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Up until a month ago my 95 year old Mom resided in a ALF. She fell and hit her head which caused blood on the brain and a hairline stress fracture to her hip up until this accident she was doing great ambulating on her own. She spent 7 days in the hospital, 3 weeks in a rehab hospital and was moved a week ago to sub acute rehab the body will eventually reabsorb the blood on the brain but due to the fall she has a stage 4 pressure ulcer which is being treated by the SNF. She can no longer ambulate after all this therapy, is incontinent and has CHF with her supplement Medicare will pay 100 days at 100%. I see her rapidly declining. Going back to ALF is an option but I feel SNF is where she needs to be. Long story short I have read that there are some instances where one can receive both Medicare and Hospice at the same time. The wound was the primary reason she's in the SNF but CHF is a qualifying condition for hospice. Has anyone had any experience with this journey?

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You could leave her in SNF but the cost of the SNF comes out of Moms pocket. Medicare does not pay for the facility only when recieving rehab. I would ask the AL if she would be allowed back if she qualifies for Hospice. Otherwise, Mom will be paying OP for the bed with Medicare paying for Hospice. That could be 10k a month. If she runs out of money, then u apply for Medicaid.
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anonymous183986 Jun 2019
Thank you so much this journey is so confusing yes I checked with the ALF which I'm continuing to pay rent monthly to keep her apartment she can be transported back there and go on hospice if it comes to that which is a viable plan B
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I was just going through the same thing with my mother. She was living at home, with an aid and hospice services, but after a series of events she ended up in the hospital with a need for 24/7 care. Similar situation of bed sore/no longer able to ambulate/toileting issues compared to where she was before. She has Medicare and Medicaid, and was presented with a choice for transfer to SNF: 1) stay on hospice and enter the facility under long-term care with no rehab, which would be covered by Medicaid, or 2) revoke hospice and enter the facility under Medicare, which would pay 100% for up to 100 days as long as she was on therapy. She has hopes of regaining some function, and so she chose the latter. My understanding is that without Medicaid option 1 would have required out-of-pocket payment for the SNF, because Medicare won't cover it. With option 2, the main consideration is the medication management, since the facility would be taking over her prescriptions, so we made sure we found a place with a good doctor who won't leave her in pain. Medicare will also stop covering as soon as she is terminated from therapy (either because of refusal, lack of progress, or meeting all her goals). But I was told that it would not be difficult to go back on hospice when that time comes, so overall it seemed like the way to go for now.
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It's all so confusing! I'm a little confused by your question, since MediCare is a payor, and hospice is a program that Medicare covers. Maybe the confusion is that while medi-care covers Hospice services, they will not cover the room and board at a nursing home, you would need to also have medi-caid to cover that portion. Maybe I just confused things more!?
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Shane1124 Jun 2019
No, you’ve got it. Medicare won’t pay for the actual physical space (bed, meals, etc). That would be an out of pocket expense unless her secondary pays it.
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