Update to the Medicare “Observation Status” Problem

Several months ago, in September 2013 specifically, I wrote about the issue of being under “observation status” when in the hospital.  A problem occurs when a hospital deems a patient “under observation.”  Such a status means just that.  What it does not mean is that the patient has been admitted to the hospital.  The patient may be in the hospital, on a unit, and in a hospital bed in a regular room, even receiving all the routine procedures of a hospitalization, but if they are “under observation,” it can create a problem, especially when the discharge plan is to go to short term rehab in a skilled nursing facility.  Unless the patient was “admitted,” and was in the hospital for at least three days, the rehab stay currently will not be covered by Medicare.  The person’s only option is to pay privately for the rehab stay, or go directly home, if that is possible.

Now, though, efforts are under way to change that.  Congress is addressing this issue through the “Improving Access to Medicare Coverage Act” (HR 1179 and S 569).  If passed and signed into law, the time spent in observation will count toward the three day hospitalization requirement.  Let your representatives know if you support this bill.

Weather Wise – Keeping Seniors Safe During Winter’s Extremes

It’s early January and we’ve just been through a spell of extreme winter weather.  During the week of the Polar Vortex, there were 21 cold related deaths reported in the U.S.  Some were related to shoveling snow, and some were homeless people who chose not to come in out of the cold, or tried and did not get inside fast enough.

All this brings up a good time to review the measures we should take in caring for an older adult during the winter months.  Older adults require more awareness on our part to assure they are properly attired and warm, so that they do not develop hypothermia.



What is Hypothermia?

Defined as having a core body temperature of 95 degrees Fahrenheit or lower, hypothermia can occur when the outside environment gets too cold or the body’s heat production decreases. Older adults are especially vulnerable because their bodies’ response to cold can be compromised by medical conditions such as diabetes and by use of some medicines, including over-the-counter cold remedies. Hypothermia can develop in older adults after relatively short exposure to cold weather or even a small drop in temperature.

What are the Signs of Hypothermia?

Be aware of slowed or slurred speech; sleepiness or confusion; shivering or stiffness in the arms and legs; poor control over body movements; slow reactions, or a weak pulse.   

Some Tips to Help Older Adults Avoid Hypothermia

  • Keep the house warm enough. Set the thermostat to at least 68 to 70 degrees. In older adults, even mildly cool homes with temperatures from 60 to 65 degrees can lead to hypothermia.
  • Older adults should wear long underwear under their clothes, along with socks and slippers. When indoors, use a blanket or afghan to keep legs and shoulders warm and wear a hat or cap.
  • When going outside in the cold, it is important for an older adult to wear a hat, scarf, and gloves or mittens to prevent loss of body heat through their head and hands.  Wear several layers of warm loose clothing to help trap warm air between the layers.
  • Check with their doctor to see if any prescription or over-the-counter medications you are taking may increase their risk for hypothermia.



Alzheimer’s Awareness Month – Know the Seven Tips for Successful Aging


November is Alzheimer’s Awareness Month, and it creates a good time to stop and learn what we can do to improve our awareness of the disease, as well as to increase our chance of improved brain (and heart) health for a lifetime.  The Alzheimer’s Foundation of America has a colorful poster style graphic on just what we can do throughout our life for successful aging.  Good brain and heart health practices last a lifetime, and may help prevent or delay Alzheimer’s, other dementias, and cardiovascular diseases.  And of course, healthy practices feel better too.

November is Alzheimer’s Disease Awareness Month – Video

November is Alzheimer’s Disease Awareness Month, and a great way to tell the story of Alzheimer’s in America is through the above video, created by the Alzheimer’s Association.  The video is short and informative, and the background music is very effective in supporting the message.

Sleep: The Brain’s Washer?

It turns out our mothers were on to something when they told us to get to bed, and we would feel better in the morning.  Now there is the science to back that up.  And it may even have something to contribute to the Alzheimer’s field.

A paper published in Science this week provides direct experimental evidence that the mouse brain cleans itself during sleep, by expanding channels between neurons that allow an influx of cerebrospinal fluid. The fluid flushes out neurotoxic waste products, such as amyloid proteins, which accumulate as plaques in Alzheimer’s disease, twice as fast when mice are sleeping as when they are awake.

Promising news, especially in the field of Alzheimer’s research.  See the study article in the Journal Science.




Are You Being “Observed?”

If you are a Caregiver for a Senior Heading to the Hospital, Be Sure They are “Admitted”

Have you or your elderly loved one ever been in the hospital and find out as you are leaving that you were never really “in” the hospital?  It can happen, and it can have repercussions, especially if you need to go to rehab/skilled care following the hospitalization.  If one’s admission status is classified as “Under Observation,” further care in a skilled nursing facility or rehab, which is often the next step for an elderly individual following a fall and a hip repair or replacement, would not be covered under the Medicare skilled nursing benefit.  Instead, it would be the responsibility of the elder or family to pay out of pocket.  NPR recently featured a story on observation status.

As a Geriatric Care Manager, I have seen families find out too late that their loved one was only “Under Observation,” even while receiving all the regular care provided in a hospital – x-rays, MRIs, medications, orthopedic care, etc.  In one case, the family realized as their mother was leaving the hospital, and the only way to have her moved to a rehab facility was to pay $30,000 for the stay.  The issue has recently come to a head with the Center for Medicare Advocacy taking legal action on behalf of all the people who have faced this issue.