If the resident is paying for her care and services with private money and/or through a private insurance carrier, nursing homes usually allow the resident to hold her bed indefinitely until she returns. The reservation typically applies to a specific bed, not a comparable bed or any bed. State laws may specify the time limit for reserving a bed. In one state, a private-pay resident may hold a nursing home bed for no more than 30 days. Medicare does not pay to reserve or hold a bed but does not preclude a resident from using private funds to do so. Medicaid programs typically pay to reserve a bed for a limited period of time. This time period varies depending upon whether the readmission is sought after hospitalization or whether the resident's absence from the facility was due to therapeutic leave or family visits.

If a resident has not reserved her bed but needs or wishes to return to the nursing home, she is entitled to return to her former bed if it has not already been taken. If the former bed is no longer available, the resident is entitled to the first available bed at the nursing home. This is true for Medicaid recipients even if a hospital stay exceeds the minimum number of days established by law. A returning resident has priority over those who are on a waiting list to enter the nursing home for the first time. A circumstance that might prevent mandatory readmission is where the resident now requires specialized care that the nursing home does not provide. Non-payment for previously provided services is not a valid reason for refusing readmission.

Only a few states provide an appeals process if a resident is denied readmission. However, each state has an ombudsman who has been appointed to deal with residents' grievances and expedite resolution of residents' complaints. A resident who has been denied readmission may contact the ombudsman or seek judicial intervention as a remedy.

Copyright 2009 LexisNexis, a division of Reed Elsevier Inc.