Medicare’s “3-Midnight Rule” Waiver has Expired: What it Means for Hospital Staff and Patients


Re-emerging Gaps in Care
The first 48 hours after discharge from a hospital or rehab are critical to the safety and health of patients. This small window of time is when they are at their weakest, and at greatest risk for a fall or other adverse event, which can result in a return trip to the hospital. Preventing hospital readmissions following discharge greatly improves the quality of life for patients and saves our partner hospitals (and the healthcare system as a whole) a tremendous amount of money. Yet, there is often a gap in care from the time that a patient is released from the hospital until their rehabilitation or Medicare services begin.

This gap in care is at risk of being exacerbated by the May 2023 expiration of the Public Health Emergency (PHE) spurred by the COVID-19 pandemic. With the end of the PHE, the Centers for Medicare & Medicaid Services (CMS) has in turn expired their waiver of the “3-midnight rule” requiring Medicare beneficiaries to have a three-day hospitalization to be eligible for Medicare-covered skilled nursing facility (SNF) services without incurring high out-of-pocket costs.

A Changed Healthcare Landscape
During the PHE, hospitals came to rely on the “3-midnight rule” waiver to free up hospital beds and relieve overwhelmed acute care facilities during the pandemic.

Now, the Medicare rule has returned despite facing a changed healthcare landscape. Some hospitals continue to experience surges due to respiratory viruses, leading to a shortage of inpatient beds and cancellation of elective procedures. Additionally, the pandemic has led to critical shortages of healthcare workers including nursing staff and physical and occupational therapists. These workforce shortages often result in delays in starting Medicare services after hospital discharge.

One regional hospital reviewed its records for December 2022 and found that 160 patients were discharged to a SNF under Medicare who would have been sent home without the 3-midnight rule waiver in place. While advocates continue to push for the permanent establishment of the 3-midnight rule waiver, upon its expiration, hospitals will need to make sure they are complying with the reinstated rule to avoid any penalties or reimbursement issues from Medicare.

On the patient side, the reinstatement of the Medicare “3-midnight rule” impacts those who may have previously qualified for SNF coverage but may no longer meet the 3-midnight requirement. These patients may need to seek alternative care options or pay out-of-pocket for SNF care. This could be a financial burden for some patients and families, and hospitals will need to work closely with patients and their families to ensure they understand their options and can make informed decisions about their care post-discharge.

Enter Family & Nursing Care
Family & Nursing Care helps patients receive the crucial care they need as they transition home from the hospital. During the first 48 hours post discharge, when there is the most confusion and misunderstanding of needs and instructions and there are often delays in the start of Medicare or Medicaid services, there is a dramatic difference in successful transitioning between patients who utilize home care services and those who do not.

As a regional leader in providing access to compassionate and reliable home care services since 1968, Family & Nursing Care’s Hospital to Home program existed long before the COVID-19 pandemic, and continues to help ease the transition home for patients after a hospital stay.

  • We can help provide a safe and comfortable environment for recovery at home with easy and quick access to home care provided by experienced and compassionate Caregivers.
  • Family & Nursing Care liaisons are available to visit with patients and their families while the patient is still in the hospital or rehab facility to help them understand their options for coverage and care at home.
  • Support can be on a short-term basis to help with the transition home or on a longer-term basis as needed.
  • Family & Nursing Care requires no up-front deposits or long-term commitments from clients.

For instance, we partnered with Medstar Montgomery Hospital to identify patients in most need of care at home and to discuss options and set up a plan for receiving home care services upon their discharge.

In addition, a few years ago, we conducted a “Skilled Nursing Facility to Home” pilot program in conjunction with Nexus Montgomery, where we learned that even after a SNF stay, patients often experienced delays in getting home health care started following discharge due to the bureaucracy for home health agencies, including Medicare and Medicaid, in helping a new patient or client.

The Family & Nursing Care Difference
Getting a dedicated Caregiver on board to help with the transition home from the hospital or rehab can make a world of difference for patient outcomes. Caregivers not only help manage tasks of daily living such as errands, medication pick-up and reminders, groceries, meal preparation, bathing, dressing and support for those who may be at risk for a fall, but they can also help clients digest all the information given to them upon discharge.

Caregivers can also help effectively manage the patient’s specific needs by ensuring they adhere to a special diet, practice breathing techniques and required exercises, and more.

Many Caregivers have used their extensive background knowledge and training to recognize “red flag” symptoms for a client, so that post-discharge issues that can commonly lead to readmission can be treated at a lower level of care.

When hospital readmission statistics are lowered, everyone wins.

Neal Kursban Joins Panel at Capital + Strategy Conference

Home care company leaders are increasingly being challenged to find creative ways to solve some of the sector’s most persistent issues, while looking to thrive in a space that has more eyes on it than ever.

Our CEO, Neal Kursban, recently participated on a panel of home care company leaders at Home Health Care News’ Capital+Strategy conference in Washington, D.C., where he shared some of the secrets to Family & Nursing Care’s success at tackling the issues and staying a relevant and thriving business.

Click here to read more.

Neal Kursban Featured in 2023 Future of Care Guidebook

We are thrilled that our CEO, Neal Kursban has been included in MissionCare Collective‘s 2023 Future of Care Guidebook.

As an industry leader for 27+ years, Neal has dedicated his career to improving the lives of older adults and their families through exceptional home care services. He also recognizes the vital importance of home care companies like Family & Nursing Care making every effort to treat Caregivers with the deep appreciation and respect they deserve.

We’re proud to see Neal recognized amongst fellow senior care industry thought leaders.

If you’re interested in learning more about the future of care and the leaders who are shaping it, be sure to check out MissionCare Collective’s 2023 Future of Care Guidebook.

Family & Nursing Care Receives 2023 Best of Home Care® – Leader in Training Award


We are proud to have received the distinguished 2023 Best of Home Care® – Leader in Training Award from HCP, the leading firm in experience management for home care. The Leader in Training Award recognizes home care businesses that consistently provide an outstanding level of Caregiver education. As a Leader in Training, Family & Nursing Care is now recognized among the top 25% of home care providers participating in the nationwide HCP Training Program.

This accomplishment demonstrates Family & Nursing Care’s long-term dedication to excellent care and employment. To qualify for this award, we implemented HCP Training to provide specialized education for Family & Nursing Care Select Caregivers. We have achieved a high level of Select Caregiver participation in continuing education, as well as an average of at least 8 courses completed by each participant.

The Best of Home Care – Leader in Training Award highlights the top-performing home care businesses in the nation. HCP believes that by honoring these providers, families looking for in-home care for a loved one will be able to recognize and choose a trusted home care provider.

“At HCP, our mission is to help home care businesses create a training program that goes beyond client and Caregiver expectations,” says Todd Austin, President of HCP. “When we see companies like Family & Nursing Care that have so effectively provided outstanding care and employment experiences through continuous learning, we know we’re on the right track. Family & Nursing Care has worked extremely hard to prioritize high-quality care and employment, and their work hasn’t gone unnoticed. This award allows them to show proof of quality to potential clients and Caregivers.”

About HCP
HCP leads the home-based care industry in experience management, training, and reputation management. Through its Care Intelligence Platform, HCP empowers providers in home care, home health, and hospice to attract and retain employees during workforce shortages. HCP also conducts the annual Benchmarking Report, the most comprehensive survey of providers in North America, and administers Best of Home Care awards to agencies that achieve best-in-class satisfaction scores. For more information, visit

Coordinating Care in a Crisis


Whether you need care for a client, a resident, a patient, yourself, or a loved one, it’s not always possible to plan ahead perfectly. When emergency situations arise, it’s easy to feel lost and overwhelmed.

Family & Nursing Care is a 24/7, 365 day-a-year business that understands critical care needs can arise at any time. We strive to go above and beyond in our response to clients and their family members facing crisis. Our goal is to support and usher them through every aspect of their home care needs — from that first point of contact with us and throughout the care journey.

The importance of the initial contact
Almost 75% of people who call Family & Nursing Care are looking for a caregiver in the next 48 hours, especially when following a hospital discharge. “Our team’s first priority is to be a calming presence,” says Jeff Briggs, Director of Intake. “We want to understand a caller’s concerns and connect with them on a personal level. We know they didn’t plan for this, so our intake team serves as their guide.”

Often, family members are not only under the stress of wanting to quickly get help for their loved ones but are also new to the process of setting up care. Our team works to understand each clients’ individual situation, so we can help families move forward with the best care for their loved one.

Understanding each client’s unique needs
When speaking with a client or their family member for the first time Family & Nursing Care staff will ask a series of questions to better assess the situation and the needs of the client. Questions may include:

  • What’s on your mind?
  • What main concerns do you have?
  • How long has your loved one been experiencing the specific issues you are describing?

“Each client is unique, even if their situations may appear similar on the surface,” says Mitch Markowitz, Vice President of Business Development.

Making the right client/Caregiver match
We also pride ourselves on our ability to make the right match between client and Caregiver. This process begins in the initial call when we ask about who, if anyone, lives in the home with the client, what kind of home they live in, their preferences, and even if they have pets. A good client/Caregiver match can mean the world to clients and help their family members relax and achieve peace of mind knowing their loved one is being looked after by a trusted resource. The daughter of one of our clients recently sent us a note saying, “I appreciate our Caregiver Angele, who is very understanding and patient with my mother’s needs. She gives us sound advice and stays in contact with me while I’m at work.”

Care when you need it for as long as you need it – no long-term commitment required
Since crisis situations can be unpredictable, and clients’ needs vary, we don’t require long-term commitments. Whether short-term or long-term care is needed, Family & Nursing Care can help. We are able to place a Caregiver with a client as soon as the same day of the initial call, if required.

We have teams of people dedicated to ensuring our clients receive excellent service. Client Services Managers and Associates are always on hand to provide a high-level of support to clients and their families. All the while, Care Coordinating Managers are working beside them, helping to match the right Caregiver for each situation and give Caregivers all the information and support they need. This support is not only available at the start of care, but for as long as the care is needed. In addition, our skilled Accounting and Long-Term Care Insurance teams are there to shepherd clients and their families through the billing and Long-Term Care Insurance reimbursement process. Our longstanding relationships with hospitals, senior living communities, skilled nursing facilities, and insurance companies, allow us to liaise in the coordination of what can often be confusing discharge and/or intake instructions and other paperwork.

When a client or family member calls Family & Nursing Care in the throes of a crisis, our first priority is to address the immediate need, getting a client the care and support they need at home with the aid of a capable and compassionate Caregiver. But our commitment doesn’t stop there … our whole Family & Nursing Care team will be there to help every step of the process. With Family & Nursing Care by your side, crisis situations don’t have to be confusing and intimidating.

Meet Our Caring Client Service Manager Associates

From L to R: Jennie Ray, Savannah Staubs, Meghan Jackson, Katie Cash

Our Client Service Management Associates are not only compassionate and hardworking but also integral to the Family & Nursing Care team.

While you might not get the chance to see them in person often, you likely have heard our Client Service Management Associates on the other end of the phone when you call Family & Nursing Care. They help ensure lines of communication are kept open even while the Client Service Managers are out in the field visiting clients and their families.

This close-knit team — Jennie, Savannah, and Meghan— have much in common, and it’s not just their passion for helping enhance the lives of older adults. This group is empathetic, responsive, and knowledgeable, making them the perfect active listeners and points of contact to form relationships with clients and their families and gain a sense of how to best help them. The Client Service Management Associates innately know how to help clients and families feel heard, comfortable, and confident in their next steps. What’s more, in working closely with Client Services Managers, the Associates gain valuable on-the-job experience, making them skilled candidates for promotion when the time is right. Katie Cash was recently promoted from the Associate group to Client Services Manager.

Their unique blend of perspectives and backgrounds adds that personal touch the Family & Nursing Care team strives to achieve with every interaction. Prior to joining our team, these Associates’ work varied including elder care, case management, working with marginalized communities, teaching, and real estate.

When these D.C. Metro natives aren’t at work, they enjoy biking, painting, making pottery, and spending time with their families, friends, and pets.

2023 Begins with a Win! Family & Nursing Care is Voted the Area’s “Best In-Home Care Provider”

Best of Bethesda Winner logo 2023


Here at Family & Nursing Care, we began 2023 by celebrating being voted “Best In-Home Care Provider” in Bethesda Magazine’s Best of Bethesda Readers’ Poll!

Each year, Bethesda Magazine, a local feature and lifestyle publication, enlists its readers to vote on Bethesda’s best of the best — from restaurants to businesses to bars to shops to health care providers. Readers are encouraged to write-in votes to identify local companies they believe provide premium service to their customers and community, while making the Bethesda area a great place to live, work, and play.

We are proud to say the 2023 Best of Bethesda: Best In-Home Care Provider award marks the 8th year Family & Nursing Care has been voted for this honor. We are humbled and honored to receive this distinction as it’s public recognition like this that enables us to reach out and provide support to even more clients.

We would like to thank the clients, Caregivers, and professionals with whom we are privileged to interact. By placing your trust in us and allowing us to continue our valuable work, we can keep moving forward in making a difference in someone’s life every day!

Kelly Salb, Vice President, Client Services, Named to Aging Media Network’s Future Leaders Class of 2022

Kelly Salb, Director of Client Services, Named to Aging Media Network’s Future Leaders Class of 2022
We are so proud of Kelly Salb, LBSW, Family & Nursing Care’s Vice President, Client Services, who was named to Aging Media Network’s Home Health & Home Care Future Leaders Class of 2022. Kelly works tirelessly on behalf of the clients she serves and is a true partner to the professionals she works with. Read more about this prestigious award here.

Kelly has learned over the course of her career that it’s important to meet people where they are in order to provide a better overall experience.  Read more of Kelly’s interview here.

To become a Future Leader, an individual is nominated by their peers. The candidate must be a high-performing employee who is 40 years old or younger, a passionate worker who knows how to put vision into action, and an advocate for seniors and the committed professionals who ensure their well-being. Please join us in congratulating Kelly on this amazing and well-deserved accomplishment!