Panic may set in. You are told that your hospitalized loved one is going to be discharged home before you think they are ready, or you object to the place they will be transferred to for care, upon release.
Marilyn Lawson, an experienced Detroit elder care specialist, says she knows just how stressful these issues are, not only because she has helped others with their problems but because she recently faced them with her own husband.
Ray Lawson, 90, her husband of 50 years, died in July just five days after being discharged home from a short-term rehabilitation center. Now, to help others, she hopes to pass along knowledge about essential information that caregivers need to know about health care facility discharges.
Urban Aging News interviewed Lawson about questions caregivers may have when they face decisions to discharge or transfer loved ones from hospitals, rehabilitation centers and nursing homes.
Q: Who makes discharge decisions?
A: In a hospital, the primary care physician or the head of the interdisciplinary professional team decides whether a patient’s condition has been stabilized, no longer requiring inpatient hospital care and the patient can be discharged home or to another health care facility.
Q: How much advance notice does a hospital have to give before discharge?
A: Procedurally, up to two days before, but not less than four hours before the discharge occurs.
Q: Is the hospital required to give written notice of a pending discharge?
A: Yes. A discharge planner, a social worker or nurse administrator, will give the patient who is able to act on their own behalf, or the patient representative notice. Medicare patients receive form CMS 10065-IM, titled Important Message from Medicare. The recipient is asked to acknowledge receipt, and should read carefully as it provides information about the appeals process.
Q: Where do you appeal if you disagree with a decision to discharge?
A: First, appeal to the primary care doctor at the health care facility, or a member of the interdisciplinary professional team. If you think the discharge will adversely affect a person’s health, tell them you object because it would be unsafe to discharge, and why you think so. If you disagree with their decision after discussion, you can appeal further.
People with private insurance need to file appeals to their company. Medicare beneficiaries can appeal to Livanta, a quality improvement organization, by calling 888.524.9900, or going to www.bit.ly/3ZC3WMP.
Michigan Medicaid recipients can file appeals through the Department of Insurance and Financial Services by calling 877.999.6442 or going to www.bit.ly/3ZC3WMP
Q: How much time do you have to appeal a discharge that you dispute to Livanta?
A: Act promptly, as the timely arrival of an expedited decision in the patient’s favor will prevent an interruption of service. Your appeal should be made no later than your planned discharge date, but certainly before you leave the hospital. If you miss the deadline, please refer to the “Important Message from Medicare” form for other options
Please note: Discharges from rehabilitation centers are similar to that of hospitals except that an independent review company is contracted by your insurance company to review weekly progress reports submitted by the rehab center’s therapy staff. If the patient’s performance does not meet standardized measurement tools, the discharge process is set in motion. A “Notice of Medicare Non-Coverage” form CMS 10123 - NOMNC 12/31/2011 is issued to the patient. Read the instructions carefully and file an appeal immediately if you feel you are being discharged too soon.
Q: How can caregivers find out about a nursing home or rehabilitation facility’s quality of care?
A: Visit the facilities.Try to equip yourself with information such as that in “Questions to Ask When You Visit a Nursing Home,” at www.bit.ly/3Be1tOC.
Ask the social worker for a list of transfer options, including their Medicare ratings. Specify your preferences and desired criteria, such as proximity to home, specialization in the unique care your loved one requires, and facilities with a Medicare rating of 3 and above. You may find this Medicare checklist helpful: www.bit.ly/47InOQA. Prior to visiting the facility, you’ll likely want to look up each facilities’ Medicare rating for yourself to determine what the rating was based on. Ratings are listed at https://www.medicare.gov/care-compare/?providerType=NursingHome. Facilities are rated on a 1– 5-star scale, with 5 being the highest.
Q: What responsibilities does a caregiver have if their loved one is discharged home?
A: The caregiver should become thoroughly familiar with the Post Discharge Summary Plan prepared by the facility to ensure continuity of care. It contains vital information about the patient’s diagnosis, medications, follow-up doctor appointments, special diet, alertness and physical dependency level. Also, if doctor prescribed, it includes medical equipment ordered, with the name of the supplying company. It also includes the home healthcare agency providing home visits and for how long.The caregiver is responsible for overseeing all tasks indicated on the PDSP, seeing that they are performed.
Q: How can a caregiver know if they are capable of caring for a loved one at home?
A: 1. Caregivers must research and understand their loved one’s condition and diagnosis.
2. Understanding your loved ones’ legal and financial affairs is equally important as these will determine service eligibility.
3. Confirm or establish a power of attorney for healthcare and finances, those who can legally act on your loved one’s behalf.
4. Work with the discharge planner to ensure a successful transition home.
A limited list of supportive equipment, supplies and services that might be needed includes:
Durable medical equipment:
• Hospital bed with side rails
• Oxygen system
• Wheel chair
• Walker with or without seat
• Exercise equipment
• Hoyer Lift
• Bedside commode
• Portable ramp
• Geri Chair or Lift chair
Supports, Supplies & Services:
• Meals on Wheels
• Respite Care
• Transportation
• Incontinence wear
• Pill organizers with time slots
• Wound care dressings/ointment
Some listed items are prescribed by the doctor and covered under the patient’s insurance plan. Others are not considered medically necessary, and are therefore out-of-pocket expenses. Hospice or palliative care programs offer many of these items at no charge. (See related story).
Establish a support team for yourself and your loved one to enhance care and avoid burnout. To learn about other supports and services for which you and your loved one might be eligible, consult your local Area Agency on Aging.
Marilyn J. Lawson founded Eldercare & Caregiver Solutions in Detroit to educate families on sources of support for caregivers and seniors. She can be reached at 313.377.9516 or by email EldercareSolutions@Outlook.com. To learn about ECS’s monthly Caregiver Support Group, contact Takisha V. LaShore, PhD, LMSW, program facilitator and care management consultant at 734.519.1227.
Veteran journalist Patricia Anstett was a Detroit Free Press medical writer for 22 years, inducted in the Michigan Journalism Hall of Fame.
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