Getting your 100 days of therapy matter of life, death

Funny how providers kick patients out when coverage drops to 80%

If you receive Medicare Part A benefits and have a medical incident, such as a stroke or broken hip, you are entitled to therapy, be it physical, speech or occupational. At the very least, you could get 20 days at a rehabilitation facility 100% paid for by Medicare. At best, you could get 100 days of therapy, with Medicare picking up 80% of the cost for those last 80 days.

All Medicare recipients who spend at least three nights’ hospital admission are eligible for the therapy, However, few actually get their 100 days because insurance companies control health care services, and they insist on kicking most people out of therapy after 20 days. It’s what I call the “21st day miracle.” For the first 20 days, you need 24-hour medical care. On the 21st day, however, you are miraculously healed and must leave the facility. Funny how the miracle occurs on the exact day Medicare stops paying the facility at 100%.

Given only 20 days, most families aren’t prepared to take their ailing loved one back home just three weeks after a major medical incident. It takes time to arrange home health care, buy medical equipment and coordinate schedules among family.

There is a distinct imbalance of power when advocating for your medical treatment — if you aren’t aware of the benefits available, you can’t very well advocate for yourself. Even if you know the rules, the medical professionals have well-honed and sometimes outright bogus reasons for the early discharge.

One of the favorite improper reasons given for discharge became the subject of a lawsuit known as Jimmo v Sebilius. A patient sued because he was denied his 100 days based on the fact that he wasn’t showing improvement. The Jimmo decision ruled that is a bogus reason and the actual standard should be whether the patient would decline without the therapy. Jimmo means a majority of patients should be able to get their 100 days. Instead, the 21 day miracle is denying patients much-needed therapy and putting undue pressure on families.

Those 100 days are vital while the family prepares for their loved one to come home and the patient is getting speech, occupational or physical therapy at the rehab facility. It’s not just logic — statistics show better and more therapy can make a difference in length and quality of life. After 100 days of intensive therapy, that person is at their peak physical ability with their best chance to bounce back from illness and recover mobility.

It isn’t just the patients who are being short-changed. It’s their families who suffer along with them. They feel guilty that they are not prepared to care for their loved one at home, so they will accept the unacceptable. They will quit their jobs, cobble together care schedules with anyone who will help, which in turn can cause an enormous amount of stress on the family unit.

Early discharge into unstable home environs often ends in disaster, with multiple hospitalizations and readmissions, trauma that is hard on everyone involved. Each time an elderly person must transfer facilities, there is potential to exacerbate medical conditions, and that is why sometimes the difference between 20 and 100 days is the difference between life and death.