picking up for medicare benefits within 30 days

[Connie L. Frank]

I have a client who was admitted to center following 3 day hospital stay for CVA type issues with aphasia. She was held on Medicare for  17 days with OT, PT and ST at which time she was deemed highest level of functioning for supervised care as the family had indicated they had no intention of taking her back home. She remained on ST 3x/wk on Med B. About a week later the family indicated they wanted her back home, however were not able to provide 24 hour supervision. Shortly after the doctor wrote orders indicating SW should arrange discharge in next week. Team had discussed in conference within first 2 weeks indicating that due to cognitive status she couldn’t be left alone. Memory impairment, thought process impairment r/t safety uses toothpaste on hair, deodorant as lotion, etc. and is noninsulin controlled diabetic with BID blood sugar testing. Staff have seen some clearing cognitively, but certainly no where near pre insult level. She is ambulatory and gait is again stable. ST indicates improvement as well in cognition. Would you pick her back up for Med A benefits again if within 30 days of admission, to promote potential higher level of functioning with goal of return home?