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.
We 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.
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.
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 formaladmission 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.
Checklists are “in” right now. John’s Hopkins physician, Dr. Peter Pronovost focuses on checklists to reduce mistakes, reduce hospital-acquired infections, and improve patient safety in hospitals. Writer-physician Atul Gawande publicized checklists even more widely in his book, The Checklist Manifesto, describing more examples about how physicians can make small changes and realize dramatic results.
Now Elizabeth Bailey, after going through some dramatic aging-parent hospital experiences where quite a few mistakes were made, has published The Patient’s Checklist, a compilation of ten checklists to help patients and their families keep track of things that go right and help them be on the lookout for problems that may occur.
I’ve observed how good communication can help a hospitalized aging parent maintain an optimistic outlook. This summer Dad was admitted to Rockingham Memorial Hospital in Harrisonburg, VA (read my blog posts from RMH last May) and to section 8G at the Upstate Medical University in Syracuse, New York. Hospitalizations are an enormous challenge for a family, and things can and do get confused.
During Dad’s hospital stays the thoughtful and respectful interaction with dedicated professionals — nurses, assistants, and technicians — made enormous contributions to his recovery.
Below I’ve listed seven interactions that made our stay less stressful and more relaxed. Continue reading →
I have more posts to share about Dad’s time in the hospital, but today, when he arrived home from the hospital, Dad sat down with his iPad and wrote these thoughts about his time as a patient. You may also enjoy the iPad for Dad series on this blog. Read more of the Senior Parent Hospitalization series. (MW)
It happened that I was invited to provide a Bible meditation for a study group at Virginia Mennonite Retirement Community at the fourth floor apartment of another retired couple. They provided us with a delicious supper in the dining room and took us to their lovely apartment.
I was able to lead the study session until the final five minutes when a sense of strain affected my voice, and I struggled to complete the rest of the presentation. I excused myself from the session and went into the hallway to find a drink of water. Continue reading →