Is this legal? The ulgy side of LTCCs

[Chibilou]

Dear Nurses,

I am writing to you because I just caught wind of something that could possibly be an elaborate scheme, among nursing homes in general or just this once instance? Any advise that would be useful would be appreciated.

I was talking to a friend and she explained to me that her facility is turning into a Rehabilitation center only, from once being a Rehab & LTC center. She explained that the Long Term Care residents are grandfathered in, so they are to stay here until they are transfered or expire. Sad, but alright.

Moving foward to my point. She said when the families of these potential NEW residents view the facility, that they ask if we take LTC residents too and are told exactly this; "Anything is possible". When, INFACT, the administration only wants to keep the residents here for their Medicare days (100 days usually) and then get rid of them asap.

She continued on to explain how it makes certain department heads uncomfortable because they are constantly fighting between the greater good of the resident, and essentially getting paid for medicare reimbursement.

I feel bad for her perdiciment but I have a feeling her facility isnt the only one doing this, and that this is in fact the nature of the beast itself.

Can someone please rationalize this aspect of Nursing for her? I want to give her advise but I have nothing useful to say in order to comfort her. This is the ulgy part of Nursing homes.

[TheCommuter, BSN, RN]

This practice is occurring in many nursing homes owned by for-profit corporations.

Simply put, short-term rehab patients on Medicare or private insurance are far more profitable than long-term Medicaid patients. Many nursing homes are turning to rehab patients just to remain solvent and stay financially afloat.

The typical long-term Medicaid patient's care will be reimbursed at the paltry rate of about $100 per day (sometimes a little more, sometimes slightly less) while the short-term rehab patients on Medicare or private insurance generate three to four times as much money per day.

I'm not here to discuss the morality or ethical implications of these practices. I'm simply confirming that a number of nursing homes engage in this practice.

[RNnrgrl]

This practice is occurring in many nursing homes owned by for-profit corporations.

Simply put, short-term rehab patients on Medicare or private insurance are far more profitable than long-term Medicaid patients. Many nursing homes are turning to rehab patients just to remain solvent and stay financially afloat.

The typical long-term Medicaid patient's care will be reimbursed at the paltry rate of about $100 per day (sometimes a little more, sometimes slightly less) while the short-term rehab patients on Medicare or private insurance generate three to four times as much money per day.

I'm not here to discuss the morality or ethical implications of these practices. I'm simply confirming that a number of nursing homes engage in this practice.

In my state Medicaid payments are delayed by over a year. Companies profit margins are severely affected. A lot of services are cut short.

[indiechic, LPN]

I think that is an uncommon happening, or I just haven't run into it yet... SNF's can change to rehab only by grandfathering in their LTC residents and then relicensing those beds as they transfer or die. But, that is false advertising what you're referring to. I'd recommend your friend keep documentation of that...

[SuzieVN]

I think that is an uncommon happening, or I just haven't run into it yet... SNF's can change to rehab only by grandfathering in their LTC residents and then relicensing those beds as they transfer or die. But, that is false advertising what you're referring to. I'd recommend your friend keep documentation of that...

I've worked at two places that decided they were going to be only Med-A and private pay, so they gave notice to every Medicaid resident to move out. In each case the census dropped to below 30, and in each case each place realized they couldn't take in enough revenue without the bulk of LTC patients, and changed their minds- but their reputations were screwed. A SNF does not have to keep a patient once they are no longer skilled, and more of them are headed that way. If they are a wiz at revenue maximizing (ala MDS, and also getting the 'prime' referrals, etc.), and pay their staff ever less and less, and don't provide healthcare to their staff, they can and do make a profit with fewer rehab patients. Most places though need Medicaid for the bulk of their operating income, even though they lose money on a LOT of Medicaid recipients.

A good Medicaid example- that 350 woman, with behavior problems, a catheter that gets replaced every other day, special diet, who requires a special bed, and etc.? She's costing the place the place a bundle, way more than they get back from Medicaid. Trust me, her 'discharge planning' is being discussed behind closed doors, DAILY.