The Problem of Observational Status in a Hospital

We recently got a frantic call from the daughter of one of our clients. Her mom, who was 89 but lived independently, had started to hallucinate and was brought to the Emergency Room of the local hospital. She was seen by the hospital physician and sent to a room. Testing was done that revealed a urinary tract infection. After 48 hours the daughter received a call from the hospital telling her to come and take her mom home. When she arrived, she found that her mom was still confused, and unable to walk after two days in bed. She was no longer hallucinating, and according to the physician she was back to her normal cognitive status, although she had never shown any signs of confusion prior to the hospitalization. She had never been admitted to the hospital, and had been kept under “observational status.” She could not qualify for a Medicare-covered stay in a rehab facility, because she did not meet the criterion of a hospital admission of at least three nights. Our client lived alone and had limited assets, and her daughter had no idea what to do.

Unfortunately, this scenario occurs all too often. There are several lessons to be learned:

  • If your loved one is in the hospital, be sure that he/she is admitted, and not just being held under observation status. This is especially critical if you are concerned that your loved one may not be able to return home after a stay in the hospital. It is helpful to enlist the support of the physician in the community to assist with pressuring the hospitalist for admission. It is also important to be aware that a stay in the hospital under observation status is covered by Medicare B. If your loved one does not have Medicare B and/or a supplemental plan, the stay could be expensive. You also may be billed for some of the medications.
  • You cannot assume that the physician who is seeing your loved one in the hospital has a full understanding of his/her medical condition. In this case, the physician wrongly assumed that our client had pre-existing dementia and had needed assistance prior to the hospitalization. It is a good idea to have ready a packet of information that includes a list of medications, diagnoses, recent blood work, and contact information for all physicians involved in your loved one’s care. You should also insist that the hospital physician speak to his/her community physician.
  • In this situation there was no safe discharge plan. A hospital cannot discharge a patient if it is unsafe, and is responsible for helping you to implementing a safe plan. YOU ARE NOT REQUIRED TO TAKE YOUR LOVED ONE TO YOUR HOME IF YOU CANNOT MANAGE THE CARE.

In this situation we were able to speak to the community physician, who called the hospital physician and pushed for our client to be admitted. She was treated for a few days for the infection as well as dehydration, and spent three weeks in a rehabilitation facility before returning home to live independently.

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