I remember when my 91 year old mother was admitted to the hospital after a mini-stroke (TIA), I was not caught off guard. She has had a history of having TIA for many years. As a senior living advisor, I have toured and evaluated over 400 senior living communities in the Chicago metropolitan area on the basis of cost and method of payment, level of care, staffing, quality of care, and other quality of life factors such as food and housekeeping. Therefore, I was prepared when it came time to choose a rehabilitation community for her. However, the institution of the 30 day readmission rules for Medicare recipients has made me more vigilant with watching as to whether she is admitted as an inpatient or under observation.*
The following story may not necessarily be directly related to the 30 day readmission rule, but it makes for some very interesting food for thought as you monitor your senior loved ones’ admissions, re-admissions, and discharges.
During a recent hospital stay, my husband was in a semi-private room because it was otherwise full. Due to the fact that he and his roommate were separated by nothing but a curtain, I overheard the situation involving his roommate’s admission. The man was a gentleman who was in his late seventies. He had been living at home, suffered a heart attack, and had broken his neck in some sort of fall or other incident. Most recently, he was placed in a senior community and was assigned to some rehabilitation. He was not cooperating with the therapists and was sent back to the hospital. His re-admission occurred at 1 A.M. Later that morning a social worker was in the room at 9 A.M. telling the gentleman that he was set for release that day. However, he was not able to go home alone; and, his daughter felt she was incapable of taking care of him.
Therefore, he was scheduled to go back to a nursing home community.. It was apparent that he wasn’t going back to the previous community. I heard two well- known rehabilitation communities mentioned that had a bed available to him. His initial react was to balk. The social worker came back three more times to exert pressure for his discharge. On the fourth visit, which occurred at 6 PM, he agreed to the discharge to a community. However, the beds at the reputable communities were filled, and the only option was to go to, “the place right across the street.” Suffice it to say I was mortified because the place across the street was some place I would never send anybody. Sadly, the gentleman’s daughter never made a single appearance during the whole series of exchanges with the social worker, and so could not advocate for her elderly father or ask important questions–the kind of questions I help my clients to anticipate and resolve.
While I have no proof, I cannot help but surmise that the rushed discharge may have had something to do with the new re- admission rules. I would have loved to hear the end of the story.
*Please see my blog post for February 9. 2013 to see an explanation of the differences in admission status.