Judging by the complaints to the Long Term Care Ombudsman, many Medicare beneficiaries and their families do not realize they have rights during the hospital discharge process. These rights are meant to protect seniors from being discharged from the hospital too soon and from being placed in a facility that cannot meet their care needs. Maybe you don’t need to know your rights as a Medicare beneficiary today, but file this column away for later. It may come in handy.
When you are admitted to the hospital, you should receive a notice from Medicare that describes your rights. These include the right to receive Medicare-covered services ordered by your doctor, including services you may need after discharge. You also have the right to be involved in any decisions about your hospital stay and to know who will pay for it. Finally, you have the right to appeal if you think you are being discharged too soon. The notice also explains how to file an appeal.
So let’s say you are in the hospital with a broken hip. You’re still weak after surgery. Your doctor also changed your blood pressure medications and the new drugs have made you dizzy. You’re afraid to go home because you’re sure you will fall. Besides, you aren’t sure you can take care of your basic needs. The hospital gives notice that you will be discharged the next day to your home, with home health care coming later in the week.
You should tell staff immediately that you are not ready to go home. You should also ask your doctor to advocate for a later discharge date. If the hospital sticks with the proposed discharge date, you can file an appeal by calling Mountain Pacific Quality Health at 800-497-8232. This organization contracts with the Centers for Medicare & Medicaid Services to handle appeals by Medicare beneficiaries and other quality of care issues.
Once you file an appeal, the discharge is automatically put on hold while your medical records are sent to Mountain Pacific Quality Health for a doctor’s review. Medicare will continue to cover your hospital stay. The appeal will be processed quickly and Mountain Pacific will notify you of its decision.
Medicare-certified hospitals must also help you arrange for services after you leave the facility. A nurse or social worker, called a “discharge planner,” must identify which services you will need and determine if you need help arranging them.
The discharge planner is also responsible for assessing whether you can get those services where you live, developing and implementing a discharge plan if requested by your doctor, ensuring necessary care and services are delivered upon discharge, preparing you for discharge through education, and transferring or referring you (along with necessary medical information) to appropriate facilities or outpatient services.
If you still need skilled nursing care but there are no nursing home beds or adequate substitutes available, the hospital must allow you to stay. Medicare covers hospital stays until a nursing home bed is located. The hospital cannot force you to go to any particular facility. You also do not have to go to a facility that cannot meet your needs. You can’t stay in the hospital indefinitely, but if you need long term care, it is the hospital’s obligation to arrange safe and adequate follow-up care.
Don’t be afraid to stand up for your rights. If you or your family members have concerns or questions, you can call the Long Term Care Ombudsman at 334-4480 or (800) 730-6393. We’ll do our best to make sure your rights and needs are respected.
Diana Weber is the Alaska Long Term Care Ombudsman. Visit http://www.akoltco.org to find out more about how the Ombudsman protects the rights of seniors. The public can also submit complaints online via the website.
