The more complicated a patient's needs, the higher the amount that Medicare will pay a nursing home. Nursing homes are able to increase their billings by listing every possible diagnosis for the patient. For example, if a doctor lists "Confusion possibly due to Alzheimer's Dementia" on the hospital History & Physical, a nursing home can list 1) Alzheimer's Disease, 2) Dementia, and 3) Altered Level of Consciousness. Since they are only able to bill for conditions for which the patient is being actively treated, nursing homes can ask their physician to order low doses of medications commonly used to treat those diagnoses. The physicians are usually willing to do so, and are able to increase their billed amounts accordingly. They'll tell the patients/families that they're concerned about the patient, but it can be very difficult for patients to have all of their medications changed in order for the nursing home to increase its revenue.
Those medications have certain side effects, which can mean additional diagnoses of agitation and difficulty sleeping. The patient will also require speech therapy, physical therapy, and occupational therapy. If the reason that the patient was sent to the hospital in the first place was a fall, there are additional potential diagnoses of pain management, constipation (due to the pain medications), dizziness ... and of course, the patient's usual home medications (such as high blood pressure, etc).
It's possible for a patient with virtually nothing wrong with him when he left home to return with 15-20 new diagnoses. When he arrives at home, his primary doctor can discontinue all of the new medications - the patient might go through hell with all of the changes to his system, but the nursing home would have been able to bill at the maximum rates that Medicare will pay. For more information about how nursing homes operate, order The Nursing Home Survival Guide on this site.
Have a nice week! More next weekend!