Is hospital/rehab early discharge legal?

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Latest post Sun, Mar 8 2015 1:27 PM by cbg. 5 replies.
  • Wed, Jan 19 2011 1:52 PM

    • islander3
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    Is hospital/rehab early discharge legal?

    My husband’s 80-year-old brother lives alone in Maryland.  A few days after Christmas, he blacked out and fell to the floor.  When he came to, he couldn’t get up.  So he laid there for 2 days yelling for help.  Finally a neighbor heard him and call 911.  He was admitted to a hospital where it was determined that he had both a stroke and a heart attack.

    Last Wednesday, he was discharged from the hospital and sent to rehab.  The rehab facility is actually in the hospital building -- one floor above his hospital room -- but apparently is considered a separate entity.  Now they are telling him he is okay to be discharged on Saturday.  He isn’t okay.  He isn’t feeling at all well.  Yesterday they gave him 2 blood transfusions.  He is unable to use his right arm and leg well enough to walk or take care of himself.  He can barely feed himself. How can they say he is okay to go home?

    My husband and I cannot take care of him because:  a) we don’t have the room, and b) we have medical issues of our own.  His sister has said he can come live with her in Florida, but we can’t take him there before the first week in February and she needs the extra time to get ready.

    Can the hospital/rehab center just “dump” him on the street?  He has Medicare, but no other insurance.  His income consists of Social Security and a small government pension and he has no other assets.  He has never been married and has no children.  I have the feeling that they want him out before he runs up too high a bill.  Can they do this?

  • Wed, Jan 19 2011 1:59 PM In reply to

    • Kivi
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    Re: Is hospital/rehab early discharge legal?

    Every place like this should have someone who is responsible for coordinating his medical care post-dicharge. Contact the hospital or facility's social worker to get a handle on how his discharge will be handled and where he will go and how it will be paid for as he likely needs a form of custodial care that won't be covered by Medicare.

  • Wed, Jan 19 2011 2:50 PM In reply to

    • LynnM
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    Re: Is hospital/rehab early discharge legal?

    If he no longer requires hospitalization they do not have to keep him there. He does not qualify for additional services because it is inconvenient or difficult for his family to take care of him.

  • Wed, Jan 19 2011 3:23 PM In reply to

    • islander3
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    Re: Is hospital/rehab early discharge legal?

    While I resent the implication that it is "inconvenient" for us to care for him, I think you missed the point.  I am much more concerned with his medical care or lack of it.  Aside from the fact that we are physically unable to care for him, we do not live near him.  My experience with hospitals is that you are never sent home until you are stable enough to leave.  It is not the norm to discharge a patient who's blood levels still require transfusions. It also is not the norm to be cutting off cardiac/stroke rehab in just one week.

  • Sun, Mar 8 2015 12:08 PM In reply to

    • nkiflemar
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    Re: Is hospital/rehab early discharge legal?

    That earlier reply was not only rude, it was inaccurate. This may give you some options to delay the discharge. In any event, for all stays of over 3 days, hospitals are required to give you the IMM. Contact the Social Worker and let them know of your concerns.  It is NOT your responsibility to become the caretaker for your husband's brother.  Given your age, your own medical issues and the financial obligation, it is not required for anyone to take that on.  It is nice if one can and does, but it is not an obligation as was indicated by previous reply. Do not be bullied into feeling it is all on you, your husband or your sister in law.  That is why people pay for years for healthcare coverage, including Medicare!  Read the info below and talk to the social worker. If you still don't get help or understand, then contact the Adult Protective Services in your state which you should be able to get contact information through your community information and referral service in your state.  You can also ask the social worker for this information, which may prompt them to act as well.  Additionally, there is a program under federal Title Nineteen you can apply for to see if he can get a home caretaker or even nursing care.  That longterm care program can provide numerous types of care, either in the home, adult daycare, or inpatient.  Good luck!

    Two days before the date of discharge, the hospital is supposed to give the patient another copy of the Important Message from Medicare.  However, the second notice is not required if the hospitalization was for 3 days or less.  Many people are surprised at the short hospital stays recommended after a previously healthy senior has suffered a major medical crisis, such as a stroke or broken hip.  These events are often a family's first introduction to the short and long term care system for the elderly and sometimes it may feel like the hospital is trying to rush the patient out.  The reason these short hospitalizations occur is if Medicare and/or the patient's supplemental health insurance company later determine the patient did not need to be hospitalized for some days making up the period of the hospitalization, the hospital may have a hard time getting paid.

    You may request a hospital discharge review if you:

    • Believe you, or your loved one, is not medically ready to go home from the hospital;
    • There is a legitimate medical reason to continue receiving a medical service; or
    • Your have not received clear discharge instructions.

    If your elderly loved one has received a discharge decision and you feel they are not ready to be discharged from the hospital, you would need to contact the local Medicare Quality Improvement Organization (QIO).  The QIO's telephone number should be on the Medicare notice.  A QIO is a group of physicians and other health care professionals who monitor the care provided to Medicare beneficiaries.  The QIO will review the hospital's decision to discharge.  The QIO staff is paid by the U.S. government and is not affiliated with the hospital.

    There are time limits to contact the QIO, so if you are going to appeal the discharge, it should be done quickly.  The QIO must be contacted by noon of the first business day of the day after you receive the discharge notice.  If the QIO is contacted in a timely manner, the patient does not have to pay for their care while they wait for the QIO to review the discharge

    Once the QIO is notified, the hospital must produce a Detailed Notice of Discharge no later than noon the day after you requested a review.  This notice must detail the medical decisions supporting the discharge.

    The QIO will then review the discharge, including the medical necessity of a continued hospitalization.  The hospital cannot discharge the patient during this review and the patient does not have to pay for these additional days in the hospital.  In effect, this extends Medicare coverage.  The QIO must issue its decision within three days.  Even obtaining these three additional days of hospitalization may have a beneficial effect on the older person.

    For instance, some elderly people may have become weak from dehydration or lack of eating in the days leading up to the medical emergency that led to the hospitalization.  Often, with unplanned hospitalizations, the elder is going to be discharged to a skilled nursing facility (nursing home) first, not directly back to their home.  If the hospital wants to discharge them to a nursing home for skilled physical therapy too quickly, they may not be strong enough to participate in rehab in the nursing home. This can result in the loss of the limited nursing home coverage that Medicare provides there and a premature diagnosis by the nursing home staff that the elder needs 24-hour nursing home care.  It may be that if the elder can receive a few extra days in the hospital, they will be strong enough to participate in rehab in the nursing home, which may then result in them being able to recover enough to return home, instead of having to move a nursing home at that time.  As such, considering an appeal of an early hospital discharge is important.

    If the QIO agrees with the hospital's decision to discharge, the next step is you could appeal to an administrative law judge.  This is a more complicated process and you might need a lawyer.  If you lose the appeal before the administrative law judge, in some instances you can appeal to federal court, though such actions are rare.  Families are usually too overwhelmed their loved one's health crisis to make a federal case of it.

    The QIO for Michigan is an organization called MPRO.  Their telephone number is  1-800-365-5899.

    If you receive a hospital discharge notice, you will likely be dealing with someone who works for the hospital called a discharge planner or a social worker.  One of the discharge planner's jobs is to find a skilled nursing facility that has space available to admit a new patient who needs skilled rehab services in the nursing home.  The nursing homes are usually happy to receive these patients, but the nursing home that has space available may not be to your liking or your first choice.  You will need to work with the discharge planner and remember that, while part of their job is to help arrange a safe and appropriate discharge, they are not the decision maker regarding the discharge.  The doctor and medical staff are.  Also, the discharge planners may be dealing with a high case load, so they may not be able to give as much individual attention to a family's needs as one may want.  When people are overwhelmed by their elderly loved one's health crisis, which may involve difficult emotions of dealing with an older parent's decline and possible need for long-term care, people can become distraught or angry and the discharge planner may have this frustration directed at them.  If you are in this situation, try to step back and keep a cooperative attitude.  Even if you win the QIO appeal and receive extra Medicare days in the hospital, your elderly loved one will be discharged from the hospital at some point and, if they are going to be discharged to a nursing home, you will need the discharge planner's help in finding a good one.

    An elderly person's hospitalization under Medicare Part A is a sign to become proactive and consider your loved one's future.

    - See more at: http://auburnhillselderlaw.com/lawyer/2012/07/15/Medicare/Hospital_Discharge_Issues_bl4665.htm#sthash.hB6IgWKl.dpuf

  • Sun, Mar 8 2015 1:27 PM In reply to

    • cbg
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    Re: Is hospital/rehab early discharge legal?

    Given that this thread is over four years old, I suspect that the OP's situation has long since been resolved.

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