When President Biden exhorted people to “stand up for seniors” during his State of the Union address, I was laying down. I was exhausted from a day of standing up for my senior—my mother—trying to advocate for a longer hospital stay while she recovers from multiple surgeries and other complications. The day before, I was handed the dreaded nursing home list. Every hospital has one of these contact sheets of skilled nursing facilities that they give to families when they want to discharge a patient who is deemed not sick enough to stay in the hospital, but is not well enough to go home.
We knew it was coming because we went through it with my dad years ago. But most people aren’t expecting the step-down-facility talk to come so soon because they are under the impression that Medicare covers hospital stays—full stop. Technically, Medicare pays up to 90 days of inpatient care, which resets if you have 60 days between incidents, and you have 60 lifetime reserve days. That seems like a lot, and should be enough for most people. However, it all has to be justified by doctors and often works out to much less time in reality. Your advocates don’t get clued into the nuances of discharge policies until they are standing in the hallway talking to a case manager who hands them the list and tells them to pick one. “It’s always going to be too soon; it doesn’t matter when it is,” says Joy Loverde, an eldercare expert and author of “Who Will Take Care of Me When I’m Old?” She actually suggests asking for the discharge list as soon as you begin your hospital stay and ask all along—sometimes twice a day—what the projected timeline is for the stay. Another reality check hits when the patient arrives at the skilled nursing facility and you realize there’s a countdown clock on that stay, too. Medicare cover …