McAllen Senior AdvisorWhat is the difference between rehab and long-term care in a nursing home?
Short-term rehab is daily skilled therapy and nursing after a hospital stay, aimed at going home and usually paid by Medicare, while long-term care is ongoing custodial and nursing care for someone who will live there, paid privately or by Medicaid.
Many Hidalgo County nursing homes run both, often on different halls. A resident may arrive for rehab and, if recovery stalls, stay on as a long-term resident, which is when the payment source changes.
How long will Medicare pay for rehab?
Original Medicare pays up to 100 days per benefit period after a qualifying three-day inpatient stay, in full for days 1 to 20 and with a daily coinsurance for days 21 to 100, but only while the patient needs and benefits from daily skilled care.
Most rehab stays end well before day 100. When the therapy team decides progress has plateaued, the home issues a notice that Medicare coverage is ending; the notice explains how to request a fast appeal. Medicare Advantage plans authorize days in shorter blocks and review progress often.
What happens if a parent cannot go home after rehab?
The family decides between paying privately to stay, applying for Texas Medicaid if the parent qualifies, moving to assisted living with home health, or going home with attendants, adult day care and family help.
In CMS's data, 22 of Hidalgo County's 23 licensed nursing homes are certified for Medicaid, so a long-term resident who qualifies can stay on Medicaid in almost any of them; the exception is the medical center at John Knox Village in Weslaco, which is state-licensed but not certified. Start the Medicaid conversation with the business office during rehab, not on the last covered day.
How do we choose a rehab nursing home from a Valley hospital?
Ask the hospital discharge planner for the list of homes with open beds that accept your parent's insurance, then compare their CMS short-stay quality rating, staffing and recent inspections before you choose.
Our nursing home roster sorts every Hidalgo County home by CMS rating and deficiencies. Proximity to the family member who will visit daily matters as much as a star.
Side by side
| Short-term rehab | Long-term nursing care | |
|---|---|---|
| Goal | Recover and go home | Live safely with ongoing care |
| Payer | Medicare Part A or Medicare Advantage | Private funds or Texas Medicaid |
| Length | Days to weeks, up to 100 days | Months or years |
| Measure | CMS short-stay quality measures | CMS long-stay quality measures |
Sources: Texas Health and Safety Code ch. 247 and 242; 26 TAC chapters 553, 554, 558 and 559; HHSC directories, TULIP and handbooks; CMS; CareScout; VA rate tables, as cited above. See our editorial standards.
