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Jan L. Warner & Jan Collins

Question: My 84-year-old mother was hospitalized a little over a week ago after suffering a series of strokes that left her partially paralyzed on the left side. Fearing the worst, our family took turns staying at her bedside, but no one talked to us about her being discharged until late Friday afternoon when we were told that Mom would be discharged for rehabilitation on Monday. When Monday came, we were told that because there was no nursing home bed available, Mom would be sent home and rehabilitation would be sent in. When we objected to this, we were told that if we did not take her home, Momís Medicare would be cut off that afternoon and she would be financially responsible for the cost of her care. At this point, she canít get out of bed or do anything for herself. Could you please answer this e-mail immediately as we are in dire straits.

Answer: In order to assure a timely and appropriate transition from hospital to rehabilitative care, Medicare recipients are entitled to receive appropriate discharge planning from a Medicare-certified hospital. Either your mother, her representative, or her doctor is entitled to request a timely discharge planning evaluation in order to ensure that appropriate arrangements for post-hospital care are made before discharge and in order to avoid unnecessary delays in discharge.

However, while patients or their representatives should request this evaluation as early in the hospital stay as possible, most donít know about it and are caught flatfooted when discharge is mentioned, often on short notice. And, unfortunately, most physicians do not adequately discuss these issues with patients. Thatís why families should consult with physicians and hospital personnel about discharge planning beginning early in the hospital stay. The hospital is required by law to have an appropriate discharge plan in place before discharge. Your doctorís support will be crucial in determining whether your motherís continued hospitalization is medically necessary.

Here, the bumís rush given you by the hospital appears to be well outside the standards of good care and the Medicare Regulations. Because it appears that your mother requires skilled nursing care that cannot be handled appropriately at home, the fact that a Medicare skilled nursing home bed is not available does not relieve the hospital of the obligation to provide for her care. Since a discharge in this fashion would violate Medicare policy and because it is medically necessary, we believe that the hospital is obligated to provide for your motherís continued hospital stay. Because your mother would be entitled to skilled nursing home benefits under Medicare for the part of her continued hospital stay occasioned by the unavailability of a skilled nursing home bed, we believe that a common sense approach by the hospitalís utilization review committee would solve the problem.

However, if no nursing home bed is available and the hospital still insists on discharging your mother under these circumstances, and since the discharge plan does not provide for appropriate placement, we suggest that you enlist the help of her physician and complain to the hospital administrator, the state inspection agency, or the Peer Review Organization to which she has a special right of appeal because of premature discharge. Since your mother is unable to fend for herself, it is up to you and her doctor to assert her interests. If all else fails, contact a knowledgeable attorney in your area.

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