By Steven Buttice, Founder and President, Living By Your Design, Inc.
The flowers, their beauty and pollen are out in abundance. Aunt Millie has always seemed to struggle breathing this time of year. She has had asthma most of her life, and now she has developed a further lung condition called COPD. Chronic obstructive pulmonary disease (COPD) is a type of obstructive lung disease characterized by chronically poor airflow. In late May, Aunt Millie was hospitalized as an inpatient. Yesterday, her family was contacted by a care transition RN from the hospital, and they are working together to help figure out this connection.
Life today is active, especially for women aged 45–55 who care for both their parents and children. These are people caught in the “sandwich generation.”
Medicare tracks and monitors health costs. In the past, this monitoring showed a greater number of hospital readmissions and expense due to several conditions related to heart and lung disease. In order to prevent what Medicare would refer to as “un-necessary readmissions,” hospitals and insurance companies have set up care transition teams to monitor patients after a hospital stay. So what does this mean for Aunt Mille?
First, Aunt Millie will probably receive a phone call and possibly an RN home visit to assist her with identifying things she can do to help herself stay healthier. These ideas and possible programs (interventions) can be very positive. Secondly, if Aunt Millie’s COPD worsens again within 30 days and she goes back to the hospital, the hospital would again screen to see if she meets inpatient admission criteria. If she does, she would be hospitalized as an inpatient, and the hospital would have a reduced reimbursement for that stay from Medicare. The hospital care transition programs are in place to help prevent readmissions and reduced reimbursement.
Alternatively, Aunt Millie may be sick enough to be placed in an observation bed but not fully admitted to the hospital. This “observation bed admission” is different from an inpatient admission and is basically paid by Medicare like an emergency department (or room) treatment. In this case, Medicare would pay their full reimbursement. However, Aunt Millie may have more money payable out-of-pocket. This stay would not qualify as a three-day hospital stay requirement for a Medicare-covered skilled nursing facility (SNF) admission.
What’s the bottom line? Heart and lung conditions will be carefully screened every time someone goes to the hospital to make certain they meet the criteria before a full hospital admission is ordered. While an observation bed admission may exceed three days, it will not qualify a person for Medicare SNF coverage. Aunt Millie will have more monitoring and greater access to education and possibly programs to help herself. She may also have more money payable out-of-pocket. This is a good time to review Aunt Millie’s current insurance plan and gather information on alternatives.
Coordinating care for children and parents simultaneously is not easy. What can individuals in the sandwich generation do to manage? It is important for members of this generation to heed three words of advice: Plan, Plan, Plan. Legal, financial, residential, mental and physical health care elements must be addressed prior to a crisis. An individual in the sandwich generation should guide his or her parent through tough issues while being careful not to take all control away from the parent. Start talking, making suggestions, and guiding parents early — do not wait for a crisis.
This column was a result of questions asked on our blog. Feel free to see our blog below and communicate with us.
For more information, contact Living By Your Design, Inc., focusing on the issues of Older Americans: legal, financial, free guidance for residential placement and health care issues. Call 309-285-8088 or visit our website: www.LivingByYourDesignInc.com. We are located at 809 W. Detweiller Dr., Peoria, IL 61615.
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