Home > NewsRelease > Affordable Care Act 6 Years Later: Hospitals Risk Care for Older Adults by Preventing Admissions to Avoid Financial Penalties
Affordable Care Act 6 Years Later: Hospitals Risk Care for Older Adults by Preventing Admissions to Avoid Financial Penalties
Pamela D. Wilson -- Caregiving Expert, Advocate & Speaker Pamela D. Wilson -- Caregiving Expert, Advocate & Speaker
Lakewood/Denver , CO
Wednesday, October 10, 2018


CONTACT: Pamela D. Wilson

Lakewood, Colorado, October 10, 2018

Six years ago on October 2, 2012 the Centers for Medicare and Medicaid Services, through the Affordable Care Act Section 3025, began implementing policies to reduce hospital re-admissions by older adult Medicare beneficiaries.  What this means for older adults is that hospitals are financially penalized if there is a return to any hospital within 30 days of discharge for specific conditions. Surprise exists that that hospitals have found a way around the readmission penalties placing the healthcare of older adults at risk.

The specific conditions related to financial readmission penalties for hospitals by CMS include: knee and hip replacements, heart attacks, heart failure, coronary artery bypass surgery, pneumonia, and chronic lung disease. All diagnoses common to the over age 65 population.

It's no surprise that hospitals found a legitimate way to avoid being financially penalized by refusing to admit older adult Medicare beneficiaries for care. As a caregiving advocate and fiduciary, my experience is that hospital staff does not willingly offer information about care status whether admitted or on observation. There is a significant difference for the older adult. In my experience, the information is only offered if one knows to ask.

Hospital staff avoid the subject. As a care advocate—with fiduciary responsibility of guardian or medical power of attorney—a hospital placing one of my clients on observation resulted in opposition. I consistently advocated with hospital staff to request my client be admitted so that he or she could receive real medical care and follow up rehabilitation services if necessary.

I won some battles and lost others. In some cases, angry hospital staff reported me to the police and adult protective services because I disagrreed with them. Older adults and family members lack the skills to advocate to this extent. Many fear retribution from care staff that may result in poor care so they say nothing. 

Hospital staff telling an older adult that he or she is place on observation status rather than being admitted means nothing. Without an explanation quantified in insurance dollars and the inability to receive follow up care, an older adult would not know to disagree.

As a result, the healthcare of the older adult is compromised. Observation status eliminates the potential for follow up care in a skilled nursing community for rehabilitation. Costs covered when admitted to the hospital may not be covered by an observation stay. The older adult is discharged home as quickly as possible or if held, is held on observation status and then returned home. 

Read the entire story here.

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Pamela D. Wilson, MS, BS/BA, CG, CSA, a National Certified Guardian and Certified Senior Advisor, is a caregiving tought leader, elder care expert, advocate, and speaker. Pamela offers family caregivers programming and support to navigate the challenges of providing, navigating, and planning for care. She guides professionals practicing in estate planning, elder and probate law, and financial planning to create plans to address unexpected concerns identified in her past role as a professional fiduciary. Healthcare professionals are supported by Pamela’s expertise to increase responsiveness and sensitivity to the extensive range of care challenges faced by care recipients and caregivers. Contact Pamela HERE



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