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Understanding Nursing Home Care Requirements in Florida
Your loved one deserves the best possible care in a nursing facility. While many administrators provide excellent support, some may misrepresent Medicare coverage rules. This guide clarifies federal nursing home requirements and your rights in Florida.
Federal Requirements for All Nursing Facilities
Every nursing home in Florida must follow the Medicare Nursing Reform Act, which mandates that facilities:
- Provide services needed for residents to attain or maintain the highest practical physical, mental, and psychosocial well-being
- Deliver these services regardless of payment source (no discrimination based on Medicaid status)
The "Plateau" Myth in Therapy Services
The Truth About Continued Care: Many families hear this incorrect statement from nursing homes: "Medicare won't pay anymore because your loved one has plateaued in therapy."
This statement contradicts federal law. The Medicare Nursing Reform Act doesn't require improvement to justify ongoing therapy. The deciding factor is whether continued skilled therapy will maintain your loved one's condition or prevent decline.
The Landmark Jimmo v. Sebelius Settlement
In 2013, a class action settlement with the Centers for Medicare & Medicaid Services established:
"Even if full recovery or medical improvement is not possible, a patient may need skilled services to prevent further deterioration or preserve their current capabilities."
This means nursing facilities cannot discontinue therapy simply because a resident isn't showing improvement.
Advocating for Your Loved One
When a nursing home claims they must discharge your loved one due to "lack of progress," you can:
- Reference the Jimmo v. Sebelius settlement
- Remind them that federal and Florida state laws protect continued care for maintenance purposes
- Point out that lack of progress often indicates a need for more therapy, not less
Why This Matters
Ensuring your loved one receives appropriate therapy prevents premature removal from settings providing the highest practical level of care. Proper advocacy protects their rights and maintains their quality of life.
Additional Resources:
- Visit our website: ElderNeedsLaw.com
- Medicaid planning information: MedicaidPlanningLawyer.com
- Book: "Medicaid For Some of Your Long-Term Care Expenses"
Contact our Florida elder law attorneys today for personalized guidance on nursing home rights and care planning.
