24 Jan

Posted at 21:39h in Blog

Not All Hospital Stays Are Considered Inpatient Care When a patient is put into the hospital, they're assigned a status. Inpatient status and observation status are the two most common. When you're admitted to the hospital, it's not always easy to determine if you're admitted as an inpatient or admitted under hospital observation status.   The Difference Between Inpatient Status & Observation Status Inpatient status is what we typically think of as someone being admitted to the hospital. Observation status is a type of outpatient status. However, someone in hospital observation status can spend several days and nights inside the hospital, even though they're technically an outpatient. In fact, they might be in the very same type of hospital bed, right next door to an inpatient. Observation used to be a way to keep someone in the hospital for a short time while doctors tried to decide if they were sick enough to need inpatient treatment. Now, observation patients can sometimes be kept in the hospital for days on observation status. It's easy to see how this can be confusing for patients since we don't tend to think of "outpatient" as involving an overnight stay in the hospital.   Why Does Inpatient vs. Observation Matter? Suppose you're sleeping in the same hospital ward and getting the medical treatment you need. Why should you care whether you're on inpatient status or observation status? You should care because the difference could cost you hundreds or thousands of dollars. For people on Medicare, the distinction between inpatient and observation status is crucial in terms of the out-of-pocket costs for that care and the coverage of care in a skilled nursing facility after the hospital stay. This is described in more detail below. Your health insurance company or Medicare won't pay for your hospital stay as an observation patient. It would have spent as an inpatient in the same manner. Instead, they'll pay for your hospital stay using the outpatient services part of your health insurance benefit. Your share of costs for outpatient services like observation status could be larger than your share of inpatient hospitalization expenses. Although complex and confusing, there are rules, or at least guidelines, your doctor and hospital follow when deciding whether to assign you hospital observation status or inpatient status. To understand how the observation guidelines work and why hospitals assign patients to observation status, see why you'll pay more.   Example Mr. Smith comes to the emergency room with chest pain. Unable to tell whether Mr. Smith has a heart attack, the cardiologist, Dr. Jones, puts Mr. Smith into the hospital on observation status. Mr. Smith spends the night in a hospital room attached to a heart monitor. Throughout the night, nurses check on him regularly. He gets oxygen and has blood tests drawn every few hours. Dr. Jones may even have ordered more extensive tests to determine the condition of Mr. Smith's heart. Late the next evening, after two days and one night in the hospital, Dr. Jones has enough information to determine that Mr. Smith didn't have a heart attack. Mr. Smith is sent...

24 Dec

Posted at 22:29h in Blog

  The holidays will differ this year due to COVID-19. Families more than likely will not gather to celebrate, potentially creating major consequences for aging loved ones and their adult children. These consequences may spell another pandemic-related crisis impacting older adults. Traditionally, the winter holiday season brings adult children together with their older loved ones for extended periods of time. In many cases, it’s the one time of year when families gather. But this year will differ drastically. The CDC is urging careful consideration of holiday plans, and we are seeing increasing media coverage around holiday travel. As we approach the holiday season, we look forward most to the time we spend with our family and friends. We make plans and anticipate the joy that we will experience through our time together. We make lists, and shop to our heart’s content. Most of us find “magic” in the season, and our hearts open wide to help those less fortunate than ourselves. This is a call to each and every one of you, please, do something over this holiday season to help a senior who may be all but forgotten.   Elder Orphans Imagine waking up alone on Christmas morning, with no one to share in the joy of the holiday with you. Imagine getting dressed the way you always do, having breakfast the way you always do, and watching TV as you always do—nothing special about this day, no grandchildren squealing with delight as they tear open packages under the tree, no family dinner to look forward to later. That is the scenario faced by tens of thousands of seniors who have no living family members or whose relatives who live far away and can’t visit at Christmastime. These seniors may come from a variety of faiths or backgrounds, but what they have in common is an estrangement from the holiday season, their faith traditions and all the seasonal merriment. According to the National Center for Health Statistics, as many as half of all long-term care residents have no living relations. Of those who do have family, around 60 percent of them never receive a visitor. If that statistic makes you feel sad, consider it may be just the tip of the iceberg. It’s possible a similar number of seniors who reside at home or outside a care facility also lack regular visitors, either because they have no relatives or because their families are disengaged. As many as 60% of nursing home residents have no regular visitors. In times past, seniors were part of an extended family, with children or grandchildren nearby, who would assist them in their later years. But with families living all over the globe, there is often not a relative close by, or more often, one who is willing to take on the burden of an aging parent. Many older people express a desire to remain independent for as long as possible so that they can continue with their daily living patterns, and retain their privacy and dignity. But the ravages of aging often prevent them from being well...

25 Nov

Posted at 18:54h in Blog

It’s no secret that the holidays can be rough for older adults who live alone and don’t have family members nearby. For many seniors, it can be downright depressing to spend a holiday without loved ones around. Doing something for someone in this situation, even if it is a small and simple gesture, can make a big difference. We’ve put together some ideas of things you can do to make a senior’s holiday season a little brighter and to feel a bit less lonely. Bring a home cooked dinner to a homebound senior. If you can’t do it on Thanksgiving Day, perhaps the day after or the following weekend. Even better, make it a “date” by bringing dinner for two, and eat with them. More than the food, the senior will enjoy your company. Ask them questions about their past or their family. Most people love talking about their memories. If you can’t deliver a meal in person, you can send a special meal from one of the senior’s favorite restaurants via a delivery service such as GrubHub or DoorDash. Many seniors don’t cook for themselves, or they may use meal services, so having a meal from a restaurant will feel like an extra special treat. Ask if the restaurant can deliver a note from you along with the meal. Or you can use a prepared meal delivery service, such as Luke’s Local or Good Eggs, to deliver a freshly cooked, made-to-order dinner. There are several choices in San Francisco as well as throughout California. Instead of a late day meal, surprise a senior with a cup of freshly brewed coffee and a bagel or muffin in the morning, along with some simple Fall flowers or perhaps a holiday decoration that they can enjoy during the season. If the senior lives in a home with a yard, but can’t afford gardening services, show up with some gardening tools and clean up outside. Bring the senior a cup of hot cider and cookie, and invite them to sit outside and visit with you while you work. Most of us need a change of scenery now and again, and seniors are no different. Ask them if they’d like to go with you on a walk, or to a local park where they can watch kids or dogs play. Or take them on a local shopping trip to pick up something new that they want or need. It doesn’t have to be a big or a long outing, and it will give them a breath of fresh air. ...

23 Nov

Posted at 23:01h in Blog

If choice is a major concern for you regarding health care, you don't ever want to enroll in a Medicare Advantage Plan (MA). If you can't afford a premium for traditional Medicare supplemental policy, a Medicare Advantage Plan might be necessary for you. When you enroll in an MA Plan, your choices will be dictated by an insurance company. A Medicare Advantage Plan is intended to be an all-in-one alternative to Original Medicare. Private insurance companies offer these plans that contract with Medicare to provide Part A and Part B benefits, and sometimes Part D (prescriptions). Most plans cover benefits that Original Medicare doesn't offer, such as vision, hearing, and dental. You have to sign up for Medicare Part A and Part B before you can enroll in Medicare Advantage Plan.   Disadvantages of Medicare Advantage Plans In general, Medicare Advantage Plans do not offer the same level of choice as a Medicare plus Medigap combination. Most plans require you to go to their network of doctors and health providers. Since Medicare Advantage Plans can't pick their customers (they must accept any Medicare-eligible participant), they discourage people who are sick by the way they structure their copays and deductibles. Author Wendell Potter explains how many Medicare Advantage enrollees don't find out about the limitations of their Medicare Advantage plans until they get sick: "Although Mom saw her MA premiums increase significantly over the years, she didn't have any real motivation to disenroll until after she broke her hip and required skilled care in a nursing facility. After a few days, the nursing home administrator told her that if she stayed there, she would have to pay for everything out of her own pocket. Why? Because a utilization review nurse at her MA plan, who had never seen or examined her, decided that the care she was receiving was no longer 'medically necessary.' Because there are no commonly used criteria as to what constitutes medical necessity, insurers have wide discretion in determining what they will pay for and when they will stop paying for services like skilled nursing care by decreeing it 'custodial." One of the most critical health care considerations for an individual is choosing one's doctor(s) and other health care providers. One of the hallmarks of traditional Medicare is the free choice of provider – an individual can see any provider across the country that accepts Medicare. By design, however, MA plans generally contract with a limited network of providers to care for their enrollees (such as HMOs), and some charge more to see providers that don't contract with the plan (such as PPOs). Access to specialists can be limited, and providers can be terminated from the network mid-year, with little to no recourse for their patients. Consider Premiums—and Your Other Costs To see how a Medicare Advantage Plan cherry-picks its patients, carefully review the copays in the summary of benefits for every plan you are considering. To give you an example of the types of copays you may find, here are some details of in-network services from a popular Humana...

18 Sep

Posted at 16:23h in Blog

  Thousands of elders are living in nursing homes despite lack of need, many against their will.   Many elderly patients get admitted to the hospital with profound weakness due to their acute and chronic medical conditions and they will leave the hospital with profound weakness from their acute and chronic medical conditions. In most situations, these patients will be too weak to take care of themselves.  They will need extra help with their activities of daily living either from family or from trained home health care representatives. Patients who cannot safely return to the community often need to transition through a nursing home (with skilled nurses) before returning home. Hundreds of thousands of older adults and younger people with disabilities are living in nursing homes only because that is where Medicaid drives them. They have no clinical need for skilled nursing care, and, if better elder care options were available, many could be living in other settings, including their own homes. For most elderly folks, giving up their independence and being forced into a nursing home is their biggest fear.  Nobody can ever force you to go anywhere you don't want to go, as long as you have the capacity to make your own medical decision.  Your doctor can't force you,  your nurse can't force you, even your powers of attorney can't force you.  If your family is telling you that you have to go to a nursing home or skilled nursing facility and you don't want to and you have the capacity to make that decision, no matter how poor that decision is, you have the right to go home against everyone's wishes. Related Posts They May Be Out Of The Closet, But Many LGBT Seniors Are Facing Aging Alone. Bulletin: 20,000 Elders to Lose Their Home Care Under Medicaid And Be Forced to Stay in Nursing Homes Lessons From The Front: What Nursing Homes Should Learn From Covid-19 Medicaid Medicaid—the joint state/federal health care program for the very poor—sends frail older adults to nursing homes even though they often are the most expensive and least appropriate option. And, as COVID-19 has taught us, they can be a high-risk setting for many. The Kaiser Family Foundation reports that as of Aug. 20, more than 70,000 residents and staff of long-term care facilities (including nursing homes and some assisted living facilities) have died from the pandemic. This is a complicated story, so let’s unpack it by first describing Medicaid long-term supports and services (LTSS) and then looking at nursing homes. States must provide people who have few financial assets, very low incomes, and high levels of personal care needs with long-term care. But Medicaid is required to provide care only in nursing facilities. States can apply for one of many special waivers that allow for care in the community. And every state has at least one. Indeed, more than half of Medicaid LTSS dollars are spent on care in settings other than nursing homes. But the level, quality, and definition of that care vary widely among the states. Many states provide only a few hours...

15 Jun

Posted at 16:56h in Blog

Discrimination against elders is on full display during this pandemic. Some people blame them for the shelter-in-place guidelines. Some say they should be offered up as a sacrifice for the good of the country. ...