Take this information with you when leaving the hospital
When you leave the hospital if you are over age 65, when you pack your toothbrush, you should pack away some information with it. Here are important tips for you to take with you.
You can appeal your discharge. This is not to suggest that you should appeal but only to make you aware that you can. If you are too sick or there is no place to go, have someone on your behalf deal with the hospital discharge planner and make sure that the place where you are going is where you will get the right kind of care. Elder law attorneys and patient advocates can also assist you. So can your family.
Your doctor can be your ally. Decisions regarding discharge today involve both medical and insurance determinations. If your doctor, therapists and health care providers believe you need additional days of hospitalization or if, after discharge, they recommend additional therapy, you are more likely to receive it.
How long you stay in the hospital matters if you want follow-up therapy. To receive up to 100 days of rehabilitative treatment either in a rehab facility, a temporary Medicare bed in a nursing home, or at home, generally speaking you should first have inpatient hospitalization for three days. In other words, if you are in the hospital for two days or less, for instance, you probably do not qualify for this Medicare benefit and would have to pay privately. Even if you were there for three days, they might not all count. Read below.
When calculating three days of inpatient care, consider three “midnights” and make certain the time was spent as an inpatient and not in the emergency room or “under observation.”
Three days should be easy to count. Not always. Three days means three “midnights.” Also, recently, some people have complained that, although they were in the hospital and sleeping over, they still were not considered to have been “admitted.” They were “under observation.” If a patient was classified as “under observation” or was in the ER at midnight for one of the critical days, insurers might refuse the benefit for rehabilitation. Have someone check that you are considered “admitted” for the necessary time.
Most patients who have been inpatients for the requisite period should qualify for and receive some rehabilitative treatment after hospitalization. Alzheimer’s or dementia patients with other incurable medical conditions still can benefit from therapy for conditions such as, for instance, a broken hip.
Medicare Advantage plans might try to further limit coverage. Seniors with Medicare Advantage plans need to be especially alert regarding coverage.
“Up to 100 days” of coverage for rehabilitation does not guarantee 100 days. Up to 100 days of coverage rarely means 100 days. Often insurers discontinue therapy benefits after 2 to 8 weeks. They might say the patient has “plateaued” in treatment, not showing measurable improvement on a weekly basis. This is not the correct legal standard. The correct legal standard as found in a recent Pennsylvania case is that therapy should continue as long as the patient shows improvement or the therapy prevents deterioration.
Many times therapy ends before it should. When Medicare therapy ends, if the resident stays in rehab or in a nursing home, then she must pay privately or, if assets are low enough, then go on Medicaid.
Going directly home from the hospital could limit future opportunities. A hospital patient who goes home is still entitled to physical and occupational therapy at home but, if this is not enough and it is necessary later to request nursing home placement, this can be more difficult than an admission from a hospital. Also, the applicant would pay privately from the beginning of his or her stay at a nursing home.
Hospital discharge personnel need to tell you what level of care is needed after you leave the hospital and you need to know what medications and therapies should be taken and when. Suppose family members are told that 24-hour-a-day supervision is needed; then you should ask if this means assisted living or some other interpretation. In case medications changed when in the hospital, find out what should be taken and when.
You should control your own placement. Before you leave the hospital, you or your family should know where you want to go. Do not depend exclusively on someone inside the system. Look into what would be the best place to go for more care for you.
For more, listen to “50+ Planning Ahead” a weekly radio program on WCHE 1520 on every Wednesday from 4:30 pm to 5:00 pm with Janet Colliton, Colliton Law Assocs., PC, and Phil McFadden of Home Instead Senior Care.
About the Author Janet Colliton
Esquire, Colliton Law Associates, P.C. Janet Colliton has practiced law for over 38 years, 37 of them in Chester County, Pennsylvania, a suburb of Philadelphia. Her practice, Colliton Law Associates, PC, is limited to elder law, Medicaid, including advice, applications and appeals, and other benefits planning including Veterans benefits, life care and special needs planning, guardianships, retirement, and estate planning and administration.