Understanding the Nursing Home Game

If you are searching for a nursing home bed, you undoubtedly have become discouraged. It is so hard to find available long-term care beds at nursing homes. Why?

Most nursing homes are certified with Medi-Cal. This means every bed is considered a Medi-Cal bed or a Long-Term Care bed, yet the nursing homes are telling you they have no long-term beds left. The problem is the Medi-Cal rate for nursing homes has been drastically reduced and nursing homes can no longer sustain adequate profit margins to stay in business with mostly long-term residents as they did in the past. Nursing homes now receive approximately $6,000.00 on a Medi-Cal bed, well below the average private pay rate in California. Medicare will pay a substantially higher rate to the nursing homes for what are termed short-term or rehab beds, usually $8,500.00 to $14,000.00 per month. It does not take a rocket scientist to figure out that if you owned a nursing home you would want most of your beds to be Medicare beds as opposed to Medi-Cal beds.

Another change effecting long-term bed availability is that hospitals are releasing patients much earlier than before, many of them requiring 24 hour critical nursing care for what they are calling “rehab.” Nursing homes have now effectively converted to rehab centers rather than typical long-term care nursing homes. This creates a shortage of available long-term beds at a time when the nursing home population is growing.

The easiest way to get your loved one into a nursing home is for them to be admitted through the hospital. The patient is usually discharged to a nursing home under rehab and under Medicare coverage, providing they were admitted to the hospital for 3 days. If the patient does not make progress and cannot return home, the nursing home will be required to convert the short-term bed to a long-term bed. No matter what pressure you get from the nursing home, it is critical that you do not take the resident home as the nursing home is not required to take the resident back, and you will have lost the bed.

Making a Medi-Cal application during the Medicare rehab days can make the difference of staying at the nursing home or not. It will certainly make it easier to find a bed when transferring to another nursing home. And, most of all, it will drastically reduce the cost when Medicare coverage runs out. If you are facing this dilemma, give us a call. We can help you sort through the process and secure the Medi-Cal coverage you will desperately need.