Leaving the Hospital in Baton Rouge: Rehab, Home Health or Back to Assisted Living

What happens when a Baton Rouge hospital says your parent is ready to go?

Discharge planning moves fast. The case manager at Our Lady of the Lake, Baton Rouge General, Ochsner Medical Center Baton Rouge or Lane Regional in Zachary will recommend a next step, line up options and expect a decision within a day or two. You can and should ask questions before agreeing to anything.

Three questions do most of the work: was my parent admitted as an inpatient or kept under observation, what level of care do you recommend and why, and which facilities or agencies have you already contacted?

Why does inpatient status matter so much?

Medicare Part A pays for a skilled nursing facility stay only after an inpatient hospital stay of at least three days. Time under observation, even overnight in a hospital bed, does not count. Days 1 to 20 of a covered skilled stay are paid in full, with a daily coinsurance from day 21, up to 100 days, and only while your parent needs daily skilled care. Medicare Advantage plans have their own rules and often require prior authorization.

What are the options after a hospital stay?

The main choices are home with Medicare home health, an inpatient rehabilitation hospital for patients who can handle about three hours of therapy a day, a skilled nursing facility for short-term rehab, a long-term acute care hospital for complex medical needs, or a return to an ARCP with outside services.

Ask the case manager whether your parent is a candidate for inpatient rehabilitation before accepting a nursing home rehab bed; the therapy intensity is very different.

Can a parent go back to assisted living?

Usually, if the ARCP can meet the new needs. A Level 3 building cannot deliver nursing itself, but a Medicare home health agency can come in for therapy, wound care or medication teaching while the ARCP coordinates. Louisiana also allows a resident with a temporary prohibited condition, such as wound vac therapy, to stay up to 90 days if the resident, physician and provider agree and the physician certifies the condition is time-limited.

Call the ARCP's director before discharge day. Some buildings reassess residents after a hospitalization and may change the care level or decline readmission under the termination criteria in the residency agreement.

How do we choose a nursing home for rehab?

Open the CMS data for each option: the short-stay quality measures, nurse staffing hours, turnover and the latest inspection. Ask how many therapy sessions a day patients receive and whether therapy runs on weekends. Then look at the home's long-term side, because if recovery stalls, a short stay can become a long one in the same building.

What if the plan is to go home?

Going home after a hospital stay usually means Medicare home health: intermittent skilled nursing, physical, occupational or speech therapy and part-time aide visits for a homebound patient under a doctor's plan. Ask which agency the hospital has contacted, when the first visit will be, and who will set up equipment such as a walker, shower chair or hospital bed. Medicare home health does not cover hourly aides or overnight help, so plan who will be there at night for the first week.

If your parent qualifies for nursing home level of care and has limited income and savings, ask about LT-PCS and the Community Choices Waiver, and request them early; the waiver uses a registry ordered by request date.

How do Medicare Advantage plans change things?

Many Baton Rouge-area seniors have Medicare Advantage plans, which often require prior authorization before a skilled nursing or inpatient rehabilitation stay and may limit you to in-network facilities. Ask the case manager whether authorization has been requested and which facilities are in network. If the plan denies or ends coverage, you have appeal rights; the notice will explain them. Free counselors at SHIIP, 1-800-259-5300, can help you understand the plan's rules.