The 100 Days in a SNF Question

The 100 Days in a SNF Question

Dear jaynie,

My father is in a SNF (skilled nursing facility) and they just released him from physical therapy and now he will only get nursing care for the remainder of the 100 days. They said he wasn’t progressing enough to keep getting PT. I wish I knew if this is something they can do.

– T

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Dear T,

Unfortunately, they can. That is why I wrote “qualified days” in my post. Trust me, he won’t be there for ‘the rest of his 100 days’ That isn’t what the 100 days means.

So, we have 100 qualified days. Let me explain. Medicare gives all seniors ‘up to’ 100 days to ‘rehab’ as defined by Medicare guidelines. The first part of that guideline is, the 3 day ‘qualifying stay’ in an acute care hospital. The second part it is a ‘qualifying need’ like physical therapy or occupational therapy (PT & PT), IV antibiotics etc. This gets you to the SNF, how long you stay here is the ‘qualifying part’ and greatly differs from the 100 days you ‘think’ you get.

Once in a SNF what happens? You get evaluated for rehab. They ask questions about what the patient, to find out what their ‘baseline’ was before the incident that took them to the acute hospital setting. Then they set ‘Goals’. The goals could be just PT or they could include OT too. But whatever got you there will not keep you there for 100 days be assured of that. PT and OT usually work with a patient 2xs a day M-Sat. This is intense therapy, to motivate you to get better. And for the most part it does and you keep improving, but once you reach the Goal set for you, you don’t need to be there any longer…yay.

So, your loved one has been in the SNF for 2 weeks and they tell you they are done and you have to leave, but why? You have 100 days right? Wrong! Question you ask, why are you discharging dad/mom? He/she can’t walk to the bathroom without a walker or a person standing by them constantly. You have to keep her until she can do what she did before, at least that is what we think. Wrong again. Here is where the Qualified Stay for those 100 days comes in.

Medicare will give you those days as long as you are ‘Improving’! So if the goal is set at 40 feet with a walker ( even though you never used a walker before), and you get to 20 feet, and 20 feet is all you do for 3 or 4 days in a row, you have reached your ‘new baseline’. Therefore you are done, and have exhausted your qualified days in SNF. So in short, as long as you ‘progress’ with all therapies, you get to stay. Once you stop progressing you stop being qualified to stay in skilled nursing.

This ‘qualified’ stay has been miscommunicated to seniors and their loved ones for decades. No one really understands it and no one wants to be the person to have to explain it. But, I don’t have a problem explaining it to you here or in person. The system is broken, but the parts that work should be relayed to seniors in a forum other than a yearly book sent to explain Medicare to seniors. Especially when they don’t or can’t read it, don’t understand it due to dementia and then they find themselves in the thick of it during a crisis mode. Hopefully this helps anyone reading this post. For more information please don’t hesitate to call anytime.

– askjaynie.com