will pay for some or all of personal care or assisted living. But, regrettably neither offer coverage in Pennsylvania, therefore private out-of-pocket payment tends to be the primary funding source for PA seniors. But, a fair number of states like Florida, North Carolina and Maryland do provide full coverage through their state Medicaid program. For full details on all 50 states, click [here].

For many older Pennsylvanians who begin to decline and struggle to live safely at home, moving to a personal care home can be the perfect solution. However, again due to average monthly costs of $3,450¹, it’s just not an option for many.

Of course this is nothing new, so state funded programs through Home and Community Based Services (HCBS), also known as Waiver Funded Services or Waiver Programs, were created to provide alternatives. They provide support and services that enable individuals to remain in a community setting rather than being admitted to a long-term care facility. Some of these waiver funds particularly aimed at helping seniors include adult day programs, non-medical home care, home modification grants and environmental adaptation services. While these are helpful, they may fall short for someone who cannot live alone safely 24 hours a day, for instance those with a dementia diagnosis. In cases where placement is an absolute must, the other option is nursing home placement; because if financially eligible, Medicaid will pay for them to be in a nursing home. The problem with this is that a number of these people don’t actually need true nursing care. For example, someone with moderate dementia may be in decent physical health, but because of safety or behavioral issues coupled with little income and no assets, nursing placement becomes the only option. Thus – “becoming stuck between a rock and a hard place.”

Some good news

There are two direct funding sources that will provide partial or possibly full coverage for PCHs and ALRs in PA. The first is Supplemental Security Income (SSI) and second is the Aid and Attendance Pension Benefit through the U.S. Department of Veterans Affairs.

Not to be confused with Social Security income that most everyone receives after retirement, Supplemental Security Income is strictly a needs-based program determined by one’s income and assets and, of course, physical need. It exists for people age 65+, as well as blind or disabled people of any age, including children.

To meet the SSI income requirements, you must have less than $2,000 in assets (or $3,000 for a couple) and a very limited income. SSI provides a number of benefits like the Supplemental Nutrition Assistance Program (SNAP), formerly known as food stamps. It also provides a monthly payment for the PA “Domiciliary Care or “Dom Care” program. As stated on PA Aging website, “Dom Care was created to provide a home-like living arrangement in the community for adults age 18 and older who need assistance with activities of daily living and are unable to live independently. Dom care providers open their homes to individuals who need supervision, support, and encouragement in a family-like setting.

Dom care residents are matched to homes that best meet their special needs, preferences, and interests. Dom care homes are smaller than the traditional personal care home in that home providers care for no more than three dom care residents. Unlike larger personal care homes, dom care homes are the individual providers’ homes. They are inspected annually to ensure they meet health and safety standards. If the home and provider pass this inspection, they become certified.

The local Area Agency on Aging is responsible for the initial certification and ongoing annual inspections of Dom Care homes in their area. They are also responsible for the placement of individuals into certified Dom Care homes.”

Supplemental Security Income in Pennsylvania will also cover monthly Personal Care/Boarding Home (PCBH) costs at $1,189.30 per eligible person or $2082.40 per eligible couple∗. The drawback to this funding option is that personal care homes must be willing to participate and accept these shortfall amounts. Thus, finding a participating facility can be a challenge. To get a list of facilities that accept SSI payments, please contact your local County Area Agency on Aging.

Next, the V.A. Aid and Attendance benefit provides an additional monthly pension to eligible veterans and/or their surviving spouses. Eligibility is based on income and assets, war-time service status and physical/medical need. This additional monthly stipend can be used for community based services, but can also be used to cover costs associated with placement in a personal care home or assisted living setting. To learn more click [here].

Lastly, another alternative in Pa, which falls under the category of community support is the LIFE (Living Independence for the Elderly) program. A person continues to live at home, but LIFE offers heavier partial day services and care to keep them there for as long as possible. “…it is an option that allows older Pennsylvanians to live independently while receiving services and supports that meet the health and personal needs of the individual [such as physician, nursing and rehab services, transportation and heavy physical assistance.]

Living Independence for the Elderly (LIFE) is a managed care program that provides a comprehensive, all-inclusive package of medical and supportive services. The program is known nationally as the Program of All-Inclusive Care for the Elderly (PACE). All PACE providers in Pennsylvania have “LIFE” in their name. The first programs were implemented in Pennsylvania in 1998.” This is a program, if eligible, Medical Assistance (Medicaid) will pay for.

Final thoughts

In Pennsylvania, those who can afford to pay privately for the assistive care facilities, the burden is mostly on you. If you are someone who might qualify for coverage based on low income and assets, you may be fortunate enough to find a local option. But for a large chunk of older adults who fall between these two extremes, I wish I had more options to share. My advice is to be more proactive and anticipate the possibility of needing care as we age. Be mindful of unnecessary spending or gifting after retirement. Become more familiar with placement options and related costs. And most importantly, save more for retirement and earmark it for future care! We’re all living longer and care is not getting any cheaper. And although senior advocacy groups like LeadingAge™ PA continue the push to have ALR/PCHs receive partial government funding; current legislation is trending away from covering institutional types of care.

For more information or help on this topic, please contact Messiah Lifeways Coaching at 717.591.7225 or coach@messiahlifeways.org.

¹Genworth Financial Cost of Care Survey 2017
∗Current SSI rates as of 2018

 

Walker & Rollator Safety Tips

Written by Christina Weber, Director of Home Care Services

Article adapted from
“How do I use my walker (rollator)? at www.walkerfacts.com

More and more older adults are using wheeled walkers or rollators to get around. And whether you are a hired caregiver or a family caregiver, you can help minimize their risk of injury by encouraging safe use of their device. There are four main activities that users need to perform safely when using their walkers. These are: standing up, walking, turning, and sitting down.

Wheeled walker

Rollator

Common mistakes made while using walkers, wheeled walkers or rollators are made during these activities and include, but are not limited to:

  • Not engaging the brakes when sitting or standing.
  • Starting to sit while still turning in front of the chair/bed/toilet/car.
  • Taking uneven steps.
  • Holding the walker too close/too far away from you while taking steps.
  • Forgetting to use the walker – walking away from the walker.
  • Holding the walker with both hands while standing up and sitting down.
  • Leaning too far away from the base of support provided by the walker.
  • Twisting away from the walker while turning.
  • Sitting on the wheeled walker or rollator while someone pushes it. (Note: Some walkers are made with this capability, but you should conform the device is designed to do this.)
  • If the user needs assistance, help them by guiding their body forward and keeping their weight over their feet. Do not pull them through by their arms or shoulders. Also they should not hold onto you, they should hold on to the furniture and walker while you support them.

This devices were created to assist and support their users, but not used properly they can potentially create more danger and increase the chance of injury. For safe and efficient use of a walker, rollator or other ambulatory devices, please consult your therapist or physician. If you need additional information, please visit www.walkerfacts.com.

 

Thinking about moving to personal care?

Are you or a loved one considering a move to a Personal Care Home? One of the region’s newest options is Hopewell, which is the most recent edition to the Enhanced Living neighborhoods at Messiah Village. Check out the Top 10 Reasons to consider why a move to Hopewell might be the right choice for you.

  1. Hopewell embodies a new living option in personal care for individuals and couples. 26 new private apartments offer some of the largest personal care apartments in the region with four floor plans ranging in size from 532 to 767 square feet.
  2. Messiah Village offers a full range of daily living support options. Gain independence by obtaining your care needs without sacrificing your social needs.
  3. The Hopewell neighborhood is the newest addition to Messiah Village’s comprehensive care continuum – when skilled nursing or rehab needs arise, there’s no need to worry. A skilled team of outpatient physicians, clinicians, and therapists are available to meet your post-hospital needs.
  4. Your care will never be compromised, even if down the road financial worries loom. Our $16 million Endowment Fund for Benevolent Care means there is financial assistance if needed.
  5. Three well-balanced, chef-prepared, daily meals in the Asbury Room offer a delicious reason to leave your apron and skillets behind. If you crave a cappuccino or want to celebrate a special occasion with family, you can conveniently dine, at your own expense, in one of our four restaurants (3 of which you can access without ever going outside).
  6. Messiah Lifeways is a non-profit ministry governed by a local board of directors who live, work, and volunteer in Central Pennsylvania. You can rest assured that strategic decisions about your home are being made by people who believe in our mission.
  7. As a Messiah Village resident, trusted services from health professionals are available to you; no need to drive. You can schedule podiatrist, optician, audiologist, psychiatrist, and psychologist appointments on campus.
  8. Hopewell’s Asbury Room and Great Room are designed to resemble the inviting gathering spaces of private homes. Whether you’re entertaining family or playing games with neighbors, you will find a perfect spot to relax.
  9. Need a massage or manicure? Time for a new hair style? Leave the car keys aside and enjoy all-weather access to campus salons including the new Cerise Day Spa.
  10. So much more than your average retirement community…Amenities include a new Center for Vitality & Wellness with a warm salt water pool, lifelong learning courses, organized trips and more.

    Call 717.790.8201 for a private tour today!

       Adapted from the March 2018 Messiah Lifeways Preview Guide.

 

Dear Future Self

If you’re like most, you’ve likely had your fair share of “dear future self” moments, especially after bearing witness to the unwise, undesirable or unsafe behavior of others as well as our own transgressions. It can be a great influencer of not walking the same path or repeating history, or taking the optimist’s view and turning a bad choice into a teachable moment. This can apply to many different aspects of life…poor health choices, substance abuse, not taking responsibility for one’s actions, poor money management; the list can go on and on. But recognizing or even suffering the consequences of poor choices is not always enough to stop our own perpetuation of bad decision making.

Choices and our own mortality and well-being

During the cycle of life, adult children may one day experience an ailing parent making unsafe choices about their health and well-being. The ailing loved one may stop following doctor’s orders, not take their meds as directed, recklessly drive, live in an unsafe home environment, refuse help, or ignore a diagnosis. This list too can go on and on. Fortunately, many aging loved ones recognize and appropriately deal with some of the challenges of growing older. Accepting one’s own limitations, downsizing, moving to a care facility, asking or accepting help are smarter ways of responsibly growing older. For those who are true to themselves and are not too proud, accepting these actualities can ease a heavy burden from themselves and their loved ones. It can even be liberating!

In my line of work, I encounter families that feel “blessed” or “fortunate” that mom or grandpa realized they needed help, asked for a change and took control of their evolving lifestyle early on in their journey of aging. We often witness them living longer, healthier, happier lives when they surround themselves with care and a modified or age-friendly home or environment.

One the other hand I also meet older adults that are often described as “stubborn” and “ornery.” Pride and or denial cloud their judgment about their own safety and well-being. Memory and cognition impairment can also distort common sense and reasoning. They do not recognize their own deficits or the problems and challenges they create for themselves and their loved ones as they engage in unsafe or unhealthy choices.

Furthermore we hear family members proclaim they’ll never be that stubborn or uncooperative and won’t lay such burdens on their adult children. But again, others conversely admit they will be strong-willed and cantankerous “just like dad” or they forget just how difficult it was and perpetuate a similarly distressful journey for their family members.

Write it down to remember the lessons learned

Write your future self a letter, then open it when the time is right.

No matter your persuasion, I ask of you, or better yet plead with you, be true and accountable to your future self. Be proactive, plan ahead and remember the lessons you learned from taking care of your parents or grandparents. Write it down. Remember the struggles and heartache you had getting your father to accept the help he needed. Remember the pain and strife you dealt with having to make medical decisions on your mother’s behalf, because she did not have a living will. Remember the care facility you were forced to choose for dad because no preliminary research was ever done or even dare spoken of. If you experienced any of these or similar scenarios and it was painful and overwhelming, why would you want to put your children or caregiver through the same ringer?

Remember, being proactive about long-term care is not about admitting defeat or fearing the end is near, it’s about control and self-determination. Preplanning a funeral or researching care options for the future will not expedite an early demise. At age 65 these proactive decisions may not be relevant for 15-25 years, but isn’t it reassuring to yourself and your family that you have those ‘what ifs’ covered? At 85, if you need help to live safely in your home for as long as possible, embrace it and make a plan; do it the right way. If moving to a retirement community or care facility provides peace of mind for those who care about you, have an open mind; consider the possibilities. Be true and kind to your future self and those who care about you. They only want the best for you, just as you wanted the best for your parents.

If you have additional questions or would like to talk with me further, please contact me at 717.591.7225 or email coach@messiahlifeways.org.

Podcast 12: Reducing Caregiver Stress & Family Friction

Locking horns with a family member about an aging parent’s care? It can make an already stressful situation that much worse. Family dynamics, disagreement, and old wounds can make the process of caring for an ailing parent very complicated between family members, especially siblings.

This episode focuses reducing friction and caregiver stress between family members for the good of the cause by examining caregiver equity, putting aside differences and gaining new perspectives. Listen to the Coach’s Corner podcast and check out some the additional resources to make caregiving a little less stressful and more manageable.

Click here to listen to Episode 12

Additional resources to check out:

“What to Do about Mama?” by Barbara Matthews & Barbara Trainin Blank, published by Sunbury Press
www.amazon.com/What-Do-about-Mam…ers/dp/1620063158


“The 36-Hour Day: A Family Guide to Caring for People Who Have Alzheimer ’s Disease, Related Dementia and Memory Loss” by Nancy Mace M.A and Peter Rabins, M.D. M.P.H. published by The Johns Hopkins University Press.
www.amazon.com/36-Hour-Day-Alzhe…ias/dp/1455521159


Or visit the Family Caregiver Alliance at www.caregiver.org

The Right to Make Bad Choices

As an aging parent or loved one begins to decline or falter, naturally we want to help. That help could be as simple as cutting their lawn or driving them to doctor appointments or errands. If needs increase, your help could consist of cooking or cleaning for them, or hiring a home care agency to provide assistance in their home. Further on down the line it could mean helping them move to a personal care home, assisted living, or a nursing home if necessary.

However, what if they refuse help or won’t move from their home? This is a quandary that many adult children, powers of attorney and caregivers face with an aging parent or loved one who is declining and becoming more and more dependent. It begs the question, “How do I persuade or even force them to get help?” Fortunately, many people recognize their limitations and welcome the help as it’s needed. We also know that just as many resist intervention and often state, “I’m fine, I don’t need help” or “I don’t want some stranger coming in my home to help me” or “you’ll have to take me from my home in a pine box.” Yikes!

It’s hard to admit we need more help as we age, that we can’t do what we used to, or that we now must rely on others to get through each day. Pride, stubbornness and denial are traits that we all have, but when it’s an aging loved one that we feel is at risk, it can be a precarious dilemma. It pits your better judgment and concern against their right to choose. It’s not a science, and it’s certainly not a black and white problem you can resolve. So how do you know when you have to force your hand and mandate change? Let’s explore the challenges a bit more.

Gray, Gray and Gray

First, your hair may become gray as you worry about the safety and well-being of a parent who is really becoming more of a reckless driver, is falling more frequently, or has left the stove on several times and almost burned the house down. Next, gray matter comes into question as we age. Although no matter your age, we all occasionally forget to use our brains. But as older adults make what you think are poor choices regarding their own health and safety they tend to come under a lot of scrutiny by those who love and worry about them. Where do you draw the line and where do hold back? This is a gray area as well. There are a lot of variables, challenges, what-ifs and sleepless nights involved.

In certain times it’s very clear when a parent or spouse has declined and needs immediate assistance and intervention. Injuries like a fractured hip, a stroke and hospitalizations often leave them little latitude to make poor decisions. And if they do balk at getting help, the hospital and or physician can press for a safe discharge or placement. Also a dementia or mental health diagnosis changes the dynamic and can often mandate formal intervention. As a last resort, you could file for guardianship (conservatorship), but that can turn into a long, drawn out and costly process that may require the person in question to be deemed incompetent by a judge.

But what about that person that is mentally intact and lucid? They may not be a danger to themselves or others; however, you see them teetering and declining before your eyes. You want them to be proactive, and you encourage them to seek help or to move to a care community because the writing is on the wall. But again they’re “kindly defiant” or downright bullheaded and claim they are fine and don’t need help. You’ve tried for a long time to make things better, but have always come up against a brick wall. What can you do?

Walking a thin line

For those who’ve have pushed and pushed to no avail, there is a surprising yet simple answer. It may sound crass, but sometimes must allow things to naturally occur and allow that person to fail. For some, they need to figure it out on their own or “the hard way.” This is not to suggest that you wash your hands of the situation. You must maintain your commitment and continue helping them any way you can; however, you cannot force them into a decision and we should honor their right to make bad choices. Their failure may result in a hospitalization, the worsening of their health, or other negative outcomes. But it might just be the necessary wake-up call they need. It’s a tight rope to traverse.

Again, this is not just about you as copping a laissez-faire attitude; it’s actually an approach that many human service agencies must follow. There’s a misconception that these agencies can just swoop in and force someone to get help or move from their home or that a power of attorney can do the same. A government agency or a judge can’t just strip someone’s right to choose, because of “what ifs.” If they can show that they are not a true danger to self or others, they have the right to refuse help or refuse to move. It’s hard, but often we have to live with it and just wait in the wings to then jump in and help.

Preemptive Preparation and Patience

Another thing you can do is to be prepared for worse case scenarios. Maybe if they are not willing to actually engage home care services or move to a care facility, they might at least be willing to listen to a plan of care in case of emergency. Research the options and services, costs and how you or they would pay for them. Set those wheels in motion. Tell your parent, “I understand you don’t want help, but if you need it, I’ve done some research and these are some of your options, etc.” Have a plan in place to help cushion the blow. You should also reach out to their healthcare providers and the local Area Agency on Aging to put them on notice, although many have likely already jumped through this hoop and connected.

Lastly, be patient with this person. Badgering or yelling won’t help. Understand where they are coming from, be supportive, stay committed and be humble when they come to grips once they realize they need help.

Additional articles to read…

CASES; The Right to Make a Bad Decision by Dr. Sandeep Jauhar from the New York Times

-aPlaceforMom.com SENIOR LIVING Blog: 8 Expert Tips for When Aging Parents Won’t Listen

If you need additional guidance on this topic or others related to caregiving, please contact the Messiah Lifeways Coaching office at 717.591.7225 or email coach@messiahlifeways.org.

Messiah Lifeways At Home and The Cheryl Kay Foundation “Granting” Help for Those in Need

October is National Breast Cancer Awareness Month and was established to increase awareness of the disease and to raise funds for research into its cause, prevention, diagnosis, treatment and cure. In the U.S., nearly 40,000 women die each year from breast cancer, with over 232,000 newly diagnosed cases annually¹. The fight against Breast Cancer is constantly waging thanks to education, research and treatment funding, all working in unison to eradicate the disease and treat those affected by it.

Though survival rates continue to improve, the number of those battling through the disease process is massive. The rest and recovery period can be long and arduous. Simple daily activities can be challenging during that time as treatments like chemo and radiation drain patients of their energy and stamina. And because women tend to be primary caregivers themselves, when they need care, they often have to turn outside help such as non-medical home care. Home care can be extremely helpful, but can also be cost prohibitive for many. Enter the Cheryl Kay Foundation (CKF), whose mission is to improve the quality of living and independence for women battling breast cancer and senior citizens in financial need. The Cheryl Kay Foundation is a Mechanicsburg-based family organization dedicated to affordable, dignified, and accessible home care services. They offer $1,000 grants to help offset the cost of care for qualified individuals.

CKF eligibility requirements include any woman undergoing breast cancer treatment or individuals, 79 years of age or older, who live alone or with a spouse, and whose monthly income is between $2,022 and a maximum of $3,635, aimed at helping those who do not qualify for the PA State Waiver requirements.

CKF was founded in 2013 by the family of Cheryl Kay Stawovy, who passed away after battling breast cancer. The foundation seeks to honor Cheryl’s life and model the spirit of neighbor helping neighbor. They work with a limited number of non-profit home care providers to serve those in need, and in August 2015 Messiah Lifeways At Home (MLAH) was pleased to announce they were partnering with Cheryl Kay as one of only two not-for-profit home care providers locally. The grant can allow clients to hire Messiah Lifeways At Home as an extra set of hands during the treatment and recovery phase or eligible seniors assistance with bathing, dressing, laundry, housekeeping, cooking and shopping and even transportation.

This partnership will not only relieve some of the pressure of those fighting breast cancer, it will also give seniors additional resources to help them age in place. These grants cover approximately 50 hours of care for people who otherwise may not be able to afford it, and provides families and clients peace of mind during what can be a very difficult time.

To learn more about Messiah Lifeways At Home and the Cheryl Kay Foundation, please call 717.790.8209 or visit MessiahLifeways.org/AtHome or CherylKayFoundation.org

¹American Cancer Society, Cancer Facts & Figures 2015

 

Mr. Bicher Goes to Harrisburg

Early last month, resident, Mona Hershey, and Messiah Lifeways Director of Rehab, Jordan Bicher, were invited to testify in front of the House Aging & Older Adult Services Committee at the State Capitol. The call to participate came from LeadingAge PA, which is an association of non-profit senior services. Mona and Jordan were honored and excited to take part in this informational hearing on the “Role of Therapy in Long-Term Care.” The Messiah Lifeways delegation was joined on a panel by other providers including physical, occupational, and speech therapy professionals.

The primary purpose for their testimony was to educate and enlighten House members, including Committee Chairman Tim Hennessey of District 26, along with roughly two dozen other lawmakers. The goal was to share the perspectives of the therapists along with an older adult who went through the rehab process. They shared positive outcomes and the value and importance of rehabilitation in long-term care facilities with success stories like Mona’s. Equally important was the chance to shed light on some of the challenges they face when it comes to diminishing insurance reimbursement and caps, along with reducing length of therapy stays as a means to cut back on costs.Testifying in Front of House Aging & Older Adult Services Committee

Jordan shared, “It’s important to remember that age is just a number. It’s all about how you feel and how you live your life.” He went on to say, “Therapy plays an enormous role in that experience… working with people like Mona, inspires me every day. I have the opportunity to work with a population of patients who truly want to maximize every second. They want to stay active, stay healthy, and recover quickly. Mona’s story is a testament to that mindset.”

Mona’s testimony was an inspiration for everyone in the hearing. Her rehab journey after suffering a fractured hip is pretty amazing, especially at the age of 92! Her strength and determination to get back on her feet, along with the inpatient and outpatient therapy provided by Jordan and his caring team, speaks volumes to the importance, value, and need for comprehensive therapies no matter the setting or one’s age.

Medicare Snafu Continues to Cost Seniors

To compound the pain and suffering seniors endure during a hospitalization, financial heartache can make things worse, especially for those who may need skilled nursing care or rehabilitation after being discharged from the hospital. In order for Medicare A to potentially pay for up to 100 days of post-acute care in a skilled nursing facility, a patient must meet two Medicare criteria for coverage. First, they must have an inpatient hospital stay of three or more consecutive days, not counting the day of discharge. Secondly, they must have a condition that upon discharge requires skilled services such as physical therapy, IV antibiotics, or wound care. However, some Medicare beneficiaries are finding out that Medicare will not cover their post-acute skilled nursing stays because they technically did not have the necessary three-day stay in the hospital despite being there three days or even longer!

How’s this possible? This is where the snafu or technicality plays a role. Once in the hospital their status may remain as an “observation” patient rather than an actual inpatient admission. The observation period is meant to be used for testing and performing diagnostics to determine their illness or injury and whether full hospitalization is necessary. However, observation periods are stretching well beyond 24 hours and can go for several days and they do not count towards the required three-day stay. Some of these patients are then transferred to nursing facilities for further care or rehabilitation without any insurance coverage due to not meeting the first criteria for coverage. Plus, in some cases with communication breakdown, the individual may not find out they have to pay out-of-pocket until they receive the bill from the nursing facility a few weeks later. This all leads back to what they thought was a qualifying stay in the hospital. At a range of nearly $200 to $300 a day for skilled nursing care, that non-qualifying technicality becomes a very costly surprise.

This issue affects many seniors as well as younger disabled Medicare beneficiaries who need skilled nursing care. They run the risk of substantial out-of-pocket costs for post-acute care. Worse yet they may settle on going back home despite the physician’s recommendation or could be admitted to a lesser level of care that could jeopardize their health or safety, simply because they don’t want to pay out-of-pocket for a nursing facility.

Back in 2012, the Improving Access to Medicare Coverage (Act S. 818 in the U.S. Senate) and (H.R. 1543 in the U.S. House of Representatives) was introduced to help resolve this issue. The bill would not change the three-day stay requirement, but rather it would stipulate that Medicare beneficiaries hospitalized for “observation” for more than 24 hours would be deemed an inpatient, thus making that 24-hour period count as an admission day toward the necessary three-day stay.

Unfortunately, the bill never passed, and this problem has not yet been resolved. In 2015, there is bipartisan support in Congress to alleviate this issue. Senator Sherrod Brown (D-OH), Senator Susan Collins (R-ME), Senator Bill Nelson (D-FL), Senator Shelley Moore Capito (R-WV) and Representative Joseph Courtney (D-CT) have initiated an updated version of the Improving Access to Medicare Coverage Act of 2015 (S. 843/H.R. 1571). Again, like in 2012, this bill would require that time spent in observation would be counted towards meeting the necessary three-day prior inpatient stay.

This is an expensive and potentially harmful snafu that seniors and those with disabilities should not be saddled with. To learn more about this topic and the legislation trying to change it, go to LeadingAge.org. If you have questions about Medicare A coverage and eligibility for skilled nursing coverage, please contact the Messiah Lifeways Coaching Office at 717.591.7225 or email coach@messiahlifeways.org.

Originally posted September 4, 2012
Revised June 8, 2015
by Matthew J. Gallardo