Hospital to rehab : what to watch for

Miami's Community Newspapers

Often, when a loved one goes to the hospital and stays over two or three days, the hospital will “announce” that rehab is the next step.

When this first happened to me, it was for my father. At that time, I was not well versed in the Medicare payment system. Now I am, and here’s what you need to know. Medicare pays for 21 days of rehabilitation after a hospital stay. Most rehabilitation facilities are located in nursing homes and most of these institutions have agreements among themselves as well as with insurance companies who are happy to let Medicare pay.

This is the scenario: a senior is sent to the hospital by a doctor or nurse practitioner often for dehydration, a urinary tract infection or some “non-death” reason. The person is transported to a hospital ER and once seen the battery of tests begins. You are admitted for “observation.” The real reason you are admitted is so the hospital can charge Medicare.

Another rule: if you go to the ER and they let you go home you cannot return within 72 hours, even if you came for a different reason, they will admit you. Why? Medicare does not pay for the same patient seen in the ER within 72 hours.

Now, your loved one is being attended to by nurses, technicians, and once in awhile a doctor will show up and discuss how many tests must be done. The patient becomes totally disoriented as would anyone. Think about it, strangers come in at all hours of the day and night, sticking needles in your arm, taking blood pressure and your sleep is constantly interrupted. Time is indistinguishable. If you are a senior, you already are immuno-compromised so lack of sleep in a hospital makes it easier for you to get sick.

Your loved one has no control and can sometimes become combative because they don’t want to be there and become confused. Medication is given to calm them down, almost always a sedative. Usually security is in the room to assist. Imagine how it must feel to be held down and given a shot. The patient becomes woozier — powerful sedatives plus loss of control.

Next step, an alarm is added in case you get out of bed (like to go to the bathroom) so this very loud noise adds to the chaos.

Bottom line is you end up laying in bed, woozy, scared and not understanding who you are or where you are. Then — boom — the diagnosis, a UTI, or dehydration. The remedy for one is antibiotics for the other is water — in other words a one day of treatment. Not so fast, the hospital states. Your loved one is weak, needing physical therapy, the “other” drugs have not exited your body — a myraid excuses as to why you must go to rehab.

Oops — bad news —- you can be discharged on Saturday but the rehab doesn’t take transfers on the weekend because they don’t pay people to do the paperwork on Saturday and Sunday. In a client’s case we offered to pay for a private physical therapist to come to the assisted living center and work with the patient in his/her home. No, you cannot do that either because the hospital will only discharge you Against Medical Advice (AMA). Medicare doesn’t pay AMA claims.

Bottom line: in this case the elderly patient had to stay in the hospital for two extra, unnecessary days awaiting rehab to admit him. Now your loved one has been in the hospital for five days and is being transferred to another hospital-type setting. In the end, it became a 13-day “hospital stay.”

Who wouldn’t be stark raving mad?

Frances Reaves, Esq., a graduate of the University of Miami Law School, spent 10 years as a litigator/lobbyist. Today, she is an accomplished business woman who, when her parents could no longer take care of themselves, learned the ins and outs of senior care (or the lack thereof). She founded Parent Your Parents to assist seniors and their children through the myriad pitfalls and options of “senior care” in the 21st Century. If you have any questions or comments contact Frances at

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