How a Parent's Hospital Discharge Can Go Awry

It can be traumatic when your parent goes into a hospital. But it can be aggravating, confusing and worrisome when the hospital discharges him or her.

Knowing what to expect and the potential pitfalls of hospital discharges can ensure that you parent leaves at the right time and with the essential information for what comes next.

For the most part, hospital personnel do their jobs correctly and professionally. But, sadly, some patients are pushed out of hospitals prematurely or without the appropriate discharge instructions.

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A recent study in the European Heart Journal: Acute Cardiovascular Care shows why a proper discharge is so important. University of Leeds researchers found that heart attack survival is tied to receiving post-discharge care. The study reported that heart attack patients have a 46 percent higher chance of dying within a month, and a 74 percent chance of dying within a year, if any of nine components of post-discharge care is missed.

The 3-Day Rule

Be sure you and your parents understand Medicare’s frustrating “3-day rule.” If a patient over 65 is discharged from the hospital before three days, Medicare won’t pay for subsequent skilled-nursing care. And the three days don’t begin until the patient gets an admitting order from the doctor for inpatient treatment.

So even though your dad was in the hospital for more than three days for supervision, if he didn’t receive an inpatient order from the admitting doctor, he might not be eligible for skilled nursing care at a rehab faciliity. The hospital will consider him an “outpatient” if he’s there for emergency department services, observation, outpatient surgery or other services and the doctor hasn’t specifically written an inpatient order for admission.

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Why Your Parent Might Be Eased Out

The reason a hospital may try to push your parent out prematurely is due to the way hospitals get paid for Medicare patients. Medicare pays hospitals on what’s called a “case base.” Translation: the hospital is paid in one lump sum to provide treatment. So the sooner the patient is discharged, the sooner the hospital gets paid.

If you think your parent is being discharged prematurely, try to get the hospital to reverse its decision by explaining to why you believe the release would be a mistake. Medicare’s Quality Improvement Organizations or QIOs (groups of doctors and health care experts who check on and improve the care given to people with Medicare) offers five examples of why a patient might appeal:

• I was discharged too soon.
• I did not receive all the treatment I needed.
• I did not receive instructions for care when I was discharged.
• My condition changed and I did not receive treatment.
• I was forced to stop care before I got all of my treatment

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How to Appeal a Discharge

If reasoning with hospital staffers responsible for the discharge doesn’t work, Medicare advises patients appeal to their local Quality Improvement Organization or QIO. The more details you provide and the more aggressive you are, the better your chances.

QIOs work seven days a week, respond quickly and try to resolve issues within 24 hours. Medicare will continue covering the hospital services until the QIO has come to a conclusion. If the QIO finds the discharge was premature, the hospital must continue covering the treatment. But if the QIO decides the hospital was correct in its discharge timing, Medicare will only cover the hospital’s services until 12:00 p.m. the day after the QIO notified you and the hospital of its decision.

Ensuring a Safe Discharge

A hospital can’t discharge a patient if the release won’t be a safe one. In other words, a patient can’t be dismissed if she can’t get out of bed or is a danger to herself at home alone. If you believe a discharge will be unsafe, bring this up to the hospital and, if necessary, the QIO.

Often, safety will be a determining factor regarding whether to delay a discharge date. From personal experience, I have seen patients remain in the hospital for several weeks until they could be assured of being safe after discharge.

Jacob Edward is the founder and manager of Senior Planning, in Phoenix, Ariz., which has helped many Arizona seniors and their families navigate the process of long-term care planning.