Editor’s Note: This is part of a series of columns that will be presented in this newsletter by Sam W. Boone, Jr., a local attorney whose primary practice areas include elder law, estate planning, probate and trust administration. It is hoped that the information will be valuable for caregivers and family members dealing with issues related to elder law.

Sometimes going to the hospital is necessary but what happens when you get there changes based on the medical need.

When the medical need is serious enough your doctor or the hospital attending physician will decide to admit you to the hospital on an inpatient basis. In some cases you may be treated, and when the treatment is done – generally in a few hours – you are released.

Another status is becoming increasingly common – observation admission status – sometimes referred to as outpatient. Initially devised to monitor patients for a longer period of time, observation status is generally used when a patient can be treated within 24 hours, or if the conditions causing the problem have not been determined and the hospital medical staff wants to observe the patient for a longer period.

After the 24-hour period your doctor will generally decide whether you can be released or admitted as an inpatient.

However it is becoming increasingly common for patients to stay in observation status for longer periods if the medical condition requires it, and that creates a financial issue.

Patients are often designated as being in observation status or outpatient even though they are staying in the hospital for several days. During this time they stay in hospital beds, receive medical and nursing care, diagnostic tests, treatments, medications and food, just as they would if they were inpatients. The problem is that under the Medicare statute patients must have an inpatient hospital stay of three or more consecutive days, not counting the day of discharge, in order to meet Medicare criteria for coverage of post-acute care in a skilled nursing center.

Also as a result of the observation designation, outpatient co-pay will apply, and routine or self-administered drugs and medications are not covered. And depending on the hospital, you may not be able to bring your medications from home.

While the cost of those medications could impact an older person on limited income, the bigger problem is what happens if there is post-hospital rehab care in a skilled nursing facility – something that is very common with older patients. They must either pay the full bill or forgo treatment. A recent Florida law, which took effect July 1, requires notice be given to the patient or the patient’s proxy through the discharge papers. But notice of observation status is not required at the time of admission.

So it is important for you or your caregiver to understand under what status you are in the hospital. The best person to talk to is the hospital’s discharge planner. If you are going to be there for an extended period of time, and you anticipate rehabilitation in a skilled nursing home after you are released, try to get the hospital to admit you as inpatient.

Beyond that there needs to be a solution that protects the patient and recognizes the financial implications for hospitals. Legislature being considered in Washington may do just that. It would amend the Social Security Act to count the time of outpatient observation status toward the three-day period needed to meet Medicare criteria for coverage while in the nursing home. While it doesn’t fix everything, it goes a long way to help relieve the financial and emotional stress experienced by our elder community and their caregivers.


Sam W. Boone, Jr. is a Gainesville-based attorney practicing elder law and estate planning. He is past-president of the Academy of Florida Elder Law Attorneys. To learn more about elder-law issues, go online to www. http://boonelaw.com, or call (352)-374-8308.