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In the early 1980's Medicare started using a system called the diagnosed related group of guidelines for advance payments to hospitals. This has really given hospitals authority and incentive to discharge patients very soon after admission to the hospital. The hospital gets paid the same whether the patient is in 3 days or 6 days. So the hospital can make more money if they free up the bed space for the next patient. The problem this has caused is that nursing homes have become the recovery place for these patients that were not ready to go back to their homes. The problem with this is that Medicare only pays up to 21 days of skilled nursing care. Therefore, if a patient is not recovered after the 21 days in the nursing home, then the funds come out of the patients estate, provided they have one. Needless to say, it does not take long to eat up one's estate at the nursing home rates. Insurance companies have just in the last decade recognized this problem and now are offering Long Term Care Insurance. The long term insurance rates vary by geological location, as well as state and local regulations. The premiums are costly, however, a person has to weigh out the advantages and disadvantages to purchasing long term care insurance.