Why is the hospital sending me home?

REPOSTED from Times Tribune.

Many of us are familiar with or have heard of a parent or grandparent falling at home — once, twice or maybe more. Or perhaps your loved one is having a difficult time breathing or has been coughing more.

These are all reasons that someone might go to the emergency room.

Many of us, though, are finding our family members who visit the ER are being sent home without being admitted.

Why?

The Centers for Medicare and Medicaid Services has specific criteria for hospital admissions. A patient is considered an inpatient when he or she has an order from a physician to admit for inpatient services.

The physician responsible for the patient’s care must determine if the patient will require inpatient hospital care beyond two midnights.

A patient who does not require inpatient care over two midnights may be treated in the hospital under observation status and discharged home, without ever having an actual admission to the hospital.

Frequently, patients require continued care at another level after leaving a hospital, especially without an inpatient stay. For a Medicare-eligible patient to be eligible for care in a skilled nursing facility, the patient must require skilled care provided by licensed medical professionals, and must also have had a three-consecutive-night hospital admission within the last 30 days.

What does this mean for you or your loved one? And how should you navigate the health care system?

First, everyone should be familiar with and knowledgeable regarding their insurance benefits. When faced with this situation, you should be able to advocate for yourself or loved one and determine a plan for the patient and the family.

Secondly, stay in touch with your primary care physician. Many primary care doctors do not see their own patients in the hospital.

When informed of an ER visit or hospital stay, primary care physicians are a valuable resource for helping the patient and the family when the patient returns to the community.

Finally, you must rely on the hospital staff, physicians, nurses, and particularly social workers and case managers to help address any concerns you have before leaving the hospital. They are available to set up community services to assist.

Any of these resources will help you better understand why the hospital has sent you home.

KATHY STELLA, B.S.N., R.N., C.R.R.N., is assistant vice president, admissions and case management, at Allied Services.