From Hospital to Home: Know Your Options

By Amy Miller

Are you aware that Medicare will cover a hospital stay for 14 days and then release you to a rehab center, nursing home, hospice or home (“your choice”)? This can come as a surprise to many who are hospitalized with a serious illness.

A Hospitalist (a doctor who manages your care while in the hospital) makes recommendations for nursing or rehab care when you are released. What they don’t talk with you about is the cost - just where to go for care.

Room rates are not included in medical bills and not covered by Medicare. Room rates alone might costs up to an average of $1600 a day in an assisted living/rehab facility. This bill may require you to place a lien on your home or cash out your life savings. Some attorneys may advise you to get a divorce to prevent your spouse from being responsible for your medical debt after it’s been incurred. Only those who have been pre-qualified and meet the financial requirements ($120,000 for couples and $3000 for individuals in assets, excluding your home), will not have to worry about the cost of the rooms fees.

Basically, you are being told to spend down your income and wealth until you qualify for bankruptcy. Believing this is the only option you have, you don’t know to look for another options.

Many people want to live in their homes and receive care and support from their family members while they recover from their illnesses. Yet, many say they don’t want to be a burden: families are busy, live too far away, have broken relationships, or just unaware.

Men are especially vulnerable as many wives cannot physically care for their husbands should they fall. Many sons are not aware of who provides personal care (showers, shaving, toileting) for their parents. If they were, they might be more engaged. Adult children assume someone else will provide better care for them than we can for our parents. I’m here to tell you, don’t assume anything.

Family members are often surprised to learn they can be paid to care for their loved ones. Personal care companies are paid $33 an hour by insurance (yet PCA’s take home pay is between $12-$17 an hour). Private nursing care can cost be between $70-$125 an hour.

Instead, gift a family member $16,000 a year as a tax free gift (per IRS guidelines) for that same care while at home. Payroll taxes may apply if you pay them more. Of course, more than one family member can receive this gift as they provide respite or other services. Long term care and life insurance may pay if certain requirements are met. If you don’t have the money, pay what you can.

Create and design a Family Caregiving Agreements in advance to communicate your wishes. Customize it to fit your personal circumstances. This gives you and your family the peace of mind that you will get the care you need while providing for your family.

Amy Miller is Founder and CEO of Our Family Encounter, an end of life planning service covering everything from assistance with simple chores to final wishes, based in Eden Prairie. Visit for more information.