Managing Costs of Skilled Nursing

Your patient requires skilled nursing care, but the family has no resources and is unsure how to cover the costs for it. What can you tell them?

Medicare Coverage of Skilled Nursing Care

Your patient must meet the following criteria before Medicare will cover their care in a skilled nursing facility:

  • They have Part A Medicare with days left in their benefit period.

  • They have a qualifying hospital stay, usually an inpatient hospital stay of 3 days or more within the past 30 days.

  • Your patient requires care by or care supervised by registered nurses, licensed practical nurses, physical therapists, occupational therapists, speech-language pathologists or audiologists that may only be provided in a skilled nursing setting on an inpatient basis.

  • The skilled nursing facility is certified by Medicare.

  • Your patient’s skilled nursing care is required for an ongoing condition treated during their qualifying 3-day inpatient hospital stay (even if the condition wasn’t the reason for admission) or a new condition that began during previous skilled nursing care for the ongoing condition.

Skilled Nursing Services Covered by Medicare part A

Services covered by Medicare include:

  • Semi-private room
  • Meals
  • Skilled nursing care
  • Physical and occupational therapy
  • Speech-language pathology services
  • Medical social services
  • Medications
  • Medical supplies and equipment used in the facility
  • Ambulance transportation (when other transportation endangers health) to the nearest supplier of needed services unavailable at the skilled nursing facility
  • Dietary counseling

Medicare does not pay for long-term care, although it will continue to pay for medical supplies and physician care.

Medicaid Coverage of Skilled Nursing Care

If your patient requires long-term skilled nursing care, it’s likely their family will turn to Medicaid for help. The law may require some patients to “spend down” their assets by paying out-of-pocket for care in order to qualify for Medicaid.

Not all skilled nursing facilities accept Medicaid, so if you’re in doubt about a patient’s ability to pay, make sure the one you choose does.

This article from MacIntosh Company experts will give your patients and their families an idea of how Medicaid works. This article will help them get a better picture of how to manage their assets if a family member needs long-term care.

If your patient has long-term care insurance, have them contact their insurance company to determine what it covers.

If you wish to refer a patient to a MacIntosh community or your patient is already at a MacIntosh community, this list of resources will prove helpful to you.


Is it Time to Give Up Driving?

Dear Janet:

My father suffered a stroke three months ago. While he is doing remarkably well, I’m not sure how safe he is driving. My mom won’t really talk about it, but I sense she is afraid of his driving since the stroke.

I took a look at their car when I visited their Columbus home last week, and I suspect he is running into things, including the sides of their garage. The car has more than a few bumps and scrapes, and so does the garage.

My mother, believe it or not, never learned to drive. So I think the idea of my dad giving up his car keys is frightening for both of them. I don’t want to overreact and force my dad to turn over the keys, but I also don’t want to wait for something terrible to happen to have this conversation.

Do you have any suggestions that might help me evaluate my Dad’s fitness for driving?


How to Assess a Senior Loved One’s Fitness for Driving

Dear Frances,

This topic is one so many families struggle with! For most of us, driving often represents independence and freedom. Many older adults view giving up the car keys as not only a loss of independence, but a loss of dignity as well.

A challenge adult children face is how to objectively evaluate a loved one’s safety behind the wheel of a car. While some think age the primary determining factor, there is much more to the issue.

A few important things to consider include:

  • Does your Dad have good range of motion? This is necessary for him to able to turn his head over his shoulder to merge in traffic and to back out of parking spaces.

  • Another issue some stroke survivors face is changes in vision. Since you mentioned the bumps on his car, this might be a problem for him. Having a stroke can affect spatial awareness and depth perception. Both can cause drivers to misjudge distances and have problems parking.

  • Has your father’s primary care physician tested his reflexes? Slow response times can impact his ability to stop quickly or to react to changes in road conditions.

  • You should also take any cognitive changes your father has experienced into consideration. Memory loss and forgetfulness can lead to problems such as getting lost while driving or forgetting to turn off the car.

Should you want to enlist an expert to provide your family with unbiased guidance in making this determination, there are a few local resources you can turn to for help:

If you decide it is time for your father to hang up his keys for good, it is important that you have a list of senior-friendly transportation options in Columbus for your parents to use before you tackle the conversation.

I hope this information is helpful, Frances! Best of luck to your family as you grapple with this decision.

Janet McNaughten
Stroke Coordinator, Mount Carmel

Home Safety Checklist for Central Ohio Seniors

If you chose to spend time visiting a senior loved one at their home over the holidays, you may find yourself wondering how safe they are living alone. Adult children often find themselves in the position of trying to evaluate an older family member’s home environment for safety. Do the stairs have strong handrails? Is the bathroom a hazard? Making that determination is difficult when you aren’t quite sure what you should be looking for.

To help you evaluate their home, we have pulled together this Home Safety Checklist for caregivers and seniors. We hope this tool will be useful for you to identify any potential problem spots.

Issue What To Look for Concerns to Address
Fall Risks Pathway around favorite chair/couch and bed is free from clutter

Grab bars are in place near their bedside and next to the tub and toilet in the bathroom

There are no cords (including extension cords) running across carpets or floors that could create a fall risk

No scatter rugs or throw rugs that might present a fall are used in the home

Older adult has non-skid shoes and slippers with non-skid soles

Thresholds between rooms are level and secure

Easy accessible, good lighting is available in all rooms

Night lights are in place in key locations including bathrooms, hallways, and kitchen

A raised toilet seat is in place if needed

Bathroom and tub are modified to allow easy access and use


Stairways have bright lighting with on/off switches at the top and bottom of the stairway

Hand rails are secure and strong enough for an adult to use to pull themselves up

Stairways are free of clutter with secure treads on each step

Fire & Carbon Monoxide Risk

Each level of the home has at least one working smoke detector

A carbon monoxide detector is in place in the home

A light-weight fire extinguisher is in place in the kitchen

Furnace is inspected twice a year

Knobs on stove can be turned on/off without reaching over the burner

Exterior Safety

All exterior steps and stairs have strong handrails

Exterior doors and walkways have motion lights

Sidewalks and driveways are free of cracks that may present fall risks

A winter snow and ice removal plan is in place


All exterior doors and windows have secure locks

A home alarm system is in place with signs displayed prominently to discourage break-ins

Flashlights are strategically located throughout the home including the bedside table, living area, and basement

There are phones in all rooms

A medical alert system that allows an older adult to call for help is utilized

A medication management system is in place

We hope this tool gives you the information you need to objectively assess your central Ohio senior loved one’s home for safety. If you would like to learn more, the Centers for Disease Control (CDC) developed a guide you may find to be of help. Check for Safety is a comprehensive visual guide to home safety for seniors.