Wednesday, July 27, 2016

I am interrupting the chronological order of this blog. The information I am giving you may save you a LOT of money and a headache. It is about HOSPITAL STAYS FOR THOSE 65 AND OVER.

Do you think a 3 day continuous hospital stay while on Medicare will guarantee a paid admission to a nursing home? (For rehab, etc.)

Do you think if a person has a chronic illness they can be admitted to the hospital and have their insurance take care of it?

If you think the answers to the above are YES, you are sadly mistaken. This was just one of our experiences that I want to share about insurance and medical coverage.

June 2016
Mom was coughing a lot, and it sounded bad. My sister thought it was a cold or post nasal drip. After 2 weeks of this, I took mom to her doctor. They thought it was pneumonia. They took an X-ray and gave us antibiotics. The next day she sounded worse, so I called 911 for the first time in my life. They said they would take her to the hospital. The hospital said they would admit her, but just for 1 day because they were short on beds. They gave her lasics for the congestive heart failure, because her lungs were filling up with fluid. The pneumonia test came back negative, so now they said it was bronchitis. I took her home.

The next day I went over late in the morning and she looked really bad and she was lying on the couch. I made sure she got some food and I said I’d return later. That afternoon she looked like she was going to die. I called 911 again. This time we went to a different hospital.

Now this is the reason for my story and the questions above. They gave mom a form in the emergency ward and said, “We need you to sign this form. It is giving us permission to treat you.” She signed and they said nothing else. I was happy to have her in the hospital because I was afraid to let her stay alone. My sister was out of town and I was the only one checking on her. 

The next day, the doctor tells me my mother (staying in the hospital in a regular room) was not really “admitted.” I said,”What do you mean? She’s here, she’s being treated.” He said being old and having a chronic condition is not a reason to be admitted to a hospital. (Then what is?)

A social worker with long hair, a squeaky voice and looked like she was 14, told me we were going to have to pay by the hour because insurance was not paying for her stay. I said, “How much is it an hour?” She didn’t know. She said mom was not admitted so we were responsible
for payment. I questioned her more, and she said it was “All on the form mom signed.”

I said I needed to see it.

The form says: YOU HAVE BEEN PLACE IN OBSERVATION/OUTPATIENT STATUS.

Farther down it says, “Medicare and insurance companies classify an observation stay as an outpatient visit…..Medicare and/or your insurance company will hold you responsible for co-pays and deductibles associated with an outpatient claim.”

“You should be aware that Medicare and some insurance companies do not provide coverage for most medications administered while you are an Observation/Outpatient. 

Observation/outpatient services DO NOT COUNT (emphasis mine) TOWARD THE 3 DAY REQUIREMENT FOR PLACEMENT IN A SKILLED NURSING HOME. “

Then there is a box to check (no one checked it) I have a Medicare insurance plan and I have received information entitled “Are you a hospital inpatient or outpatient.”

I told Ms. Squeaky we never got a copy of that. She gave it to me.

The form talks about what insurance mostly does not pay for. It says you should always ASK if you are going to be an inpatient or outpatient. I am still fuming over this!!!

THIS IS ALL ABOUT THE MONEY AND THE NUMBERS FOR THE HOSPITAL. The elderly NEED hospitals and nursing homes!!! An old person does not just bounce back. Mom got dehydrated from the lasics, she got an infection, and death was at her doorstep. Before Obamacare, a person could easily be admitted to a hospital for 3 days and be released to skilled care. There is no way we could take her home. She could not even stand up, and she was in an independent living situation. None of us have a 1st floor bedroom, so we could not take her to our homes, and we would need a wheelchair and a different toilet.

Being old and having a recurring, chronic condition does not qualify a person for a good old fashioned hospital stay any more.

My dad was hospitalized and they released him to a skilled community for rehab. Once he got stronger (2 months) we took him to a community with Alzheimer’s care and a skilled staff. He did get the 2 months paid for by Medicare. Who knew it changed?

So mom went to a skilled facility that cost us $305 A DAY! OUT OF POCKET.  There was no way she could go home. She would not eat. She was so weak we had to actually feed her. Her hands shook so bad she could not do anything but sleep. We made sure mom had multiple visitors each day. We wanted them to know she had a family that cared. She got a bed sore, too. When a person lies in bed it is so easy for their skin to break down. She complained of her back hurting, but it was a breakdown of skin on her behind. I took her outside in the wheelchair to get some air and sun, Brenda made her eat.  Dan visited whenever he could. Then they washed mom’s bedding and her cell phone was in the sheets. Dan had to get her a new phone. 

We had no idea how long this was going to take, but we knew $305 x 30 = $9,150. She is also paying over $4400 a month where she lives.  This was an expensive July!  I talked to someone who had a lot of nursing home experience. She told me to request a family meeting. I am sure they would have gotten around to it eventually, but the money was burning up! We had a meeting and we scheduled a home visit with a physical therapist so we could see how mom could get around. In the family meeting we learned that her progress was ok, but not great. The 
home visit was helpful. We got a high toilet seat and another grab bar in her shower. We had to get rid of all the rugs so she would not trip. We actually pushed for the discharge sooner than they wanted to release her, but we promised to check  on her twice daily and we ordered  physical and occupational therapy, which mom’s insurance paid for. We also had a nurse 2 x  a week and we requested VA assistance, since mom was getting VA benefits. The Home Health Care was a godsend, because there were plenty of eyes on mom checking her progress and her safety.
A well meaning friend told me mom might qualify for hospice care, but I found out you can’t get both Home Health Care and Hospice. Choose one or the other.  You don’t have to be dying to get hospice care. Call  your local hospice organization or look up their website for information on the services they provide.

Mom went home and immediately started perking up. She missed her apartment and her friends. She did not go out of the apartment too much, because she was too weak. The recovery was slow, but steady.