A hospitalization is usually an unexpected and stressful time for both the patient and their loved ones. This article will review some helpful hints to navigate your stay.

About Insurance

First, make sure to clarify with the staff whether the patient is under observation or officially admitted to the hospital. Just because they are placed in a hospital room doesn’t always mean that they are an admitted patient. This is especially important for traditional Medicare recipients, because if they need extended care in a rehabilitation facility after their hospitalization, Traditional Medicare requires participants to be admitted for three overnights.

What about Medicare Advantage recipients? While Medicare Advantage plans don’t require a three-night minimum stay in the hospital, they do require pre-approval or authorization to go to a short term rehab facility.  The hospital social worker will have to contact your insurance company and provide any requested medical information necessary in determining if a rehabilitation stay will be covered. If you receive authorization for a rehab stay, it is important to know that every week the rehab facility must call your insurance company to request continued authorization.

You will want to inquire if any co-pays are associated with the rehabilitation stay. As an example, the social worker might relay that after your 30th day in the facility, a $175/day co-pay starts – but remember you aren’t guaranteed to be in rehab for 30 days.  The length of your stay depends on how much time your plan authorizes each week. When your Medicare Advantage plan stops coverage in the rehabilitation facility you’ll only get a 48 hour notice.  This is another reason it is important to keep in close contact with your social worker to ask if they suspect your insurance coverage is nearing an end in the facility..

Your Medical Team

Next, remember that being proactive is key. Family (or your advocate) should reach out to the hospital social worker or case manager right away.  You may wonder, what is the difference between a social worker and a case manager? Generally, the case manager will be a nurse who helps coordinate and communicate treatment and care needs throughout a hospitalization, working alongside the social worker who is making arrangements for post discharge needs.  You can think of the social worker as the quarterback of your medical team.

Consider if you’ll need a rehab stay or long term placement directly from your hospitalization.  If so, call your social worker and before you hang up make sure you ask for his/her direct phone number/extension or even e-mail; otherwise the hospital receptionist may place you into a general social work phone or voicemail when you call back. Some hospitals still use a paging system – for urgent needs ask the front desk if they can page a staff member for you.

If your loved one moves to a different floor in the hospital, they’ll likely change social workers and case managers. It is important to keep on top of the names and contact information of the new team in charge of caring for your or your loved one.

Staff keep electronic records including any correspondence with family so any staff involved in the case can refer to it for continuity of care. Another important tip is to check with your nurse and ask her to verify what your code status is on your medical chart.  A code status details the type of emergency treatment one requests if their heart were to stop or they stopped breathing.  This status has to be confirmed every time you go to the hospital. It won’t ‘rollover’ from the last time you had an admission, or from your medical records from a previous doctor’s appointment or facility unless you have a POLST form (Physician Order For Life Sustaining Treatment).

A POLST form is different from a Living Will. The nurse won’t sift through your living will in an emergent situation, they’ll look at your doctor’s order. The POLST form can be completed with your social worker, doctor, or nurse practitioner at the hospital. They have blank copies of the hospital. This form is often printed on hot pink paper and acts as a universal doctors order indicating your code status and treatment wishes. It must be signed by the physician.

Think about Discharge

Discharge may also seem to pop up unexpectedly when in the hospital. Remember to inquire about estimated discharge when speaking to the doctor or social worker, even early on. Your medical team may be able to give a general idea depending on the reason of your hospitalization.  If you feel unready or unsafe to discharge on the date decided by the medical team, you do have a right to appeal your discharge.

Some patients will be discharged from the hospital to a rehab, while others will discharge to home.  If your doctor feels it is necessary, and you have a traditional Medicare or Medicare Advantage Plan, you may receive ‘skilled’ home care upon discharge.  This skilled care can include a nurse, physical therapist, occupational therapist, social worker or home health aide.  These professionals aim to aide to help you to continue to recover and get back to feeling like yourself.

What if you need medical equipment like a wheel chair or hospital bed? Its best to ask your social worker to order this equipment for you as part of your discharge from the hospital or rehab. While you can certainly have your primary care physician or home care therapist help in ordering medical equipment, its oftentimes faster and more streamlined to work with the facility social worker.

I just want to go home!

It is normal to be eager to return home and back to your routine. Make sure the nurse who discharges you reviews your discharge instructions with you. This paperwork should also have the names and contact information for any home care agencies, new medications, equipment companies, etc. needed. If there are any blanks on the paperwork, be persistent in getting a complete set of discharge instructions before you leave.

In addition, you should receive prescriptions for any new medications prescribed or lab work needed. Staff can help get you in your vehicle if requested. Discharge transportation via wheel chair van is unfortunately not covered by insurances and cost is determined by mileage. Your social worker can arrange this service for you if needed.

Finally, you are home and you’ve navigated your stay with much more knowledge because you learned these important tips.

 

Written by Tina Kane

Tina Kane is an Elder Care Coordinator with Rothkoff Law Group and is a licensed social worker in Pennsylvania and New Jersey.  Tina has over a decade of experience advocating for seniors.  She provided comprehensive case management services, including creating care plans, facilitating care conferences, arranging skilled and private home care or assisted living/nursing home placement, and connecting patients and families with appropriate resources.

Tina is a Philadelphia native who graduated Magna Cum Laude from Gwynedd Mercy University with a BA in Psychology, followed by earning her master’s in Social Services from Bryn Mawr Graduate School of Social Work and Social Research.

In her spare time, Tina serves as a board member on the Bowl for ALD annual fundraiser, which raises funds for research to find treatments for adrenoleukodystrophy. She enjoys traveling, the Jersey shore, movies, theater, and getting together with family and friends.

 

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care chart: https://www.twenty20.com/photos/e5e64608-8b62-4106-a6a9-b0a9a13ed68f/?utm_t20_channel=bl

care team:https://www.twenty20.com/photos/8a1f0706-af70-42dd-b412-fd45fee23390/?utm_t20_channel=bl