Your situation: Hip fracture (surgery), discharged Friday to own apartment. Lives alone. Medicare only — no supplemental insurance. Two siblings: one in Boston, one remote. Primary concern: safe home setup and knowing who pays for what.
Before Friday — Time-Sensitive
Get three written orders from the discharge nurse before your father leaves
1. Home physical therapy referral — required to trigger Medicare home health coverage
2. Durable medical equipment order — walker, hospital bed if the physician certifies necessity
3. Home health agency order — must name a specific Medicare-certified agency
Without these written orders in hand, Medicare coverage may not begin on time.
Confirm his admission was "inpatient" — not "observation." This is the question most families never ask.
Medicare only covers skilled nursing facility stays and home health if he had a qualifying 3-night inpatient hospital stay. Observation status does not count — even if he slept at the hospital for 3 nights. Ask the discharge nurse directly and get it confirmed in writing.
Equipment — what Medicare covers vs. what to buy yourself
Medicare-covered with a physician order: walker or crutches, hospital bed (if medical necessity is certified), wheelchair (only if he cannot walk in the home)
Out-of-pocket — order today, 2-day shipping: shower chair, raised toilet seat, grab bars, non-slip bath mats. Medicare classifies these as convenience items — not covered.
Home setup before he arrives
Clear the path: front door → bedroom → bathroom. Remove all rugs and floor cords — these are the leading cause of falls in week one. Install a grab bar on the tub wall (tension-mounted, no drilling). Place shower chair and non-slip mat before he enters the bathroom for the first time.
Fill all prescriptions before leaving the hospital
Including blood thinners — standard after hip surgery to prevent blood clots. Confirm the prescription, dose, and duration before discharge. Do not try to fill them after with your father in the car.
First 72 Hours Home — Medical Priorities
Blood clot watch — highest risk is days 1–14
Call 911 or the surgeon immediately (do not drive to urgent care) if you see: calf pain or tenderness, leg swelling or warmth, redness in the lower leg, sudden shortness of breath. This requires immediate response — not watchful waiting.
Post-surgery confusion watch — extremely common in elderly patients after anesthesia
Signs: confusion, not knowing where he is, sleeping all day, seeing things that aren't there. This is frequently mistaken for sudden dementia onset — it is not. It typically resolves in 1–2 weeks. Keep lights on during the day, maintain regular meal and sleep times. Alert the home health nurse if it appears or worsens.
Medication list — create it today
Write out every medication: name, dose, time, who gives it. Post it on the refrigerator. Photograph it and share with both siblings. Every caregiver in the rotation needs to work from the same list.
Home health agency — confirm start date immediately
Ask explicitly: "Are you Medicare-certified?" If they cannot begin within 24–48 hours of discharge, call another agency. Delays in physical therapy extend recovery time significantly.
Family Coordination — Decide Before Everyone Leaves
Assign roles now — not in three weeks when you're burned out
You (primary): daily check-ins, medication oversight, appointment coordination
Boston sibling: weekly in-person visit for month one, owns the home health agency relationship
Remote sibling: all paperwork and insurance calls, coordinates meal delivery
Write this down and send it to both siblings before the drive home. The person who showed up most does everything by default. Name it explicitly now.
What Medicare Covers — Your Father's Specific Situation
Skilled nursing facility (if he needed one before going home):
Days 1–20: $0 out-of-pocket. Days 21–100: approximately $200/day — your father has no supplemental insurance, so this is fully out-of-pocket. A 30-day stay past day 20 costs approximately $2,000. Push for home discharge with home health if clinically safe to avoid this.
Home health (physical therapy and skilled nursing at home):
Covered 100% — no copay — if: (1) qualifying 3-night inpatient stay is confirmed, (2) he is homebound, (3) a physician certifies a skilled need, (4) the agency is Medicare-certified. No time limit as long as conditions are met.
Medicare does not cover:
Help with bathing, dressing, or cooking without a concurrent skilled need · 24-hour home aide · Grab bars, shower chairs, raised toilet seats · Meals or transportation · Most prescription drugs (check his drug plan separately)
Out-of-pocket estimate (no supplemental insurance):
If discharged directly home: $0 for home health physical therapy and nursing. If a skilled nursing facility stay extends past day 20: ~$200/day. Equipment you buy yourself: approximately $80–150 for shower chair, raised toilet seat, grab bar, and non-slip mats.
If Medicare Denies Coverage — Your Rights
Always ask for the denial in writing. You are legally entitled to this. A verbal "Medicare won't cover that" is not a final determination.
Request a formal appeal (called a Redetermination) within 120 days of the written denial. You do not need a lawyer for this first level of appeal.
Contact your State Health Insurance Assistance Program for free Medicare counseling. Find yours at shiphelp.org. Federally funded — use it.
If asked to sign an Advance Beneficiary Notice: read it carefully before signing. Signing means you agree to pay out-of-pocket if Medicare denies the claim. You can refuse the service or ask the provider to submit the claim and let Medicare decide.
Questions to Ask the Discharge Nurse — Before He Leaves
1
Was his admission status inpatient or observation? (If observation, Medicare coverage may not apply.)
2
Has the home health agency order been placed and confirmed with a specific Medicare-certified agency?
3
Has the durable medical equipment order been written and sent to a supplier?
4
Is he cleared for stairs? What are the exact weight-bearing restrictions?
5
What is the blood thinner prescription, dose, and duration?
6
What symptoms require an immediate call to the surgeon vs. calling 911?
7
What is the follow-up appointment date and where?
