By Erin Kershaw, CCA Certified
Navigating Rehabilitation Denials: Exploring Alternative Care Options for Your Loved One
Many of my clients’ family members express frustration when their loved one is denied a stay at a skilled nursing facility for rehabilitation. There’s a common misconception that any hospital stay guarantees admission to rehab, but the reality is more nuanced. To qualify for rehab under Medicare or Medicare Advantage plans, the patient must meet specific criteria:
- A three-night stay in the hospital.
- A skilled need such as IV antibiotics, wound care, or physical, speech, or occupational therapy (PT, OT, or ST).
Although most individuals would benefit from therapy, approval isn’t automatic. During the hospital stay, the patient must demonstrate an ability and willingness to participate actively in therapy sessions. If the patient refuses therapy or cannot engage meaningfully, Medicare may deny the rehab stay. Furthermore, even after entering rehab, patients must meet Medicare’s ongoing benchmarks to maintain their stay.
When Rehab Isn’t Approved: Embrace Alternative Solutions
It can be discouraging to hear that your loved one doesn’t meet the criteria for a rehab stay. However, there are viable alternatives that can deliver the same benefits, often with less disruption. In many cases, moving directly to an Adult Family Home or Assisted Living Community—with home health services in place—can be just as effective for recovery.
Home health care, often covered by Medicare, provides:
- Nursing oversight to monitor recovery.
- In-home PT, OT, and speech therapy, delivered in a familiar environment.
- Social worker support to coordinate care and access community resources.
This approach brings the rehabilitation experience to your loved one, instead of uprooting them to a rehab center. For individuals with dementia, this can be particularly beneficial. Multiple transitions—from hospital to rehab, and then to long-term care—can cause confusion and distress. Moving directly into an Adult Family Home or Assisted Living Community where long-term care will be provided often results in a smoother, less stressful transition.
The Right Care Doesn’t Have to Involve Rehab
It’s important not to view the denial of a rehab stay as a setback or failure. Instead, recognize it as an opportunity to embrace individualized therapy that meets your loved one’s specific needs in a more comfortable, familiar setting. Many patients recover just as well—or even better—through in-home health services and early placement in a long-term care setting where they receive consistent support and therapy.
At Concierge Care Advisors, we specialize in helping families navigate these challenges and find the best care solutions, whether that means exploring adult family homes, assisted living communities, or home health services.
Call us today at 1-855-444-7364 or visit Concierge Care Advisors to connect with a senior care expert and start building the care solution that’s right for your family.
