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Long-Term Care: Navigating Hospitals

Copyright © 2014 AARP. All rights reserved.

Nobody likes having to go to the hospital, but it is a necessary factor in the long-term equation. Often times, elder people utilize the hospital as a go-to solution for illness remedies when other options are available. When a hospital stay truly is necessary, there are certain points to keep in mind to help the experience go more smoothly.

A hospital stay, especially a long one or one that involves being in an intensive care unit (ICU), is certainly upsetting for everyone, and infection is an ever-present risk. Older people in particular tend to become disoriented by the noise, lights, constant questioning, and different people coming in and out of the room. Long waits in cold corridors for X-rays and other tests add to the misery.

Patients may not get enough to eat, especially if doctors order them to fast before procedures. Getting a full night's sleep is next to impossible. Patients often take painkillers or other medications that can leave them confused, or even delirious, especially in the unfamiliar surroundings of a hospital.

Extended bed rest can weaken patients’ muscles and bones. Even with kind and caring staff explaining what is happening (not always the case), a hospital stay is almost guaranteed to be unpleasant at best and debilitating at worst.

Some hospitals have special units for older people called Acute Care for Elders (ACE) units. They are staffed by a specially trained interdisciplinary team, which can include geriatricians, advanced practice nurses, social workers, pharmacists, and physical therapists.

The team assesses patients daily, and nurses are given an increased level of independence and accountability. These units have been shown to shorten length of stay and result in lower cost while maintaining patients’ functional abilities. If hospitalization is necessary, ask if your hospital has an ACE.

If you or your parent have been given a bed on a regular hospital floor, make sure that you have formally been admitted as an inpatient. If the doctor or nurse isn’t sure, ask the admitting office. The hospital may claim that you were under observation, even though you received the same services as everyone else.

Because you have not been formally admitted, Medicare will not consider this stay as a Part A (hospital) benefit, for which you pay only an inpatient deductible, but as a Part B (outpatient) benefit. Your portion of the bill may be higher and will include costs for lab tests, X-rays, medications, and other things that would be typically covered under Part A.

And if you go to a rehab program in a nursing facility after this stay, you will have to pay privately since you will technically not have had the required three-day inpatient hospital stay. Legislation has been proposed to change Medicare rules on observation stays, but the outcome is pending.

For now, make sure you ask whether you are admitted or on observation. There is no way to appeal the hospital’s decision to place you on observation, but you can register a complaint with the hospital administration and with Medicare. The Center for Medicare Advocacy has advice on filing a complaint.

Your primary doctor, whether a geriatrician or not, may or may not visit you in the hospital. Increasingly hospital care is managed by specialists called hospitalists. These doctors are trained in critical care medicine and are skilled at handling medical crises that happen to seriously ill patients. They generally work in teams so that someone from the team is available at all hours of the day and night and on weekends.

This also means that you or your parent may not see the same person every day. Hospitalists are employed by the hospital or belong to a group practice that is under contract to the hospital. They do not generally see patients after discharge, although some groups do have physicians who work both in the hospital and in the community.

For more information, see the United Hospital Fund's Next Step in Care guide to hospitalists.

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