Aging Parents: “In Patient” vs “Under Observation” — How Being in a Hospital Bed can Fool You

Does being in a hospital bed qualify Medicare-eligible seniors as In-Patient?

For some time now, we’ve been hearing about Medicare-eligible seniors who’ve been given “Under Observation” status when admitted to hospitals–for what any intelligent person would assume should be “In-Patient” status. “Under Observation” status is not “In-Patient.” 

If parents need to enter a skilled nursing facility or a nursing home after the required three days of hospitalization, Medicare will not pay and the family will be required to pay all of the bills, including the hospital costs, if hospital status was “Under Observation.”

We might also assume that those in a bed in a hospital are automatically considered “In-Patients.” Not true. Hospitalization for those designated “Under Observation”–even if they’ve been lying in a hospital bed for the three days before going to a skilled nursing facility or nursing home–does not qualify them for Medicare reimbursement. 

If this is news to you, you’ll want to click on this February 6, 2014 FoxNews. com article with video. It explains the factors contributing to the admissions status problem, as well as the many difficulties with the appeals process experienced by “Under-Observation”-Medicare-enrolled patients, who were denied reimbursement.

There is a key word in the first two paragraphs: assume.  Sr. Advisor R, as readers know, is amazingly wise about handling life and will be 101 in September. Her wise words were the subject of an earlier post.  “Don’t Assume” is an example of R’s wise words. Perhaps that’s one reason she has navigated the challenges of life so well.

May the FoxNews link help all Medicare-eligible seniors and their caregiver children to better navigate the hospital-admissions-status challenge and all that follows.

Personal note: My Tuesday, Saturday posting schedule is still ify, so my goal of one post a week remains for the time being. My out-patient procedure in the hospital this past week (no bed involved) prompted this post when I learned that some of my “learned friends,” who are on Medicare, were clueless about the important bed nuance.

Changing often: “Of Current Interest” (right sidebar near bottom). Links to timely information and research from top universities, plus some fun stuff–to help parents age well. (Note 5/17/14 addition from Harvard Medical School for Caregivers)


Medical Emergencies, Emergency Rooms, Hospitals: Getting Optimal Care

Follow-up to yesterday’s post: U.S. News & World Report 2013-14 Best Hospitals. 

Had I been able to be proactive (instead of at the North Rim of the Grand Canyon without Wi Fi or cell capability) this “Best Hospitals” information would have been posted, as close as possible to the day the magazine came out in July. Because of the time lapse, I was able to watch this CBS News broadcast video (

The video’s specific information, imparted by Dr. Jon Pook in the interview, was the best–spontaneous, personalized, current and instructive. Dr. Pook is a doctor at at NY-Presbyterian/Columbia U. Medical Center and chief medical correspondent for CBS news.

I learned from his discussion, how to get optimal hospital care. For example, he elaborates on the importance of communication needing to be “a good hand-off” between the patient’s regular doctor and the hospital’s doctor or the hospitalist, comparing it to the passing of the baton in a relay. He calls attention to basic, but critical, things like hand-washing that “could save your life” and tells you what to be on the lookout for. Dr. Pook uses the term “electronic healthcare buddy.” It was new to me, but made so much sense that I, for one, am glad to know about this option.

Take a five minutes and watch the video. You too will be glad.

Hospitalized Aging Parents: Avoiding the Accidental “Bad Things”

EACH YEAR, half-a-million injuries occur in the United States because of medication errors,” according to a 2009 U Magazine (UCLA health) article. 

We live in an imperfect world. The older we get the more we’re aware. With a better understanding of “best practices” are we better equipped to help hospitalized aging parents avoid accidental bad things because we know what to look for and thus, know what questions to ask? How can we know and ask pertinent questions if we’re clueless about it in the first place?

The following excerpted information from U Magazine’s 2009 article, “Do No Harm,” illuminates measures the UCLA hospital system began implementing to reduce the potential for accidental “bad things” (my words for the overarching concept). Having this knowledge helps us know what to look for. Hopefully our hospitals have implemented some of these measures so we and our aging parents can take advantage–now 4 years later.

For example: Hand hygiene, infection control. General hearsay is that we can “get things” in the hospital. Isn’t that a reason for the hand sanitizers and latex gloves within reach in every examining room and sanitizers in–or outside–every hospital room? But, for example, do we take advantage of this by checking that hands are washed or sanitized or fresh gloves are put on when a health care person comes into our parents’ hospital room?  The “Do No Harm” article empowers us in this regard.

We learn of a national effort to create a kind of safety net in medicine. A UCLA doctor is quoted as saying  “Our hospitals are very safe. But we can always do more.” UCLA, in particular, has embarked on an ambitious program to enhance patient safety that touches on a variety of areas, including controlling infections, eliminating medication errors, improving incident reporting, and enhancing surgical safety.

Medication errors:  To help prevent errors, UCLA Health System [now has]…a bar-coded medication-administration system. The rationale? Experts say adding bar codes to the drugs given to patients could substantially reduce the number of medication errors by applying an extra layer of oversight to every step in the delivery process. That said, do we check to make certain aging parents are getting the correct medications and dosages? Do we keep a list..even when they aren’t in the hospital?

A personal note: it would seem to make sense to make sure parents (especially when they’re not too “with it” for whatever reason), drink lots of water with pills. Mother (never a big water-drinker) didn’t do this during one hospitalization. Pills more or less collected in her throat someplace, causing bad irritation. Not a medication error –just no one was checking water consumption with pills.

Incident reporting: Visitors occasionally take tumbles in hallways; equipment sometimes malfunctions; and patients may have bad reactions to their medication.

To track such mishaps, hospitals in California must report any “adverse events” to the state’s Department of Health Services. UCLA has implemented a cutting-edge computerized reporting system that can be accessed from any computer terminal within the hospitals and affiliated clinics and by those involved in patient care, from physicians and nurses to respiratory therapists and housekeeping personnel.

This computerized system also has an event-reporting system to improve its own monitoring of the quality of care at its hospitals and clinics. This system eliminates the time-consuming paperwork to report “adverse events” and the necessity to deliver the report to a central office in a timely manner.

Says Tod Barry, quality director for Ronald Reagan UCLA Medical Center. “If people are comfortable in reporting, they’re more likely to report.

Read the article in its entirety: “Do No Harm” article

–February 2013  Hospitalization and the Importance of Family post.–Quality website links for everything  hospital-related throughout California and the USA