Dear Richard,
Yes, you can take your wife out of the nursing home for a short time without losing coverage or a bed, but some of the details governing a “leave day” are different depending on what program is paying for her stay in the nursing home.
Medicare
Medicare pays for nursing home coverage when a person is rehabilitating from surgery or other hospitalization. For this reason, I will call the person staying in the nursing home a patient.
The nursing home shouldn’t tell you that leaving the nursing home will cause loss of Medicare coverage. Medicare recognizes that temporary absences don’t necessarily mean that a patient no longer needs nursing home care. Thus, if you can arrange for your wife to be absent while meeting her care needs, she should be able to celebrate the day outside the nursing home.
Under Medicare, a leave day is when the patient leaves the nursing home and is gone past midnight, returning the next day. In contrast, if the patient leaves the nursing home and gets back before midnight the same day, it’s not a leave day and the nursing home can bill Medicare for the day.
The patient may be charged for the leave day. Before the patient takes their leave day, if the nursing home gives notice that they can charge for a “bed hold” during the leave day, informs the patient of the amount of the charge, and the patient agrees to pay, then the nursing home can bill the patient for those leave days. By holding the bed, the nursing home reserves the patient’s bed and keeps their personal belongings and effects in their room.
Medical Assistance
Medical Assistance pays for long-term care, also known as custodial care, in a nursing home. I will call a person living at a nursing home a resident.
A resident can temporarily leave the nursing home for hospitalization or therapeutic leave when Medical Assistance is paying for their care. A leave day under Minnesota law is defined as an overnight absence of more than 23 hours. Before leaving, check the nursing home’s policy on absences/leave days.
A nursing home resident might need to go to the hospital. This is allowed for up to 18 days per episode and Medical Assistance will still pay the nursing home (albeit at a reduced rate). Therapeutic leave can be leaving the nursing home to visit family. This is allowed for up to 36 days per calendar year. During this time, the nursing home has to hold the resident’s bed. If the resident is gone more than the allowed days, then Medical Assistance won’t pay the nursing home, but the resident or the resident’s family has the option to pay for the extra leave days in order to reserve the room.
Note: If a resident is gone longer than the nursing home’s policy, the nursing home has to readmit the resident to the first available room.
Thus, if your wife is up for it and you can take care of her during the absence from the nursing home, she should be able to leave the nursing home for a short period without losing her bed or coverage. If she comes back before the end of the same day, the nursing home won’t bill her and it won’t count against her allotted leave days.
