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.