Going to a Nursing Home Following a Hospital Stay

Imagine this: You are admitted to a hospital for 5 or 6 days following a fall with broken bones. Upon discharge from the hospital, you are admitted to a nursing home or extended care facility until you are ready to care for yourself at home. The good news is that you healed completely and are able to care for yourself at home, again. The bad news: You receive a bill for more than $10,000 from the nursing home because the hospital changed your admission status and now claims that you were only “under observation”. Because of that change of status, Medicare will not cover your nursing home bills unless you were classified as an inpatient and stayed at least three days. How could this happen? It already has, to more and more elderly patients on Medicare. According to the Center for Medicare Advocacy, they are hearing of many of these kinds of cases where patients who stayed several days in the hospital were re-classified as under observation, sometimes long after the hospital stay.

To make matters worse, there is a coverage gap for some patients who are not sick enough to become inpatients but not well enough to care for themselves at home.

What you can do:

1. If at all possible, contact your Medicare office before you are hospitalized. Get it on record that you are being admitted as an inpatient and will be staying several days.
2. If you know ahead of time that you may be sent to a nursing home following your hospital stay, contact the nursing home, as well, and get it clear with them as to what your hospitality news stay is about and how long you will probably be there.
3. Talk with your doctor about this issue and make sure he is on the same page with you. Let him know that you are taking a pro-active stance with your hospital visit and nursing home care.
4. When you are admitted to the hospital, let them know up front that you are aware of this practice of “re-classifying” patients from inpatients to observation. State clearly that you know you are being admitted as an inpatient with a several day stay and you will expect all of your qualifying Medicare costs to be covered under those guidelines.
5. If you have a family member or friend who is close to you, have them come with you through the Admissions process (to witness your statement about being an inpatient) and also to visit you while you are in the hospital. On the day you are to be moved to a nursing facility, you should have this person with you and you should ask, upon discharge, to see the classification of your inpatient stay, again. (There will be resistance to this, for obvious reasons, but you should insist before you are transferred). Don’t sign any discharge papers from the hospital unless you read them carefully and make sure your status was not changed to “observation”.
6. Write your congressman and voice your concern about the hospital’s and Medicare’s apparent collusion to deny their financial responsibilities to older patients. And you should know that this issue is NOT currently part of any health care reform discussions… but it should be.


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