Actions To Manage Hospital Care for Elderly Parents
Learn how to manage hospital care for elderly parents by identifying specific actions you can take to ensure they receive needed care. This article will address:
- The important differences to know about hospital observation or admission status
- How to advocate for nursing home care
- Steps to take if a parent isn’t admitted to the hospital and can’t care for themselves
Hospital Emergency Room Experiences
How many of you have been treated in the hospital emergency room or admitted to the hospital? It is a stressful experience.
This stress is why some parents who have been in the hospital before refuse to return. While others with complicated health conditions worry that something terrible will happen to them if they do not.
These experiences can make
managing hospital care for elderly parents emotionaly distressing.
Caregivers who have accompanied a parent to the emergency room know that a visit can take hours. Doctors and staff work to determine whether a person will be treated and sent home, placed on observation, or formally admitted to the hospital.
When my mom was alive, she had a lot of health problems. I spent many hours in the emergency room with her.
When I managed care for clients, I spent even more time in hospital emergency rooms, in hospitals, and nursing homes coordinating medical care and discharges.
Over this 25-year period, I learned how challenging and frustrating managing hospitalizations can be. Especially when older adults and their caregivers don’t know the effects of hospital and insurance company regulations and rules, which no one has time to explain.
Questions Family Caregivers Can Ask
If you are a caregiver who is puzzled, struggling, or frustrated managing hospital care for elderly parents, begin with an inquisitive mind.
- What don’t I know about this that might be helpful in getting needed care?
- What questions should I be asking that I may not know to ask?”
Helping elderly parents or managing their care becomes more complicated when third parties are involved.
Hospital Observation Versus Admitted
Medicare and Medicare Advantage plans treat hospital observations and admissions differently with respect to payment and billing status. Most caregivers and older adults are unaware of the difference.
This status determines whether a person can be discharged to rehab—also known as skilled nursing or a nursing home—to receive additional medical care, physical, occupational, or speech therapy, or discharged home.
Hospital care for elderly parents addresses serious health concerns but can be challenging due to the time required for physical recovery. Some parents bounce back quickly and recover at home.
Others may benefit from a nursing home stay.Arranging after-hospital care for the elderly, including scheduling a doctor’s appointment, is an important follow-up step to avoid another hospital stay.
Emergency Room Visit? What Caregivers Should Know
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Pamela’s YouTube ChannelElderly Care in the Hospital
So let’s start with an action step for hospital care for elderly parents. Ask this question:
- Is my parent or loved one in the hospital on observation, or are they being admitted?
Initially, the hospital staff may not have an answer for this question. But after a few hours, when the test results are received, a definitive answer should be available.
The visual appearance of a hospital room makes it difficult to distinguish between observation and admission rooms. Some hospitals have built entire hallways or wings for patients on observation that look just like hospital rooms for admitted patients.
This makes it more difficult for consumers to differentiate hospital care for elderly parents when they are unaware of the differences in treatment and payment sources.
The Hospital Readmission Reduction Program in the Affordable Care Act
One might wonder
why being concerned about observation or admission status is critical. The answer is the Affordable Care Act
Section 3025 Hospital Readmissions Reduction Program (HRRP).
The Affordable Care Act Hospital Readmissions Reduction Program reduces payments to certain hospitals when elderly patients are readmitted within 30 days for certain conditions.
Learning more about the Affordable Care Act Section 3025 is a proactive step to become more informed and a better advocate for yourself or your elderly loved one.
If you have not guessed, the words used to describe the “Affordable Care Act” do not mean care is more affordable for patients. This terminology is misleading for hospital care for elderly parents.
- Do not be swayed by words or arguments you hear about affordability
- Investigate all information and validate the accuracy
- These steps are critical to managing aspects of care for yourself or a loved one, so you have accurate information and avoid preventable mistakes
The Hospital Readmissions Reduction Program is a Medicare payment penalty for hospitals
Hospitals are businesses that will take every possible step to avoid financial penalties, including, in some cases, refusing to admit elderly persons. This is one reason observation status and
rapid discharges are more common in hospital care for elderly parents.Unintended Effects on Post-Hospitalization Care
The unintended effect of Medicare payment penalties on hospitalization care for the elderly includes:
- Longer hospital observation stays
- Delayed hospital readmissions for conditions with financial penalties, like heart attacks, heart failure, pneumonia— which is a common condition for the elderly—COPD breathing problems, heart coronary bypass surgery, and elective hip or knee replacement
- Higher costs are shifting to Medicare beneficiaries on observation rather than those admitted, due to differences in payments between Medicare A and Medicare B.
All patients should be informed about hospital charges so they know what to expect. This may involve requesting a room visit from someone in the billing office to obtain this information.
- Read every document before signing.
- Ask questions about information that may be confusing.
- Understand what a signature approves: permission for treatment, billing, and a payment guarantee.
Never sign forms for anyone else unless they are unable to sign, you have legal authority to sign, and you know how to sign to avoid becoming personally and financially liable.
Costs of Care After Hospital Visit
Learning how Medicare and Medicare Advantage Plans work is another action step to avoid being surprised by a medical bill.
The costs of care after a hospital visit and the bills received can be shocking.
Medicare doesn’t pay for everything.Even though hospitals and some doctors’ offices request that you sign a “no surprise billing document,” that still does not mean you will not be surprised when a bill shows up.
The
No Surprises Act of 2020 seeks to address high medical expenses when individuals lack a choice of hospital or facility.
Hospitals contract out physicians, anesthesia, and other services. This means a patient may receive a bill from the hospital and separate bills from contracted service providers. The forms signed include details about these services.
- The best way to avoid surprises with hospital billing is to educate yourself on what a Medicare insurance plan pays for and what it does not.
- With respect to hospitalizations, know and understand the difference between hospital observation and admission.
- Ask which services are provided by the hospital and which services are contracted out.
Asking about bills related to hospital care for elderly parents is a practical step. For the elderly on limited budgets, large medical expenses can be difficult to manage. Know that a payment plan and other arrangements can be requested by contacting the hospital billing office.
Elderly Care After Hospital Discharge
Caregivers can struggle to
figure out elderly care after a hospital discharge and what happens next.It is important to know that another risk of being on observation is the risk of being denied access to physical rehabilitation in a nursing home paid for by Medicare.
The Medicare requirement for discharge from a hospital to a nursing home can range from 1 to 3 admitted overnight stays.
Action steps:
- When a parent goes to the hospital emergency room, call the Medicare plan to find out about discharge to a nursing home if you do not have this information.
- Ask for a list of nursing homes associated with a loved one’s plan so you know your options and can make a choice.
- Visit the nursing homes that seem to be the best match for a loved one
- Contact the local ombudsman to find out about patient satisfaction levels.
Taking these proactive actions allows families to discuss post-hospitalization care needs for elderly loved ones.
For example,
if a parent has recently become physically weak, has lost weight, or has fallen, in addition to the condition for going to the hospital, these factors may support admission and discharge to a nursing home.
Discuss the pros and cons of a short stay of one to two weeks in a nursing home so that a parent can physically improve and then return home, able to take care of themselves. Motivation is important as nursing homes evaluate length of stay on a week-to-week basis.
Discuss this option with the doctor, nursing staff, and discharge planner in the hospital as soon as possible. This conversation can support a well-planned discharge home or to a nursing home of choice.
More details on the hospital-to-nursing home discharge are below.
Elder Care Advocacy Tips for Families
Elderly parents who are physically weak, have poor balance, or are
at risk of falls can benefit from rehabilitation care services in a nursing home. This is a key action for elder care advocacy.
When I was a professional care manager, a power of attorney agent, and a guardian, I spent a lot of time advocating with hospital medical staff and discharge planners. My goal was to have my client admitted so that nursing home care was an option if needed.
There was one time when this request was denied. My client had to pay for a week’s stay in the nursing home to regain their strength.
Another time, a hospital would not admit my client with pneumonia on two consecutive days despite attempts. On the third day, she was taken to a different hospital, was admitted, and died.
My client’s death was an unintended cost of the Hospital Readmissions Reduction Act. This hospital refused to admit an elderly woman with pneumonia to avoid a potential financial penalty.
Many caregivers have these puzzling and frustrating experiences because they are unaware of the underlying reasons that loved ones are refused medical care. The Affordable Care Act, which seeks to improve hospital care but penalizes hospitals financially, may have significant unintended consequences for hospital care for elderly parents.
How Hospitals Determine Admissions
To be an effective advocate, it is important for caregivers and older adults to understand the reasons hospitals admit or refuse to admit. Plus, the reasons admitted patients are eligible for discharge to a nursing home for post-hospital care.
Hospitalizations for older adults pose risks.- Hospital emergency rooms do not admit patients for non-emergency conditions
- Hospitals admit patients for life-threatening conditions
- For some illnesses, going to an urgent care center for evaluation if you cannot get a same-day appointment at a primary care physician, can confirm whether you can receive treatment or if the UCC recommends transfer to a hospital emergency room
- Some individuals without a primary care physician use the emergency room as their primary care. A better option is to establish a relationship with a primary care physician. (Millbank Memorial Fund Article)
Dementia Behaviors and Hospital Emergency Rooms
Caregivers of elderly loved ones with dementia who become exhausted or frustrated can feel that “behaviors” are a reason to go to the emergency room.
Unless there are serious conditions or threats, such as an infection, that are causing the behavior, a loved one will likely be evaluated and discharged.
This can make it frustrating for family caregivers to get needed hospital care for elderly parents. Yet, there are other options that can offer more support.
If identified early, conditions like urinary tract infections can be confirmed in a doctor’s office with a lab test and treated. Dehydration or other conditions can be resolved by offering fluids.
Dementia related behaviors can be evaluated by a
geriatric physician, neurologist, geriatric pharmacist, or neuropsychologist and then treated. Medicare programs like Guide and Care Management can offer dementia caregivers and persons with dementia much-needed support.
Oftentimes, dementia behaviors are environmental. People with dementia react to interactions with others, noise, or commotion. If the environmental causes of distress can be identified and addressed, the behaviors can lessen or disappear.
So rather than subject a loved one with dementia to the busyness and commotion of a hospital emergency room, which can increase their behaviors, consider less disruptive options.
Risks of Using the Emergency Room Too Often
Some older adults with complicated health concerns use the emergency room as a replacement for their primary care physician.
A caregiver recently shared that a sibling becomes anxious when a parent feels sick. The sibling takes the parent to the emergency room instead of calling the primary care doctor’s office to schedule an appointment.
Know that if a parent has multiple emergency room visits for no serious reason, the hospital staff may enter a chart note.
“Patient is unable to care for themselves due to cognitive impairment. The caregiver is unable to manage care. Older adult at risk of elder neglect and abuse. Recommend third-party intervention and solution.”
In my experience, hospitals make referrals to adult protective services (APS) and the police for investigation. If the investigation does not go well, the hospital may initiate other legal steps, such as a guardianship petition, to
place a third party in charge of a parent’s care.There is no reason for this to happen if you and an elderly parent or a caregiver sibling work together to identify and manage health conditions so they don’t become emergencies.
Home Care After Hospital Stay
What action steps can caregivers take when a hospital does not admit a parent?
1 Have a serious talk with a parent to discuss health concerns and the circumstances that result in repeatedly seeking hospital care.
Ask these questions:
- Can you describe the change in their health or daily activities that led to a need to go to the emergency room?
- Did you have a fever, feel more tired, have trouble urinating, not sleep well the night before, or have a loss of appetite and failure to drink fluids?
- If they have a health condition like high blood pressure or diabetes, are they taking all of their medications as scheduled?
- What conditions changed and when? Document the timing.
2 Use the responses to these questions to create a list of facts. Then
make an appointment with your parents’ primary care physician to share the information. Ask the doctor for signs to identify risks and steps to take that may include scheduling a same-day appointment.
- For example, when managing client care, I became an expert in their health conditions, medications, and daily habits. In many cases, I could tell just by looking at them if something was not right.
- I made spreadsheets and checklists for my clients or their caregivers. Information documented included daily temperatures, blood pressure, and blood sugar readings, weekly weight, food and fluid intake, and other measures. Changes in one or more of these might indicate a potential change in health requiring attention.
Staying out of the hospital and remaining in good health can take more effort with age if one has many health conditions to manage. Being healthy at 60, 70, 80 or 90 is not as easy as it was at 20 o 30. It can be a lot more work.
Returning Home After a Hospital Stay: Hiring In-Home Caregivers
In some cases, returning home after a hospital stay requires temporary assistance. This may be from a primary family caregiver, another family member, or by hiring a non-medical in-home care agency.
Action step: If you haven’t already researched non-medical in-home care agencies, now is the time. In addition:
An action step is to become more knowledgeable about company health insurance, insurance purchased off health insurance exchanges, Medicare, Medicaid, and how the health care system works, so that you can be well-informed.
With the information and resources available, there is no reason to be stressed out about a parent going to the emergency room. Through research, you will learn about home or nursing home discharges. Plus, have contact information for home care services to hire.
Create an Elder Care Plan to Avoid or Manage Hospital Care for Elderly Parents
Research care services before something happens. Unfortunately, this does not always happen because most families do not have planning discussions around care for elderly parents until something, such as a hospitalization, happens.
If you are in an emergency “we didn’t know how to plan ” situation,
complete the Elder Care Consultation form to request a consultation.
How Does a Hospital-to-Nursing Home Discharge Work?
Now, let’s review what happens when a parent is admitted into the hospital and approved for transfer to a nursing home.
Like understanding hospital care, nursing home care is equally detailed and complicated. Both are governed by federal and state laws.
- The hospital doctor writes an order for nursing home care.
- The discharge planner contacts the insurance company for a list of approved nursing homes and sends referrals and medical information to multiple locations.
- When the referral is accepted, the discharge planner confirms the nursing home with the patient.
- The discharge planner arranges transportation and advises the patient of the discharge date and time.
Once at the nursing home, the billing office works with the Medicare insurance company to approve care on a week-to-week basis. The length of time one is in a nursing home depends on participation in therapies and improving health.
Nursing Homes Work to Prevent Readmission to Hospitals
A nursing home stay for an eldelry parent is not a break for their caregivers. The older adult’s goal is to return home and live independently.
Depending on a parent’s condition, 20 days in a nursing home paid for by Medicare may not be enough. If this is the case, the co-insurance charge on day 21 is $217 per day in 2026.
But what if a parent can’t pay for nursing home care?This daily cost may motivate a parent to do everything physically and mentally possible to improve.
Nursing homes, like hospitals, are
monitored for care and readmissions. If a parent becomes seriously ill, the nursing home may hesitate to send Mom or Dad back to the hospital from which they came.
This hesitation stems from financial penalties associated with the 30-day hospital readmission reduction program.
If a hospital continually receives patients back from a nursing home within 30 days of discharge, guess what happens? The hospital can be financially penalized. This means that the hospital will eliminate the nursing home from its list of referral partners.
Nursing homes that sent patients to the hospital may also refuse to readmit them for a similar reason.
In some situations, the financial interests of hospitals and nursing homes can take precedence over patient care and much-needed hospital care for elderly parents.
Proactive Elder Care Discussions for Families
These and other reasons are why it’s important to have conversations with parents about being proactive about their health and taking care of themselves. Being sick is expensive and eventually unaffordable.
And while parents can be resistant, most people can understand expenses related to money, health costs, and care choices.
- Are hospitals, nursing homes, and medical care places where elderly persons want to spend money if other choices can be made?
- What about changing health habits and spending money on enjoyable activities?
Family caregivers who are working, raising children, and caring for aging parents benefit from
realistic discussions with parents.
Caregivers doing more is not always the answer to a parent’s care needs.
Elderly parents can learn to be more proactive and self-sufficient.
For caregivers of persons with dementia who cannot make decisions, the legally responsible party makes the decision to provide care as previously directed in legal documents.
Make the Healthcare System Work for You
Healthcare costs in the United States continue to rise. Fortunately, consumers have a wide range of choices between company-sponsored programs, state healthcare exchanges, original Medicare, and Medicare Advantage plans.
It’s easy to see a doctor or receive medical care quickly, without long waitlists. Some countries with fully government-managed public healthcare systems can have months-long waitlists.
Even so, hospitals in rural areas in the U.S. can struggle to stay financially viable. Nursing homes with a large percentage of residents on Medicaid can struggle financially due to low reimbursement rates.
Yet, the healthcare system still has challenges in providing hospital care for eldelry parents and addressing other care concerns and unmet needs.
If you learn how the system works, you can:
- Be more knowledgeable about how to advocate for care
- Learn how to take better care of yourself so you don’t need expensive care
- Talk to elderly family members about their choices.
Make Your Own Choices
Choices may include not pursuing life-saving care. The choice may be to accept hospice care and live the remaining days in peace and comfort.
There will come a point when all of us may have to make that decision.
Quality of life over repeat hospital visits and nursing home stays.
- Being sick is not easy for elderly parents, who may struggle to get through the day.
- It’s not easy for people who are frightened about their health problems and dwell on thoughts of dying.
- Navigating care can be complicated for caregivers and people who need care, even if you are knowledgeable.
Offer Compassion, Understanding, and Knowledge
In addition to the action steps above, work to be compassionate and understanding of others’ experiences. Their worries and their pain.
Being a caregiver and a care receiver has its own challenges.
Do your best to become more knowledgeable about the options available to you and your elderly loved ones.
Few, if any, people want others to decide how they will live when older. Yet this happens to many elderly people who make no plans and have no discussions.
So, if you want more control over your life and your care as you get older, create it. Be proactive, seek and share knowledge, and create plans with your family and loved ones.
©2026 Pamela D Wilson. All Rights Reserved.