Q: My 90-year-old cousin lives by herself. She’s in overall good health but she has fallen a few times. She wears a medical alert button and can summon the paramedics fairly quickly. Her neighbor, who is a retired nurse, told her that if she falls too many times, Medicare won’t pay and can force her to go into a nursing home. This has been very upsetting to her. Is this true?
A: No, Medicare can’t force anyone into a nursing home. Emergencies should be fully covered, but there are some limitations on Medicare coverage, which could result in the senior being admitted to a nursing home. At some point the hospital may determine that it’s not safe to discharge your cousin back to her home, but Medicare will no longer pay for her to stay in the hospital because she no longer needs medical care. This can get complicated. In theory, we’re all entitled to make our own autonomous decisions about our health and living situations, even bad decisions. But along with some age bias, there is the reality that some seniors start losing their capacity and may not make decisions that they would make if perfectly competent. When these types of disputes arise, the hospital may seek guardianship over the senior along with placement in a nursing home.