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If you receive Medicare, are hospitalized as an inpatient for at least two nights and need rehabilitation, your Medicare insurance will pay for the first 20 days and, with a copayment, the next 80. You also have a lifetime bonus 60 days.

But can you afford the copay?

Many nursing homes don’t want to wait to find out.

Nursing home discharges. That’s the bum’s rush.

A study of 4.5 million nursing home discharges from January 2012 through November 2016 published in JAMA Internal Medicine looked at patients who were discharged on days 19, 20 and 21. It found that nursing homes are more likely to discharge economically vulnerable patients – and patients suffering from chronic medical conditions – just before they become responsible for a copay.

Since Medicare pays about $535 and Medicaid about $212, nursing homes have a financial incentive to keep patients for the full 20 days – but no longer.

Particularly if a nursing home fears that you may not be able to meet your copay, there is no incentive to keep you one minute longer.

Who is most likely to be discharged on day 20?

  • Someone with high needs – and should stay.
  • Someone who appears to have low income.
  • Someone who is Hispanic or African American.
  • Someone who is male.


Resources for choosing a nursing home:

How to Choose a Nursing Home or Assisted Living Facility

Checklist for Evaluating Senior Facilities


Elder law attorney, Terry Garrett, is a member of the National Academy of Elder Law Attorneys and is an Approved Guardianship Attorney. She assists people in elder law, estate and special needs planning, guardianship and settling estates. She graduated with honors from Cornell University. She was on the Dean’s List at Wharton Business School. She earned her J.D. at Columbia Law School, receiving the Parker Award and a Mellon Fellowship.

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