Aging Parent Hospitalizations and Observation Status

Just when you think that you have settled the most significant adult child-aging parent issues — when you and your parents have spoken about medical care support, finances, and the range of their end-of-life wishes — along comes another concern to worry about, and it’s one that may be completely out of our control.

Medicare ObservationWe now need to be concerned about the possibility of a parent entering a hospital and assigned to observation status for several days. Observation means that, rather than being officially admitted as a patient, the person is there to be watched, sort of like an out-patient, but not really an out-patient. The problem is, it’s difficult to discover what status a hospital assigns a patient  — the two look almost alike with nurses, doctors, hospital rooms, blood pressure checks, etc.  Admission and observation do not look that different to the patient and family, and apparently many hospitals are not especially  forthcoming with the information.

Why is patient status significant? It’s simple, really. If your parent needs to enter a skilled nursing facility or nursing home after three days of observation status, Medicare will not pay and the family will be required to pay all of the bills, including the hospital costs. For Medicare to pay the bills, a family member must be admitted as a patient for at least three days and not assigned observation status.

Over the past year newspapers and medical or health journals have carried stories about elders and observation, and I share them here so that you can learn as much as you can.

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Keeping Elders Out of Hospitals as Much as Possible

H 4 hospAnyone who has spent time with an elder parent in the hospital knows just how easy it is for one problem to be solved only to have the person discharged with different problems. This is not necessarily the fault of the medical caregivers or the hospital itself — it’s a result of a system that puts older people into beds and keeps them there. Add in bed alarms, the inability to move much, and that hospitals isolate elder patients from their routines and support communities, and you have a recipe for unsuccessful care, a result of age associated hospital complications.

So I recommend reading The Hospital is No Place for the Elderly, a November 20, 2013 article that appeared in the The Atlantic. This piece aptly illustrates the conundrum of frail elderly patients with chronic health issues admitted to hospitals where medical care focuses primarily on fixing acute health problems. The difficulty is that most of frail elders’ medical issues cannot be fixed — but the quality of their lives can improve. Author Jonathan Rauch also describes several programs in the United States — teams of physicians, nurses, and other health professionals — that collaborate to keep patients as healthy as possible and out of the hospital. The teams even save money.             Continue reading

Pets and Patients: Can Pets Help With Healing?

Our family’s dog is ready for the Red Sox celebration parade.

Our family’s dog is ready for the Red Sox celebration parade.

Ever so often a blogger, in this case me, discovers a piece of news that’s old, but so interesting and relevant. When Best Friends Can Visit, appearing in the New York Times New Old Age blog, is just such an article.

This report, written by Judith Graham, describes how some hospitals and medical centers have decided to allow pets — as opposed to trained therapy dogs — to visit sick patients. One of these programs, at the University of Maryland Medical Center, has been in place since 2008. The report is filled with patient and family testimonials, explaining the positive differences that visiting pets can make.

Best Quote                          Continue reading

Aging Parent Hospitalization

I’ve written about senior parent hospitalizations several times on this blog. When a parent is hospitalized, an adult child needs energy, clarity, and attention to detail.

Transition Aging Parents

Check out the Transition Aging Parents blog.

Recently Dale Carter, over at Transition Aging Parents, wrote an excellent post about her experience when her mother was hospitalized for surgery, and she includes lots of ideas that can assist those of us who help to support our parents and may spend some time with them at hospitals.

Last week I shared that I had been away, helping my mother through surgery and recovery for colon cancer. As I reflect on the many lessons learned from this experience, I’ve decided to devote this post to the 5 things I believe were key in ensuring the best care for my mother. These are things that will make a true difference, regardless of the diagnosis, your location in the country, or selection of hospital.                    Continue reading this post at Transition Aging Parents.

Avoiding a Return Trip to the Hospital

Dr. Cleary speaks about helping patients stay involved with their medical care.

One out of five hospitalized Medicare patients needs to return to the hospital a second time within 30 days of their first discharge.

A second hospital admission, shortly after the first, is a no-win situation for everyone concerned about an elder parent. Patients are often sicker, they are unnecessarily exposed to other hospital bacteria, and families of the patient have more worries and parent monitoring. Moreover, Medicare spends a lot more money — 17 billion dollars — on these readmissions.

A blog post at The Agency for Healthcare Research and Quality (AHRQ) website, explains a lot more about preventing Medicare patient hospital readmissions. Written by the agency’s director, Carolyn Clancy, M.D., the post provides links to research, successful hospital readmission prevention programs, and patient guides. Dr. Clancy’s columns are also available at the AARP website.

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Aging Parents and Hospital Admission for Observations

When your parents go to the hospital and need to stay over night or longer, be sure the medical staff admits them as official patients and not for observation (which means that technically they are not admitted at all).

People hospitalized for observation do not qualify for Medicare’s skilled nursing care benefit after leaving the hospital, and they will have much higher out-of-pocket costs because many Medicare benefits require formal admission as an inpatient to a hospital, not a stay for observation, which is more like outpatient status.

Much has been written recently about this situation. Brown University gerontologists published their findings in the June 2012 Health Affairs (abstract), explaining that the number of observations rose 34% when compared to standard hospital admissions in 2007-2009. The study analyzed a huge amount of data — the Medicare claims of 29 million individuals between 2007 and 2009.

A report on the study in the June 4, 2012 Kaiser Health News, Study: Hospital Observations Stays Increase 25 Percent in Three Years, points out how researchers also found that patients under observation stayed in the hospital longer than admitted patients — some “observed” for longer than three days.

Interesting Quote from the Kaiser Article                 Continue reading