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By John M. Bigler This month I'd like to discuss what can be one of the most stressful times in elder law planning. Sometimes when an older person is hospitalized, discharge from the facility can occur sooner than expected - even when the patient and his or her family do not feel that discharge is appropriate. Knowing your rights in a discharge planning scenario can be crucial, both for proper placement after the hospital and for preserving assets and income.
The patient and family should be sure that they have read all documents purporting to explain Medicare, HMO or insurance rights. They should question treating physicians, nurses, social workers, home health-care providers and other care providers about necessary services. Any questions should be voiced and the family should be sure to participate in all care decisions. Most important, there should be an awareness that any inpatient in a hospital who requests discharge planning services or would suffer adverse consequences without a discharge plan is required to have a written plan. That plan should be made on a timely basis and should be placed in the patient's medical records. The plan must be prepared under the supervision of a registered professional nurse, social worker or other appropriately qualified hospital employee. Further, the hospital must make an individualized assessment of the patient's needs for a skilled nursing facility. If the nursing facility is required, then there must be a determination whether there is a bed available in the local geographic area.
If a patient or representative thinks that he or she has been discharged from a hospital too soon or without the necessary post-hospital services being arranged, then they should contact their local quality improvement organizations (QIO) to file a complaint. The hospital must provide a written discharge notice and that notice should provide the name, address and telephone number of the QIO.
In order for a hospital to justify discharge, it must determine that the patient no longer requires inpatient care, and the attending physician must agree with the hospital's determination. Alternatively, if the physician disagrees, the hospital may request an immediate QIO review and that will suffice in lieu of the physician's agreement. In addition, the hospital must notify the patient in writing that they no longer require inpatient care, that charges will be made for continued hospital care beyond the second day following the date of notice and customary charges will be made for continued hospital care beyond the second day following the date of notice.
If the patient remains in the hospital after the date which the hospital has indicated as a discharge, then the QIO will make a determination whether the patient is liable for charges. The QIO decision is appealable by the patient, the hospital or by an attending physician.
Patients have a right to an appeal and can file a request for reconsideration of an initial denial. If they do so, the QIO must complete its reconsideration within three days after receipt if the patient is still in the hospital or the initial determination relates to institutional services for which admission to an institution is sought. The QIO can take 10 days if the appeal is regarding an inpatient stay in a nursing home and could take 30 days if the appeal is for non-institutional services or the patient is longer an inpatient in the hospital or nursing home, or the patient does not request an expedited reconsideration.
As a general rule, before leaving a hospital, the patient should make sure that someone from the hospital staff has discussed with them their post-hospital care need and that a plan of care and services has been developed for them. They should also make sure that the discharge plan identifies services that they need and how the services will be provided. Patients should request assistance in assuring that necessary services are put in place prior to their discharge. Most importantly, they should be aware that they have rights. Very often, an employee of the hospital may make it appear as if the hospital's decision is a fait accompli and there is no alternative. Above all else, make sure that any decision made by the hospital is in writing.
Reprinted with permission of the Suffolk Times © 2005 [ Contact Us ] [ Guestbook ] [ Email ]  The Law Offices of John M. Bigler, Attorney At Law 1421 Wantagh Avenue, Wantagh, New York 11793-2206 1-888-ELDER-LAW · 516-409-6565 · Fax: 516-409-6522 E-Mail: info@biglerlaw.com · Web Site: www.biglerlaw.com |
Many times the first indication patients and their families get that time in the hospital is ending is a telephone call or visit from a hospital discharge planner advising that the hospital stay is no longer covered by either Medicare or insurance. It's not unusual for the patient or family to be advised that discharge will be the next day. This leads to panic. Can home care be arranged in time? If institutional care is warranted, has the family had an opportunity to look at various nursing homes and make a decision as to which would be most appropriate? If the patient and family are aware of their rights, hospital discharge does not have to be traumatic.