Chapter 4: Care after a Hospitalization

Arranging care for a parent or loved one after a hospitalization can be a maze of options. You may be pressed by the hospital’s care management department to make arrangements quickly, as the day of discharge approaches. At the same time, you feel pressed to find the optimal care setting and to do so with the available financial resources.

Under Medicare or commercial insurance, a patient coming out of the hospital will only get intermittent home care for a few months.  That means a nurse will make home visits a couple of times a week to check and monitor symptoms, medications and progress. These visits may be more frequent if some sort of skilled service such as injection or dressing change is needed. Various rehabilitation therapists may set up an exercise program and also visit several times a week to work toward improved ambulation, transfers, and endurance.  For the months that the nurse or therapists come, the insurance will provide home health aide services about two hours at a time several days a week-- to support the plan with activities, exercise, and bathing. This coverage may not be enough for the patient to be maintained at home without additional private resources.

If the hospitalization was for an advanced illness and the patient meets hospice eligibility criteria, there is more generous aide coverage.  Depending on the patient’s needs, hospice generally will cover daily aide service for up to four hours a day.  What families usually do is arrange for this aide service for hospice and have them do the daily bath and health related care, and then privately hire another aide, or just a sitter (depending on what he needs) for the rest of the day.  Hospice also has volunteers who will come in and visit , but not regularly where you can count on it for coverage.  

If the patient is eligible for Medicaid, then he or she might be able to get additional aide service coverage, but this is getting more and more difficult to get approved.  State requirements for Medicaid vary, and it is best to consult with a hospital or home care social worker or an elder attorney to explore this option.  Medicaid would also give you the option of getting care in a nursing home covered if the patient deteriorates and requires that level of care.

If the patient has Medicare there is another option right after hospitalization. This option is to seek admission into a nursing home for skilled services under Medicare coverage.  That might only last a few weeks up to three months depending on needs and the requirement of skilled services, but it would gain you some time to pursue a more permanent option at home.  It also gives the social workers at the nursing home time to work with you on a Medicaid application for continued care in the nursing home after Medicare runs out, or for extra services at home when the patient leaves the nursing home.  If you want to try this option and the patient has an advanced illness, don’t go on hospice care yet as they wont pay for nursing home care in most cases (Medicare will only allow a patient to be on one Medicare program at a time-- skilled Medicare nursing home placement, or hospice, but not both).  

Making post discharge arrangements is a challenge. The options discussed here may vary depending upon specific insurance coverage, state programs, and availability of services in your community. Most home care programs need to be supplemented by the time of family and friends, and perhaps even privately paid for care. Typically, there is not a one-stop option. You will need to build a quilt of programs, people, and resources to meet your loved ones needs. The care manager or social worker in the hospital can be an important resource. They are experienced with what programs are available in your community that meet the patient’s needs, and they also typically know the coverage limitations of the various insurance plans and government programs.