Read, Document & Question - taking care of senior citizens

Parent Cafe
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<p>The past few years with my folks (and another couple for whom I am responsible) have been pretty trying. I have done my best to attend appointments, accompany them at the hospital, etc. I am finding out, this is not always enough.</p>

<p>Two issues going on with my parents. First, the disclosure statement they received during the construction of the CCRC lifeplan community does not entirely match up with the residency agreement they signed at settlement. They had the disclosure statement for a year, describing unlimited medical care, they were given the residency shortly before final settlement in which permanent vs. temporary was introduced and some other language changes that open the door for additional fees as their needs increase. </p>

<p>Second - dad went to the ER the end of March. He was in the hospital from a Wednesday night to the following Tuesday. The Monday before he was released to skilled nursing, I got a call saying he had not been admitted, but under observation which then disqualified him for Medicare. At the time of the call, I said ok, because my primary concern at that time was getting his clothing and belongings to skilled nursing and making some other arrangements. Once he was admitted to skilled nursing, I reviewed his chart from the hospital, saw some discrepancies, but also saw a statement from the doctor saying he was to be admitted. </p>

<p>I called the hospital the week of the 23 and later that week got a call from a patient rep. Today some other administrator calls to explain why his status was changed to observation and I said I would need to file a complaint. She says it is now too late. I should have made note of my objection when I was informed or he was discharged. And the time had lapsed. When I said I called in April, she wanted to know when. I had not marked down the freaking date, but fortunately, by going thru the record of calls on my phone, I could see a call from the hospital on the 26th. I knew I had called at least a day or two before I got a call so I could narrow down when I first sought answers. </p>

<p>Hey, excuse me for not pursuing this sooner - dad gets discharged, I am supervising mom with her mild dementia and I never knew you could be in a hospital for six days under observation. </p>

<p>Repeat after me - read, document, and question.</p>

2

<p>And get names and don’t agree. </p>

<p>So it’s like you have to say to whomever, are you saying you are not admitting him but only observing? And sadly, they throw so much at you in a rushed call. I would say, I didn’t agree. I said yes I understood what was said, but I didn’t realize I was agreeing to hat sounds like a contract. Saying yes over the phone does not sound like an agreement.</p>

<p>And the way hospitals bill, weeks later, who the heck knows what they are doing. It’s never to late for paperwork to be corrected. They just want younto agree and go away.</p>

<p>Sadly, sounds like they are playing hardball. Push back, say you will have an attorney look over file because you did not agree to anyone but uttering yes over a rushed phone call without all the facts. Do this in writing. </p>

<p>If there is a bill, who pays?</p>

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<p>Oh, wnp – just breathe and carve out time for you along the way. Four elderly adults is just too much for any single person to handle without going a little crazy sometimes.</p>

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<p>workn, I am so sorry to hear your family was a victim of the inpatient vs. observation status trap. Observation is a term used to describe the status of a patient who is in the hospital but not admitted. Your father was there for one week and he was never admitted!!! Who would think to ask whether a loved one in the hospital for several days is still out-patient observation status? But, this happens to often that hospitals classify mulit-day hospitalizations as “observation” and not in-patient. The Medicare implications are huge. The hospitalization under “observation” has higher patient cost-sharing (Part B vs Part A) and also, Medicare does not pay for a post-hospital stay in a skilled nursing facility if the patient has not been admitted in-patient for three midnights. If the patient is on Original Medicare or has a Medigap, the patient is liable for the entire skilled nursing bill. It is almost impossible to retroactively change an observation status to in-patient.
This needs to change!</p>

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<p>Thank you, Sewhappy for your kind words.</p>

<p>DuckMom - Well, the trap was new to me! I understood the rules of Medicare for skilled nursing, but I had NO idea he had not been admitted until the night before they discharged him - although discharge is a funny word since he had never been admitted. </p>

<p>When he went to skilled nursing, I was looking over his records from his stay (I was trying to see if they ever ran a second urine screen) and the second day he was there the plan states “At this point he will be admitted.” </p>

<p>What I was told today, was that decision was reviewed and changed prior to his discharge. So, even if I had asked (which since I didn’t even know that you could be observed for such a long time) it could have been changed. </p>

<p>This is a hospital with a low patient count. When we were there only about a third of the beds were filled. I think this was a way to fill a bed and meet a lower standard of requirements. </p>

<p>I have two hopes for the hospital overturning their decision - although I am not optimistic. One - the fact that the record indicates dad was admitted initially and two, I caught one doctor in a bold face lie. I came early one morning to try to catch a doc on rounds. I had been with dad every day he was in the hospital but had not seen a doc since the ER. When I finally met with one on Sunday he told me he had a good conversation with dad the day before and he seemed lucid. </p>

<p>Well, dad wasn’t lucid, he told me he was locked in a garage, had played golf, had been visiting with his dead sister, etc. but what was patently false was that the doc had NOT talked to dad. When the doc came in for his rounds the previous day, dad was asleep and the nurse told us that she hated to wake up dad. I did not confront the doc at the time, because I did not want to get the nurse in trouble. </p>

<p>Then again, if they tell me dad was just a little confused maybe I should tell them I plan to sue them for locking the poor guy up (oh, and letting him walk to the recycling center in the rain). </p>

<p>Thanks for your help, DuckMom. I will try to get the decision overturned, but it may be a waste of energy.</p>

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<p>wnp, I’m sorry for all of the stress this must put on you. You have certainly not gotten off easy in the whole “sandwich generation” business. </p>

<p>One very specific question, however: I thought that under Medicare, one couldn’t be admitted to a skilled nursing facility unless one had a hospital admission immediately prior to the SNF admission. So if he didn’t have a hospital admission, how is the SNF admitting him?</p>

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<p>Two words - private pay. </p>

<p>The skilled nursing facility is part of his continuing care retirement community. He and my mom have a Type A Extensive contract which was described in the disclosure statement they received prior to entering the community (for over a year while it was being built) as providing unlimited medical care. </p>

<p>Unfortunately, the Residency Agreement they received at settlement differentiated between temporary and permanent medical needs. </p>

<p>So - cha-ching. Out of pocket. </p>

<p>Honestly, I have learned so much these past few months. The regulations governing CCRCs and Lifeplans vary from state to state. It is very interesting. I predict that fifteen years down the road we may see an implosion similar to the mortgage meltdown. </p>

<p>Many of these communities are self-insured and there just so many issues. For example - since the best source of funding is the entrance fee, many of these communities are expanding independent apartments. There is no standard for how many skilled nursing beds are needed for x number of apartments so when all of the residents start to age up, they won’t have enough beds. </p>

<p>I could go on, but I won’t bore you. Suffice to say - it is a mess. Everything looks good, but I am not sure we know if it is sustainable.</p>