Often, when a loved one goes to the hospital and stays over two or three days, the hospital will “announce” that rehab is the next step. When this first happened to me it was for my Father.

At that time, I was not well versed in the Medicare payment system.

Now I am, and here’s what you need to know: Medicare pays for 21 days of rehabilitation after a hospital stay, most rehabilitation facilities are located in nursing homes, most of these institutions have agreements amongst themselves as well as with insurance companies who are happy to let Medicare pay.

This is the scenario: a senior is sent to the hospital by a doctor or nurse practitioner often for dehydration, a urinary tract infection or some "non-death" reason. The person is transported to a hospital ER and once seen the battery of tests begin.

You’re admitted for “observation.” The real reason you’re admitted is so the hospital can charge Medicare. Another rule, if you go to the ER and they let you go home you cannot return within 72 hours otherwise, even if you came for a different reason, they will admit you. Why? Medicare does not pay for the same patient seen in the ER within 72 hours.

Now, your loved one is being attended to by nurses, technicians, once in a while a doctor will show up and discuss how many tests must be done. The patient becomes totally disoriented as would anyone. Think about it, strangers come in at all hours of the day and night, sticking needles in your arm, taking blood pressure and your sleep is constantly interrupted. Time is indistinguishable. If you’re a senior, you’re already immuno-compromised so lack of sleep in a hospital makes it easier to get sick.

Your loved one has no control and can sometimes become confused and combative because they don't want to be there. Medication is given to calm them down, almost always a sedative. Security may be in the room to assist. Imagine how it must feel to be held down and given a shot. The patient becomes woozier — powerful sedatives plus loss of control.

Next step, an alarm is added in case you get out of bed (like to go to the bathroom) so this very loud noise adds to the chaos. Bottom line, you end up lying in bed, woozy, scared and not understanding who you are, or where you are. Then — boom — the diagnosis, a UTI, or dehydration. The remedy for one is antibiotics for the other: water – in other words a one day of treatment.

“Not so fast,” the hospital states. You're loved one is weak, you need physical therapy, the “other” drugs have not exited the body . . . a myraid of excuses as to why you must go to rehab.

Oops — Bad news —- you can be discharged on Saturday but the rehab doesn't take transfers on the week-end because they don't pay people to do the paperwork on Saturday and Sunday.

In one client’s case we offered to pay for a private physical therapist to come to the assisted living center and work with the patient in his/her home. No, you cannot do that either because the hospital will only discharge you Against Medical Advice (AMA). Medicare doesn't pay AMA claims.

Bottom line, in this case scenario the elderly patient had to stay in the hospital for two extra, unnecessary days awaiting rehab to admit him. Now your loved one has been in the hospital for five days and is being transferred to another hospital-type setting. In the end, it became a 13 day “hospital stay.”

Who wouldn't be stark raving mad?