Rides Home From Rehab on Discharge Day in Massachusetts

The rehab facility will not drive your mother home, and Medicare will not pay for the ride unless an ambulance is medically necessary. Discharge day transportation is almost always the family's problem to solve, usually on about a day of notice. A wheelchair accessible ride with us is $115 each way within five miles, then $2 a mile after that.

Will the rehab facility arrange the ride home?

The discharge planner will help you arrange it, but the facility is not going to supply the vehicle. Ask the social worker or case manager two days before the target date who is expected to provide transportation, because facilities differ. Some will call a vendor for you. Others hand you a phone number and expect you to book it yourself.

Three answers are worth getting in writing before you book anything: the discharge date, the expected time window, and whether your parent will be leaving the building in a wheelchair or on her feet. The third one decides what kind of vehicle you need.

Does Medicare pay for a ride home from rehab?

Only for an ambulance, and only when an ambulance is the only safe way to move the patient. The Medicare standard is that other transportation could endanger your health. A trip from a skilled nursing facility to your home can qualify, but the test is the patient's medical condition, not convenience and not the fact that she cannot walk. Someone who can sit in a wheelchair and ride in a van will generally not meet it.

For a non emergency ambulance trip that is scheduled in advance, Medicare also expects a written order from the doctor dated no earlier than 60 days before the trip. If your parent has a Medicare Advantage plan rather than Original Medicare, call the number on the back of the card and ask whether the plan includes a transportation benefit, because some plans add one.

Can MassHealth cover the discharge ride?

MassHealth non emergency transportation runs on a form called the PT-1, and a medical provider has to complete and sign it. You cannot submit it yourself. A nursing facility can submit a PT-1 for a member in its care, which is the route to ask about first.

Two things make this hard on discharge day. A PT-1 can take up to three business days to process, and MassHealth asks that trips be scheduled at least three days ahead when possible, while a discharge date often firms up about 24 hours out. When there is not enough time, the provider can request verbal authorization from the MassHealth Customer Service Center at 800 841 2900.

The other thing to know is that this transportation is built around trips to covered medical services, so ask the discharge planner plainly whether a PT-1 can be submitted for the trip home rather than assuming it will be. Once a PT-1 is approved, the ride is arranged through a regional broker, MART in western and northeastern Massachusetts and GATRA in the southeast. Members enrolled in a Senior Care Options plan, One Care or PACE do not use that brokerage, so ask the plan directly instead.

What does curb to curb actually mean?

It means the driver stays with the vehicle, and nobody helps your mother out of the building or into the house. MassHealth brokered sedan and wheelchair van service is curb to curb, and the brokerage will not schedule rides for members who need transport staff to help them exit the facility or get from the vehicle into the home.

That is the gap families find out about at the curb. If your parent can transfer herself and somebody is waiting at the house, curb to curb is fine and it costs you nothing. If she cannot, you need either a family member who is physically able to do the lifting or a paid service that includes hands on help.

What if she cannot get up the front steps at home?

Two trained staff and an electric stair chair, which is what a flight of front steps with no ramp actually takes.

That is a separate problem from the ride, and it is the one that most often sends somebody home and then straight back out again. Our stair assistance visit is $200 and brings two trained staff and an electric stair chair. We will give you the rated weight capacity on the phone.

Count the steps and measure the width of the doorway before discharge day, and tell whoever is handling the transport what you found. A driver who arrives expecting a flat walkway cannot improvise a solution in the street.

What does a wheelchair accessible ride home cost?

$115 each way, or $230 round trip, within five miles, then $2 a mile beyond that. A discharge is normally one way, so it is the $115 figure that applies. There is no separate booking fee. More detail on how that is calculated is in how much wheelchair transportation costs in Massachusetts.

If your parent is walking and only needs a steady arm and someone to carry the bags, that is a different and cheaper conversation than a wheelchair van. Tell us on the phone which one it is so we send the right vehicle.

Should I try the free options first?

Yes, and we will say so on the phone. If your parent has MassHealth, the PT-1 route costs nothing and the facility can submit it for her. Your local Council on Aging may run a van, although most need more notice than a discharge gives you. A Medicare Advantage plan may include rides, and the facility social worker often knows about that benefit before the family does.

We are the paid option for when none of those line up with the actual discharge date, or when nobody at the curb can do the lifting. Start with free rides to medical appointments in Massachusetts for seniors and call us if it does not work out.

Should someone stay with her the first night home?

Judge that on how she is actually moving on discharge day, not on how she looked in the therapy gym. The first night at home is when people try to reach the bathroom alone in the dark, in a house they have not walked through in three weeks, and fall.

Our home health aide care is $45 an hour, one to eight hours a day, with no minimum contract, no assessment fee and no four hour minimum per visit. A three hour evening shift is a real option, not a package you have to buy your way into. An overnight is $540 for a twelve hour night. Care at home for a Friday discharge covers how to think about the first few days.

Our aides are trained, background checked and insured, and they are not nurses. They do not administer medication of any kind, including insulin, do not change dressings, and do not make clinical judgments. They can be present while your parent takes her own medication, help if something goes wrong, and call for help. If she is coming home with a wound, an injection schedule or new oxygen, ask the facility about a visiting nurse, which is a separate service.

How do I book when the discharge time keeps moving?

Give us the date and the window, then call again when the time is confirmed. Discharge times slip to the afternoon routinely, because the paperwork, the last therapy note and the pharmacy all have to land before anyone can leave. What we need from you:

• The facility name and room number
• Whether she is leaving in a wheelchair or walking
• How many steps are at the house and whether there is a railing
• Who will be home when she arrives
• Whether she needs anything carried in, such as a walker or oxygen

Care Remedy serves clients across Massachusetts from offices in Woburn, Springfield and Brockton. Call 781 957 8076 or email info@careremedyinc.com.

Coverage rules change. Confirm transportation benefits with your own plan and anything medical with your parent's doctor or the discharging facility.