• Posted February 10, 2026

Outdated Medicare Rule Keeps Seniors In Hospital Longer Than Necessary

An outdated Medicare policy is keeping seniors in hospitals longer than necessary, wasting their time, hospital resources and federal health funding, a new study says.

Established in 1965, the “three-day rule” was intended to justify the expense of sending a patient to a skilled nursing facility.

The rule requires patients to spend at least three straight days in a hospital before Medicare will cover their rehab in a nursing facility, researchers said in background notes.

But this rule has not kept up with the times, researchers said.

Modern medicine has dramatically shortened hospital stays, which means some seniors must be kept longer than necessary so their nursing home care will be covered by Medicare, researchers found.

In one month alone, Medicare paid for between 2,064 to 5,617 additional days of hospital care that weren’t needed, researchers estimate in JAMA Internal Medicine.

“When the policy was created, typical hospital stays were close to two weeks, and requiring three inpatient days may have helped ensure appropriate use of post-acute care,” said researcher Dr. Amal Trivedi, a professor of medicine and health services, policy and practice at Brown University.

“Today, hospital stays are far shorter, and hospitals can quickly assess patients’ need for skilled nursing care,” Trivedi said in a news release. “In that context, it has been difficult to justify a rigid three-day threshold.”

Skilled nursing facilities are not the same as long-term nursing homes. They are meant to provide short-term care and rehabilitation for people who have the ability to return to independent living.

Health experts have suspected that the three-day rule had become outmoded, and the COVID-19 pandemic provided a perfect natural experiment to test this notion.

The rule was suspended between March 2020 and May 2023 as part of the federal government’s response to the pandemic, researchers said.

This gave researchers the opportunity to compare hospital stays during the rule’s suspension to what happened after its reinstatement.

Researchers analyzed more than 600,000 hospital stays in 2023 involving traditional Medicare patients.

Results showed that as soon as the three-day rule was reinstated, the proportion of hospital stays lasting at least three days increased by more than 1%.

The increase was even greater — more than 5% — among patients who later went into nursing home rehab, researchers found.

“We found that the rule does not reduce skilled nursing care use among patients who are admitted to the hospital, as was its original purpose, but instead led to longer hospital stays to meet requirement for coverage,” lead researcher Zihan Chen, a doctoral student in health services research at Brown, said in a news release.

Longer hospital stays didn’t lead to better outcomes among patients, researchers said.

In fact, these extra days increased patients’ risk of complications like hospital-acquired infections, bed sores or adverse drug reactions, the study found.

Extended hospital stays also meant that beds that could have been used for other patients were kept occupied, researchers noted.

Death rates during the month after discharge didn’t change once the rule was reinstated, nor did patients’ likelihood of another hospital day, the study found.

And finally, patients didn’t wind up spending fewer days in a nursing home because they spent more time in a hospital, researchers said.

Congress has repeatedly sought to repeal the rule, but each attempt has stalled over fears that removing it could increase Medicare spending, researchers said. Past efforts to remove or relax the rule has led to sharp increases in Medicare-covered skilled nursing use.

“These factors have made policymakers cautious about any reform,” Chen said.

However, the new study’s results indicate there might be an opportunity for reform.

“Rigorous evaluation helps us understand what these long-standing policies are actually doing today — how they shape care delivery, patient experiences and system efficiency — so they can be updated to better serve patients while using public resources wisely,” Chen said.

More information

The American Institute of Alternative Medicine has more on skilled nursing care.

SOURCE: Brown University, news release, Feb. 9, 2026