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She has spinal stenosis and in hospital - they want to send her home. She can't sit up, walk with out assist and is in tremendous pain. She would need care 24/7 and there is no one available to do that. They said she can't go to rehab because she is a "watch" not a regular patient. Not sure what that means.

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Glad this is starting to work out!
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Good news! Thanks for the update and best wishes to you and to your mom for some very helpful treatment for her spinal condition.
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On Mom's first hospital stay, they were trying to find out why she'd blacked out. Because they were focused on the black out, they didn't do PT or OT evals. But when she was rushed back in for another fall in two days, the doctor brought in a cardio, ordered both evals and turned out there were other issues that necessitated that she move to NH. And this time, she had a diagnosis so Medicare req's were met. I tell all my friends about this because being in the middle of the crisis is NOT the time to get the education about the fine details of hospital stays and Medicare.
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Thank you so much for all of your advice. I was able to speak with the case manager in a more informed way and we were able to get an MRI done - results of MRI led to her being admitted as a patient. Now the case manager is looking into rehab facilities. Thank you all so much, I would not have known how to handle this without your input. Hugs to all.
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We had the same problem a couple of times with Mother. Her doc was very medicare savy and could usually come up with acceptable reason for admission before the 3 days were up. Mother would sometimes help out by coming down with UTI or very low oxygen rate causing necessary admission.

I guess we were lucky because the change in obvs to adm was always approved.
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Correction: Paragraph beginning with "Linda..." should have read I was prepared to order the ENTIRE medical chart/records..."
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The issue of payment by Medicare for meds administered during an observational stay is another pitfull of just an observational status.

We experienced this in 2012 when my father's pacemake was changed and we had to go to the electrophysiologist's preferred hospital, which had technology that his alternate hospital did not have. The issue was one of safely removing and replacing the pacer, and there was an ancillary issue of a defective defibrillator.

Dad developed CHF post-surgery; nurse practitioner said it was "probably due to overinfusion during the surgery". Because of the CHF, he was kept overnight, but I didn't realize the difference between admission and observation.

The hospital later billed him about $80 for meds, including outrageous charges like $14 for a lip balm which he couldn't use because it was petroleum based and he was on oxygen for the CHF.

Medicare refused to pay. I appealed and battled with the hospital and Medicare for about a year. Medicare dropped the ball and failed to respond after the second appellate level was reached.

The hospital also gave up. The $80 for about $15 worth of meds was never paid.

Linda, I don't know for sure whether you can appeal the discharge status, but I demanded explanations and was prepared to order the enter medical chart if the hospital didn't cooperate, which it eventually did.

But you can appeal any Medicare decision not to pay the meds. The outside deadline is listed in the Medicare EOB.

I think I was enough of a thorn in the side of the hospital staff that they just gave up.


Carmichael, I have no particular information on IV meds as a factor for requalifying an admission status, but ask the hospital, in writing (by e-mail if preferred) to document their policies, explain, etc.

But also contact her orthopedic doctor and ask for a script. You might be able to get around the hospital issue by taking your mother for an immediate visit post-discharge (i.e., directly after she's discharged). But better to try and resolve this before she's discharge since she wouldn't be able to stay home alone.

The other issue would be whether she's already used her Medicare "quota" of PT for this year.
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We ran into this situation last fall with my mom. We asked about her status and was told she was admitted but later learned she was admitted under obs. When they discharged her too early (unsafe discharge), we learned we had no rights to appeal the discharge because she was under obs, not in patient. She was readmitted two days later after a fall and this time, we made sure of her status and the doctor made sure there was a diagnosis (failure to thrive). He said that Medicare reviews inpatient admits and can reclassify the patient to obs if they see fit. So the hospitals are very cautious about admitting inpatient.
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AARP has an excellent article about this particular situation:

http://www.aarp.org/health/medicare-insurance/info-08-2012/medicare-inpatient-vs-outpatient-under-observation.html
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thanks, i never new the difference - that there was even an observation vs admitted. I was told that they could not change her to admitted, but if she needs intravenous meds for 3 days, would that make a difference?
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Your last question: They aren't going to put her out in the street. HOWEVER, if Medicare isn't paying anymore, she would be liable for her hospital expenses. Not really a good option.

Keep on social services. Become their flea.

And note to all: Make sure your loved one is actually admitted into the hospital and not kept 'on observation' without admission. Those 3 days are magic.
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She was taken to the hospital by ambulance and this will be her third day. I talked to the case worker today. She said that she is under observation and because of that medicare rejected the request for rehab. I asked if they could change that to being admitted and they said no. They are going to resubmit request today. I told her that there is no one at home and that it wouldn't be safe. Is it possible to not remove her from the hospital if they say they are going to discharge?
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I think Ba8alou nailed it. Before one can go directly to rehab, one must be admitted to the hospital for three days. Sans that, I'm sure there's a way to get there, but you'll have to discuss it with the doctor.

Fight for pain control for your mom. That and contact social services in the hospital and tell them what you've told us. Don't remove your mom from the hospital.

There's Magic in those 3 hospital-stay days. Everyone should confirm with the hospital that their loved one has actually been ADMITTED and is not just being held for observation. I think they'll often do that if it's a RE-admission within thirty days.

Come to think of it, though, if it's BEEN less than thirty days after an at-lease 3-day stay in the hospital, mom would STILL be eligible for rehab.

You sorely need to get with the social services department at the hospital. Fast.
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Have you talked to her doctor? They are normally the ones to send patients to rehab. Tell the social/caseworker at the hospital there is no one to care for Mom if she goes home. You really just need to sit down with these people and honestly explain the situation to them. Normally, they want to be sure the patient has everything they need at home and someone to take care of them before discharge. They even make arrangements for services/med supplies to be there before patient goes home.

Are there other medical issues? Did she get admitted by ambulance and they were just observing her? You just have to question everything going on and demand good answers. Best of luck!
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Do they mean she was not admitted, in hospital for observation?
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