Greenville Senior AdvisorWhat is the difference between short-term rehab and long-term nursing care?
Short-term rehab is skilled nursing and therapy after a hospital stay, aimed at going home, usually paid by Medicare for up to 100 days; long-term nursing care is ongoing custodial and nursing care for someone who cannot return home, paid privately or by Healthy Connections Medicaid.
Many Upstate nursing homes do both, often on separate units, and many have names ending in “Post Acute” that reflect their rehab focus. A patient can begin a stay under Medicare rehab and convert to a long-term stay in the same building.
How long will Medicare pay for rehab in a nursing home?
Up to 100 days per benefit period, after a qualifying inpatient hospital stay of at least three days: the first 20 days with no coinsurance and days 21 through 100 with a daily coinsurance, and only while the patient needs daily skilled care.
Coverage often ends well before day 100, when therapy goals are met or progress stops. The nursing home must give written notice before Medicare coverage ends, and the patient can appeal through the notice's instructions. Medicare Advantage plans set their own rules and often require prior authorization.
What is observation status, and why does it matter?
Observation status means the hospital treated the patient as an outpatient even if they stayed overnight, and observation days do not count toward the three inpatient days Medicare requires before it pays for skilled nursing care.
Ask the hospital, in writing, whether your parent has been formally admitted. If the patient is under observation and will need rehab, ask the doctor whether inpatient admission is appropriate, and ask the hospital's case manager what coverage options exist.
How do I choose a rehab facility in the Greenville area?
Compare CMS Care Compare data for each nursing home on the hospital's list, including the short-stay quality measures, staffing hours and recent inspection results, and ask how many therapy sessions a day patients receive and how often patients return home.
Hospitals must give patients a list of options and respect their choice. Encompass Health's rehabilitation hospital in Greenville and AnMed's in Anderson are inpatient rehabilitation hospitals, a more intensive setting than a nursing home rehab unit, for patients who can handle three hours of therapy a day.
What happens if a parent cannot go home after rehab?
The family can arrange a long-term stay in the same nursing home, paying privately at first or applying for Healthy Connections Medicaid, or move the parent to a CRCF if their needs fit within Regulation 60-84's limits.
Start the decision before Medicare coverage ends. The nursing home's social worker can help with the Medicaid application, and the Area Agency on Aging can explain options for returning home with Community Choices services.
At a glance
| Short-term rehab | Long-term nursing care | |
|---|---|---|
| Goal | Recovery and return home | Ongoing care |
| Paid by | Medicare, up to 100 days after a 3-day inpatient stay | Private pay, then Healthy Connections Medicaid |
| Typical length | Days to weeks | Months to years |
| Quality data | CMS short-stay measures | CMS long-stay measures |
Sources include S.C. Code Regs. 60-84, DPH Healthcare Quality and SCDHHS pages and bulletins, CareScout, CMS and VA rate tables as cited above; see our editorial standards.
