‘Tis the Season…for hospital admissions and long-term care planning!

Newsletter | Nov 28, 2016 | Hook Law Center

Author: Stephanie Washington

Co-Author: Letha Sgritta-McDowell

During the holidays, it is not uncommon for emergency rooms to see an increase in visits by the elderly population. As we know, the elderly are more susceptible to catching pneumonia due to their waning immune systems, falling due to lower body weakness and poor balance, combined with vision problems or home hazards like throw rugs and/or clutter that can be tripped over, and even medication mismanagement caused by having too many prescriptions to take or being prescribed a combination of medications by several different doctors that do not work together but against each other.  With the rise of hospital admissions this time of year, come families who are thrust into a situation they have never experienced before; they are often worried, scared, and confused.

We often receive calls from family members trying to understand the processes for hospital admissions, rehabilitation services, and long-term care for their loved one. There are several points at which families can become easily confused.  The first is upon discharge from the hospital.  Hospitals are acute care facilities; meaning that a person’s stay is only temporary.  For longer term rehabilitation and care while a person is recovering from an acute illness, this type of care is provided either at home or in an outside facility.  Any number of terms are used at this juncture.  Families may hear “rehab,” “skilled nursing,” “nursing home,” or simply “therapy.”  The discharge planner at the hospital will offer you and your loved one options for this continuing care.  For individuals who are recovering from an acute illness, this possible discharge to a nursing home is not permanent.  This is merely a suggestion that the elderly person move to a facility where he or she can receive nursing services as well as all available therapy with the goal that they can recover enough to safely return home.  For many seniors who live alone, a short rehabilitation stay is the safest way to receive the care they need.  Understandably, many people would prefer to go home.  The same therapy may be offered on an outpatient basis.

When evaluating outpatient rehabilitation instead of going to a nursing home, the individual and their family need to consider who will be able to take their loved one to any and all doctor’s appointments and therapy sessions as well as who will cook, clean, do laundry and assist the loved one with bathing, dressing and other essential daily activities. It requires a strong support system and/or the ability to hire private duty care providers to ensure a successful rehabilitation in the home.  Therefore, when faced with this decision, it is important that the family consider all options.  If a discharge to a facility is chosen but rehabilitation in the home later becomes feasible, that certainly can happen.

If an individual is discharged to a nursing facility but does not fully recover or if they have needs which will continue long after rehabilitation is finished, then they often face another stressful and confusing crossroads. If the individual was admitted to the hospital for three nights or more prior to their discharge to the nursing facility, then Medicare can pay for up to 100 days, so long as the patient responds to the therapy being prescribed by his or her doctor, or if the stay in the facility is necessary to maintain the individual’s current level of health and functionality.  However, once the patient stops responding to therapy, refuses to participate, or if the care is not necessary to maintain his or her current level of health, representatives from the facility will discuss “discharge.”  Unfortunately, the context of discharge at this stage is often not explained fully, and many family members assume that this discussion means their loved one is being sent home.  As discussed earlier, for many the transition home is complicated and can be potentially dangerous for the senior.  Understandably, the sense that an elderly person is being sent home when provisions are not available to assist them can cause family members to panic.

However, the discussion of discharge at this juncture simply means that the patient is no longer eligible for Medicare-covered rehabilitation services. If, after rehabilitation, the individual still needs assistance with bathing, dressing, walking, eating and other activities of daily living, then the family can (and should) request that their loved one transition to long-term care within the facility.

Many times we hear that family members were not provided options and were simply told that their loved one was being discharged. This often leads to family members scrambling to find care for their loved one. In other situations, when the family asks about staying longer, a facility representative may explain to the family that no beds are available or they cannot accommodate the care needs of the patient.  There are laws in place which require the nursing facility to assist with a safe and appropriate discharge plan for the patient.  If no beds are available at that facility and services and supports are not sufficient in the community, then the facility representative must find another facility which has an available bed and which can accommodate the person’s care needs.  While looking for a suitable bed, the patient is allowed to stay at the same facility in their current bed.

The rules and regulations surrounding hospital discharge planning and discharge from Medicaid covered rehabilitation can be mysterious and, without proper understanding, can cause additional stress in an already emotional and stressful time. If you or your loved one find yourself in this position, you should immediately seek someone experienced with resident rights who can help navigate this process and develop a long-term care plan focused on developing a solution to the problem.  The attorneys and staff of Hook Law Center are experienced and prepared to assist you or your loved one through this process.  Please call us today to schedule an appointment to discuss your rights and options.

Ask Kit Kat – Mickey, Our Own Star

Hook Law Center:  Kit Kat, I hear that Hook Law Center has many employees who love pets. One in particular—Mickey—the beloved cat of Cynthia is making medical history. What can you tell us about her cat?

Kit Kat:  Mickey is an 18-pound male cat who has just been diagnosed with gigantism or its scientific name of acromegaly. His length from head to tail is more than 3 feet! He is a beautiful brown tabby with white feet who is 10 years old. On January 11, 2017, he will turn 11. Anyway, he was gaining weight, and at one point he weighed in at 21 pounds, even though he was  on a diet. Such a large figure caused him difficulty in jumping onto chairs, etc. When Cynthia took him to the vet, they treated him for arthritis and an underactive thyroid. Still the vet thought there might be something else affecting his condition. It was suggested that Cynthia collect a blood sample, and send it to a lab at Michigan State University in East Lansing, Michigan. Cynthia recently got the results. The suspected condition of gigantism was confirmed. This is an extremely rare condition in cats, caused by over production of the growth hormone (GH). It usually affects males around the median age of 11, so it looks unfortunately like Mickey falls into a classic case. He also displays some other common signs of the disease with his enlarged lower jaw and head.

Treatment can include radiation therapy. However, at this stage in his life and because of the severity of his case, the vet has not recommended anything other than to continue to address his arthritis and thyroid. Mickey is lucky he is in the home he is in. Cynthia and husband, Carl, have even built him a stand to hold his food and water bowls, so he doesn’t have to bend over so far. Eventually, he will undoubtedly succumb to heart disease or renal failure, though the latter is very common in cats as a whole, even those without gigantism. Cynthia and Carl will do their best to keep him comfortable and extend his life as long as possible. (http://www.cat-world.com/au/acromegaly-in-cats)

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