They Said Mom Needs a Nursing Home. Read This First.

You are getting this conversation on a Tuesday afternoon and the discharge is scheduled for Thursday. That is normal and it is also why families feel cornered. Before you sign anything, ask the discharge planner three questions.

One, what level of care does she actually need? Skilled nursing (24-hour licensed nursing) is different from custodial care (help with bathing, dressing, meals). Many people who are told nursing home actually need custodial care, which can be done at home.

Two, what would home care look like? If the planner has not given you a home-care option, ask. Hospitals are required to give you a choice of post-acute providers.

Three, who is paying for what, and for how long? Medicare covers up to 100 days of skilled rehab after a qualifying hospital stay. Long-term nursing home care is on Medicaid, which is a different application.

ProMedica Toledo Hospital, Mercy St. V's, and St. Luke's all have discharge planners working under pressure. Their job is to free up a bed. That is not bad, it is just the math. The planner is not going to spend an hour walking you through your options unless you ask.

If you tell the planner you want to take her home with services, the conversation changes. They will involve the case manager and you will get a more detailed plan. We work with all three hospital systems and our coordinators can be on a call with the case manager same-day in most situations.

Step one is usually short-term home health (skilled nursing and therapy visits paid by Medicare). This handles the medical follow-up like wound care, IV antibiotics, and physical therapy.

Step two is custodial home care for the help-with-daily-life piece. Bathing, dressing, meals, medication reminders, transfers. This is what we provide. It is not covered by Medicare. It is covered by DODD waivers (PASSPORT, MyCare, OHC) if your mom qualifies, or by long-term care insurance, private pay, or private pay.

Step three is filing for the right waiver if she is Medicaid-eligible. We start that application during the hospital stay so it is not a sprint later.

Sometimes it is. If she needs 24-hour licensed nursing because of vent care, complex wound care, or aggressive behaviors that put her in danger, a skilled nursing facility is the safer choice. If you have no family to be in the home and she cannot be safely alone for even short periods, the round-the-clock staffing of a facility may be necessary.

Short-term rehab in a skilled nursing facility (the up-to-100-days Medicare benefit) is often a good bridge. She gets stronger, you get time to set up home care, and then she comes home.

We tell families to slow the discharge down. You are allowed to delay 24 to 48 hours to make a real plan. We can usually have a home-care assessment in the hospital room within a business day, talk to her doctor, and have authorization started before discharge. That is the difference between a panic move to a facility and a plan you actually chose.

Ask the social worker: 'Has anyone assessed mom for private pay or DODD waivers at-home services?'

Ask: 'Can you make a referral to the Area Office on Aging of Northwestern Ohio before discharge?'

Ask: 'What is her assessed Level of Care?' Nursing-facility level of care is the threshold for both waivers.

If discharge planner is unfamiliar with waivers, call us. We've walked families through this on the day of discharge.