Were you admitted to the hospital as an inpatient or just for observation?

By Daneen Cline

My poor mother, not only is she plagued with numerous health issues, but to add insult to injury, her experiences as she travels through the health care system have repeatedly been chronicled and used as a teaching opportunity in this very blog by her opportunistic daughter (me). So what has happened to her recently that I am about to shamelessly exploit?

It was a hospital admission, no wait, that isn’t entirely accurate. Actually it was a Doctor-ordered “observation” in a hospital setting. What is the difference between admission and observation, you ask? Most of us are aware that if you have a 3 day hospital stay prior to a nursing home admission that Medicare will pay up to 100 days for the nursing home. However, a person can be in the hospital for 3 days under “observation” and will not qualify for the 100 days of nursing home benefits paid by Medicare.

My mother was in a regular hospital room, in a regular hospital bed, being tended by the same Doctors and nurses that were tending every other patient on the 6th floor. She even had an IV in her arm and was receiving both physical and respiratory therapy. In short, she looked and was being treated like every other patient there. It wasn’t until 2 days after she entered the hospital , when her Doctor recommended we consider placing her in a nursing home for some rehabilitation that I discovered she was in the hospital for observation and therefore was going to be privately paying for that rehabilitation. When I questioned the Doctor as to why she was there under observation as opposed to being admitted as an inpatient he simply said that Medicare regulations didn’t allow him to admit her because her condition didn’t warrant it.

It has been 9 weeks since this happened to my mother, and since then we have had several clients in our office who have experienced the same thing with a loved one. The days of assuming a 3-day hospital stay will qualify you for Medicare paid nursing home benefits are long gone. If a loved one who has Medicare is admitted to the hospital, ask if they are an inpatient or if they are only under observation, it will save you from an unpleasant surprise if the subject of a nursing home placement comes up in the ensuing days. If you need help in a catastrophic healthcare emergency that may require a long-term nursing home stay, call our office to see if we can assist you.

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