by: Alex Smith @AlexSmithMD The patient was elderly and was hospitalized for a COPD exacerbation. Fortunately, her breathing problems were easily treated, and came under rapid control after one night of hospitalization. She was ready to return to the nursing home the next day. I informed our discharge planner that she was ready to be discharged, and was shocked to hear her respond that, "Her primary care physician said she needs to stay for 3 nights in order to quality for the Medicare skilled nursing facility benefit before the nursing home will take her back." This seemed nuts - dumb even - she "needs" to stay in the hospital, exposing her to all the risks of hospitalization, to qualify for the Medicare Skilled Nursing Faciliity (SNF) benefit? Her skilled needs would be the increased frequency of nebulizer treatments - fair enough. At that point, she had not experienced any loss of function that would warrant skilled rehabilitation care above the usual