Understanding Hospital Discharge

A live and interactive discussion with the author of The Hospital Discharge Handbook to learn how we can be prepared and advocate if it happens to you, your clients, or your loved ones! 

Courtney Nalty, Author of the Hospital Discharge Handbook

• courtney@generationalsupport.com 

Questions Asked

• difference between case manager vs. social worker
• If the hospital says you need to leave the hospital say tommorow, are you requited to leave? Can you wait a few more days? What are the rules?
• cost of handbook?
• can you please discuss observation v. admission status
• Does appeal process stop discharge if family or advocate believes and or feels family member not well enough or health has not improved enough for safe discharge from hospital
• so what items should be in a go bag?
• necessity of POLST form
• what happens with expensive cell phones and hearing aids, some of these cost thousands of dollars, are they put into safekeeping in the hospital?
• Courtney... what is the number one thing family caregivers can do to help make your work easier to be of assistance to them?
• One point of contact - thank you!
• Who are the people who can help solo agers?

Chat Transcript

12:11:13     From  GEMENA Murchison : Gemena Murchison FOunder and Geriatric Care Manger of Genada's Helping Hands, LLC. We provide assessments, comprehensive care planning,, monitoring, aging place services, and alternate aging living locator, and billing/insurance issues, and solving all aging challenges. www.genadashelpinghands.com or 240-745-5519. I offer free 30 minute consult.

12:11:31     From  Bonnie Danker : Good Morning Bonnie Danker with CarePatrol assisted living placement service. We are excited to be with you today and love this handbook.

12:11:59     From  mary jane Spence   to   Hosts and panelists : do you mail the handbook

12:12:54     From  Paula  J Phillips : Paula J Phillips, Housing Opportunities Commission of Montgomery County - Elizabeth House.

12:13:52     From  Kimberly Stravers   to   Hosts and panelists : Morning, all! Kim Stravers, death doula, Phoenix ????️

12:14:14     From  Kimberly Stravers : Morning, all! Kim Stravers, death doula, Phoenix ????️

12:14:29     From  JoAnn Lynn : And the patient's insurance!

12:14:29     From  Kathleen McGuinness : Good Morning All   Kathleen McGuinness, Director SmithLife Homecare,  400 caregivers helping families age in place.    Moco & Wash DC   cell 301-873-5506  www.smithlifehomecare.com

12:17:20     From  Jennifer FitzGerald : Good Morning! Jennifer FitzGerald from Georgetown Home Care- providing personal and companion care for those again in place. Serving DC, Northern Virginia and Maryland. 703.328.5465 jenniferfitzgerald@georgetownhomecare.com

12:17:20     From  Liz Greway : Shouldn't Insurers be included in the Team? They seem to have the final say!

12:18:13     From  Cedar Dvorin : I'm pretty sure that aides provide the majority of non-skilled hands-on care.  Case managers & discharge can be nurses. They are not all social workers,

12:18:19     From  Cele Garrett : Also, the "hospitalist"?

12:19:15     From  Barbara Hillard : Good afternoon Everyone! Barbara Hillard - Business Development Director for Visiting Angels Serving   MD/ DC Area  1 888-320-1994

12:19:34     From  Ron Carlson : Devote some time to the role of the patient - often overlooked regarding his/her desires and needs that may be at odds with the case  manager, etc.

12:19:44     From  Steve Gurney - ProAging Community : What Is a Hospitalist? Learn What to Expect from Hospital Medicine https://www.sgu.edu/blog/medical/what-is-a-hospitalist/

12:20:08     From  GEMENA Murchison : utilization reviewer works with insurance and the SW. Utilization reviewer get authorization for stay tend to be RN.

12:22:28     From  Barbara Hillard : RX for wound care for RN to come out

12:25:41     From  steve jefferys   to   Hosts and panelists : A duty of a Hospitalist includes practicing efficient and judicious use of hospital and healthcare resources ie they have a duty to the hospital that may be over that of your loved one.

12:25:41     From  JoAnn Lynn : Age of patient can be a determinate of discharge options: it is difficult for a patient to go to rehab after a  3 night hospital stay unless has Medicare insurance.

12:26:28     From  Barbara Hillard : Hand held shower head

12:27:35     From  Liz Greway : Does the Social Worker have any responsibility once the discharge has occurred, if you subsequently realize theses are questions you didn't know to ask prior to discharge?

12:27:43     From  GEMENA Murchison : POLST form

12:28:12     From  Kate Chutuape : For anyone who's not aware, VHC offers emergency alert system (Lifeline) to ALL patients at time of discharge (free service for 2 months.)

12:28:37     From  Steve Gurney - ProAging Community : Safe and Accessible Home Discussions https://www.retirementlivingsourcebook.com/videos?q=Safe+and+Accessible

12:31:38     From  Ellen Pincus : Hi Ellen Pincus with Silverado Memory Care in Alexandria VA 571-775-9408 ellen.pincus@silverado.com. According to US News and World Report "Best Memory Care" 2022-2023

12:31:46     From  Carolyn Pennington : Carolyn Pennington, Shepherd's Center of Northern Virginia, (703) 281-0538, nonprofit that offers free volunteer transportation for medical and nonmedical needs. Not means tested.

12:32:55     From  steve jefferys   to   Hosts and panelists : Make sure someone knows what medicine you are taking before you enter the hospital, especially important for emergency admittance.Medical info on fridge.

12:35:15     From  Chawanta Williams : What is a good ratio of nursing assistants to patients?

12:38:11     From  Ellen Pincus : where do we get your book?

12:38:42     From  Barbara Hillard : In MD/DC area average is 1-8 clients in facilities - depends on case most  family would prefer home care for one on one care

12:39:06     From  Chawanta Williams : Thank you Barbara!

12:39:42     From  steve jefferys : A duty of a Hospitalist includes practicing efficient and judicious use of a hospital and healthcare resources - they a duty to the hospital that may be over that of your loved ones.

12:40:00     From  Steve Gurney - ProAging Community : Here is the link to order Courtney's Handbook https://generationalsupport.com/shop-generational-support-caregivers/

12:40:01     From  GEMENA Murchison : appeal discharge if you have medicare there is a number on back of card

12:40:38     From  kathleen macleod   to   Hosts and panelists : Stephe Jefferys' statement is a very sad statement of our culture.

12:41:11     From  Liz Greway : Does any of what you are saying apply to being discharged from a rehab?

12:41:13     From  Cedar Dvorin : For those on Medicare contact your Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO) for help with filing an appeal. A fast appeal only covers the decision to end services. You may need to start a separate appeals process for any items or services you may have received after the decision to end services. For more information, view the booklet Medicare Appeals. (see Medicare.gov & keep info if needed for future reference) https://www.medicare.gov/claims-appeals/your-right-to-a-fast-appeal/getting-a-fast-appeal-in-a-hospital

12:41:36     From  steve jefferys : Make sure someone knows what medicine you are taking before you enter the hospital, especially important for emergency admittance. Medical info on/in fridge.

12:41:38     From  kathleen macleod   to   Hosts and panelists : How do we find the balance between what the patient needs and supporting the hospital's running fees?

12:42:24     From  Gail Crockett : QRCode shows price as $29 how do we get the discounted price?

12:42:54     From  Barbara Hillard : What is the average cost for Elder Law attorney?

12:43:12     From  kathleen macleod   to   Hosts and panelists : Excellent question- going from ER to being admitted…

12:43:21     From  Cedar Dvorin : Observation v. admission also pertains to Medicare.

12:43:57     From  Ron Carlson : Comment on the issues that arise when care is provided in two different jurisdictions, e.g., adjacent states

12:43:59     From  Cedar Dvorin : The doctor either admits the person or says they are under observation.

12:44:06     From  Cheryl Calvert : observation is usually less than 24 hrs

12:44:39     From  mary jane Spence   to   Hosts and panelists : There is a different between "observation" vs. admission, it is of interest, because the charges can be different, which is of major concern.  Most don't want to be observed, because it's more expensive.

12:44:52     From  Cheryl Calvert : not charging the bed rate for that day

12:46:05     From  Cedar Dvorin : If a person has original Medicare, it doesn't matter what state you get your care.

12:46:35     From  steve jefferys : My dad was in ICU for a week and was getting better. The hospital was waiting for a step down unit for him. No step down unit came available and there were people that could fill his bed. The one day that no family member was at the hospital, they sent him to a rehab unit with little care for about six hours. He died the next day.

12:47:20     From  kathleen macleod   to   Hosts and panelists : So sorry to hear that Steve Jefferys.

12:47:45     From  Shasta Douglas   to   Hosts and panelists : I believe you must be admitted to the hospital for three days in order for Medicare to cover the cost of skilled nursing/rehab after hospital discharge. A day in observation and then two days in the hospital would not qualify the person for a skilled nursing stay. That’s the catch.

12:49:36     From  Barbara Hillard : Steve Jefferys- So sorry to hear about your father- families can pay to have a sitter/ CNA stay with their loved one so they are not left alone.  Staffing issues in rehabs are a huge concern.

12:49:40     From  Cedar Dvorin : If a Medicare bene is "under observation" they are charged as an outpatient.

12:50:25     From  mary jane Spence   to   Hosts and panelists : yes, last comment is correct.  They are charged as outpatient., which is NOT good.

12:51:48     From  mary jane Spence   to   Hosts and panelists : My husband had Covid and Pneumonia, is 92 yrs old,  he was discharged from ER, instead of being admitted.   Never got an answer as to why he was not admitted.  He has other major illnesses.

12:51:59     From  Steve Gurney - ProAging Community : MOLST and POLST are two acronyms defining medical orders. The MOLST is the Medical Orders for Life-Sustaining Treatment and the POLST is the Physician Orders for Life-Sustaining Treatment. They're both the same thing, but in different states they call them by those two different names. https://www.actec.org/estate-planning/advance-medical-directives/#:~:text=what those are?-,Sure.,by those two different names.

12:52:19     From  Cedar Dvorin : For impartial info re Medicare & related insurance, go to https://www.shiphelp.org/  & click on  the orange button "Find Local Medicare Help"

12:52:27     From  Marianne Dougherty : marianne@rls-seniors.com offers Medicare expertise

12:52:29     From  Ron Carlson : Are there some "best practice" examples where a hospital provide the patient/family with a checklist of possible actions upon a patient's admission -

12:54:32     From  Cedar Dvorin : RON- yes- hospitals must give patients the standardized Medicare Outpatient Observation Notice (MOON)

12:55:18     From  Steve Gurney - ProAging Community : file of life https://www.thefileoflife.org/

12:56:10     From  Marianne Dougherty : It is situation dependent reach out to me at marianne@rls-seniors.com

12:56:21     From  Barbara Hillard   to   Hosts and panelists : Steve Can't copy the links in chat....

12:57:02     From  Steve Gurney - ProAging Community : Medicare Outpatient Observation Notice (MOON)https://www.cms.gov/newsroom/fact-sheets/medicare-outpatient-observation-notice-moon

12:57:14     From  Ron Carlson : Re this but not useful/practical

12:57:36     From  Cedar Dvorin : https://www.hhs.gov/guidance/document/medicare-outpatient-observation-notice-moon-form-cms-10611

13:01:21     From  kathleen macleod   to   Hosts and panelists : Who are the people available to help with Solo Agers?

13:01:30     From  Steve Gurney - ProAging Community : From Shasta Douglas to All Panelists 12:47 PM

I believe you must be admitted to the hospital for three days in order for Medicare to cover the cost of skilled nursing/rehab after hospital discharge. A day in observation and then two days in the hospital would not qualify the person for a skilled nursing stay. That’s the catch.

13:02:56     From  Ron Carlson : Excellent session - suggest a follow-up hitting on two or three of the core issues -

13:04:25     From  GEMENA Murchison : Geriatric Care Mangers can help Solo agers www.genadashelpinghands.com or 240-745-5519

13:04:50     From  Kimberly Stravers : End-of-life doulas can absolutely be part of a team for solo agers, even if one is years from death

13:05:18     From  Barbara Hillard : Thank you Courtney and Steve!  Marvelous discussion and information! Keeping informed to make better choices.

13:05:18     From  Steve Gurney - ProAging Community : Solo Aging Discussion https://www.retirementlivingsourcebook.com/videos?q=solo+aging

13:05:22     From  kathleen macleod   to   Hosts and panelists : Thank you!!

13:05:35     From  Joy Loverde : Thank you, Steve and Courtney - excellent conversation

13:05:50     From  Gail Crockett : Great session.

13:05:57     From  Cedar Dvorin : Important topic- so much to know. Thank you.

13:05:59     From  Kimberly Stravers : kim@nightrosedeathdoula.com if anyone is interested in learning more about how we support