Are You Being Discharged From The Hospital Too Soon?

Posted by admin on November 28, 2011   |   No Comments

Many people do not know their patient rights if they feel that they are being discharged from the hospital too soon. If you think that it is medically necessary for you to stay in the hospital a little longer or if the transition to post-hospital services is not acceptable to you, you can appeal the decision for your discharge.

Medicare beneficiaries are able to utilize this appeal process since Medicare wants to ensure that each patient is receiving timely, quality health care. Medicare hires a Quality Improvement Organization (QIO) in each state to address health care quality concerns for their beneficiaries. The Center for Medicare and Medicaid requires hospitals to notify patients of their rights to appeal a decision for discharge. This written notification, which is called Important Message from Medicare, must be given to all patients to review and sign within the first 2 days of hospital admission. If you are in the hospital for more than 3 days, you will receive the notice again no less than 4 hours prior to your official discharge.

The timing that you file your request for appeal is crucial for the discharge process and has financial implications that affect you. If you have received official notice of your discharge date and you think it is premature, you must request your expedited review by noon of the next day. You must make your appeal no later than midnight on the date you are to be discharged while you are still in the hospital.

How do you appeal? The process to start the appeal is easy. All of the information is provided in the Important Message from Medicare notice that you reviewed and signed, or someone with your permission did on your behalf. The contact information for the QIO in your state is listed on the notice as well as instructions on how to file your complaint. The QIO that serves Colorado is the Colorado Foundation of Medical Care. Their direct phone number for the Medicare Beneficiaries Hotline for Complaints and for Expedited Review Requests is 800-727-7086.

How does this affect you financially? You can stay in the hospital while Medicare pays for your care until your appeal decision has been determined. Medicare beneficiaries are not financially liable for hospital costs while their case is being reviewed by the QIO (except co-pays and deductibles). If the QIO agrees with you that it is too soon for you to be discharged, then you can stay in the hospital and Medicare will cover your costs. If the QIO agrees with the hospital’s decision for your discharge, then you will be required to pay all hospital bills beginning at noon on the day AFTER notification of the decision was made. Patients do have the right to request an expedited reconsideration if they do not agree with the QIO’s decision. Initiating the appeal process buys you some time and can save you money while the QIO reviews your case. Typically a decision will be made within a few days. If you decide to not appeal the hospital’s decision for your discharge and you continue to stay in the hospital, you will be required to pay all hospital bills after the official discharge date.

Chronic Illness? Ask for Palliative Care!

Posted by admin on October 28, 2011   |   No Comments

70% of Americans are not aware of the benefits of palliative care. Yet a recent poll found that once they were informed of its purpose, 92% said that they would use it if a medical situation was applicable. Unfortunately, many physicians do not discuss palliative care with their patients. If they do, it often is not discussed early enough in the patient’s disease process so symptom relief can occur sooner than later.  

So what is palliative care? By definition, palliative means providing relief. The goal of palliative care is to provide specialized pain management and symptom relief that occur from a chronic or serious illness. Individuals faced with health issues caused by cancer, heart disease, arthritis, dementia, kidney failure, or any other chronic or serious illness can benefit from palliative care.

Symptom relief and symptom management can include, but not be limited to, nausea, shortness of breath, emotional or physical pain, loss of appetite, sleep deprivation, anxiety and depression. Palliative care enables a person to improve their quality of life by focusing on both the physical and emotional well-being of a patient. A person of any age and at any stage of their disease process can receive palliative care.

Palliative care is a different service program than hospice. Many people are familiar with hospice services. Hospice is a program offered by local hospitals and nonprofit/for-profit organizations for end-of-life care. Hospice is a type of palliative care since they strive to reduce symptoms of a serious illness. However, hospice is used for individuals who have been diagnosed with a terminal illness and your physician feels that you have less than 6 months to live if your disease runs its typical course. Because of this prognosis, you are not able to continue medical treatments that may cure your disease if you are under hospice care.

On the other hand, palliative care does not require you to be diagnosed with a terminal illness or have received a prognosis of less than 6 months to live. More importantly, you are allowed to continue to receive medical treatments that may cure your disease.

Who pays for palliative care? Palliative care is typically an outpatient specialty service that bills under your Medicare Part B. Medicaid beneficiaries also are able to receive palliative care as well as some private health insurance plans will include coverage. Sometimes palliative care can occur in a hospital setting for a short period of time and then the care can continue at one’s own home. Unlike hospice care, Medicare does not cover the cost of palliative care drug prescriptions. If someone does not have the ability to pay for palliative care, most organizations will not turn away a patient that needs this service. You just need to ask!   

A palliative care team is typically available through a local hospice organization or a hospital-based palliative care team. More hospitals are embracing palliative care and building teams to service their patients. This program is inline with the current objective of hospitals and medical providers to focus on patient-centered healthcare and to treat the whole person.

In 2000, 24% of the U.S. hospitals had palliative care programs. In 2009, that number increased to 63%. Unfortunately, there are not enough palliative care specialists for the growing demand. Currently, there is one trained palliative care physician for every 1200 Americans living with a serious or chronic illness. The U.S. healthcare system currently pays doctors primarily for conducting procedures. Doctors are trained to cure a medical condition. But if a cure does not exist, a person still needs medical expertise on living with the disease and its symptoms. Many hospitals are trying to determine how to offer this service within their business model and still be profitable.

Recent research has shown that palliative care can reduce healthcare usage by $6 billion a year. A palliative care patient is less likely to be taken to an emergency room since regular, individualized care is provided. Furthermore, patients receiving palliative care are more likely to have discussed end-of-life decisions with their family and/or doctors. This equates to fewer patients being resuscitated or intubated against their will.

If you or a loved one is one of the 90 million Americans living with a serious or chronic illness, you should ask your doctor if palliative care will improve your daily life. A free consultation by a palliative care team is always an option if you want to better understand the scope of their services and your eligibility.  


The Evolution of Assisted Living

Posted by admin on September 12, 2011   |   No Comments

National Assisted Living Week is recognized during September 11-17, 2011. Data from 2010 states that there are approximately 6,315 professionally managed assisted living communities nationwide with approximately 475,500 apartments. The number of older Americans (persons 65 years or older) will more than double by 2030 compared to 2000. Approximately 72.1 million people or 19% of the U.S. population will be 65 by the year 2030. Due to lack of construction financing for senior housing during the U.S. housing crisis, the supply of available communities has been reduced. With a growing senior population that will be living longer, the senior housing industry expects more residential care communities will be needed to handle the increased demand. This rise in residents will be reflected in an evolution of service offerings to cater to the diverse resident base found in these communities. Communities will be created to be places where people want to live not where they need to live due to physical, emotional or mental health issues.

Some trends that are occurring now in these communities and will continue to evolve are specialized memory care units. As the fifth leading cause of death for those aged 65 or older, Alzheimer’s disease will affect 16 million Americans by 2050. Alzheimer’s disease requires an enormous time investment from the caregiver. If those living with the disease can afford it, they can live full-time in an assisted living environment that specializes in Alzheimer’s and dementia.

The average monthly cost to live in an assisted living community is $3,270/month. This is for basic level of care. Prices vary greatly depending on location, room size, amenities, health issues and services offered. Personal finances affected by the U.S. economy combined with the cost to live in an assisted living community have brought about another industry trend – the timing when caregiving transitions from the family to a residential care community. To save money and delay the need to move into an assisted living community many seniors and their families are choosing to retrofit their own home to keep their loved one at home for as long as possible. This has led to the recent boom in home modifications for elder safety.

7 out of 10 individuals say that they are caring for a parent. 36% say that the person they are caring for lives with them. 55% of caregivers have been providing care for over 3 years. This has led to another trend. People are joining assisted living communities at an older age when health issues are more prevalent. Care coordination and communication between medical providers and family members is essential to ensure that a resident is getting quality medical care. Many assisted living communities are embracing third party partnerships with professionals in the community that can provide additional services to enhance each resident’s experience and improve quality of life. Independent patient advocates or medical navigators along with other health and wellness professionals are examples of third party partnerships.

You will begin to see more communities utilizing technology solutions for monitoring residents and communicating with medical providers. Some communities will cater to ‘environmentalism’ and promote their renewable and sustainable building products and living environment. Organic foods and gardening will be available at some select communities.

Several communities are already extending their reach to the local community. They are offering programs and services to individuals not residing at the assisted living community. For example, adult day care and geriatric medical providers are now located within some assisted living communities. Additional services that support the elderly still living in their homes will be offered at local assisted living communities. This provides another revenue stream to the communities and gives those living at home (future potential residents) an opportunity to see and experience the assisted living community firsthand.

Another trend you will continue to see is a continuum of care. Many communities want their residents to be able to ‘age in place’ and not have to relocate to another facility due to a decline in health and increase care needs. ‘Enhanced Assisted Living’ communities will have licensed nursing care available 24/7. A primary care manager may also be available for each resident to encourage individualized, relationship-based care.

The Eden Alternative, developed by Dr. Bill Thomas, has a philosophy for culture change in this industry that will continue to resonate and take hold within communities. The primary concept is to create a living environment for elders that will nurture them rather than being an institutional facility for the frail and elderly.

Assisted living communities have certainly evolved over the past 25 years to provide a myriad of choices for consumers and a more positive living environment for the elderly.

Dr. Bill Thomas has coined a term called Eldertopia which I hope many assisted living communities will embrace and find ways to incorporate within their own four walls.

Eldertopia/ell-der-TOE-pee-uh/noun: A community that improves the quality of life for people of all ages by strengthening and improving the means by which (1) the community protects, sustains, and nurtures its elders, and   (2) the elders contribute to the well-being and foresight of the community. An Eldertopia that is blessed with a large number of older people is acknowledged to be “elder-rich” and uses this wealth to advance the good of all.


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Hospitals and Alzheimer’s Are A Frightening Combination

Posted by admin on August 16, 2011   |   No Comments

If a loved one requires an emergency room visit or is admitted to the hospital it can be a very traumatic experience. However, if you are living with Alzheimer’s disease, this experience takes on a totally different perspective. The loss of memory and other cognitive abilities turns a hospital setting into a very confusing and frightening place.

A hospital is a new environment and that in itself is problematic for Alzheimer’s patients. When you add bright lights, loud noises and strangers rushing around, a confused Alzheimer’s patient requires additional care to ensure safety. Many medical facilities are not staffed with personnel that are trained to understand the complexity of Alzheimer’s behavior. When this occurs, some facilities use medication and/or restraints in an attempt to remove the behavior. To make sure that your loved one is safe and being treated respectfully and compassionately, it is critical to have a family advocate on-site or to hire someone to advocate on behalf of your loved one.

An advocate can assist in providing the increased supervision and care that your loved one needs during this time. A familiar face is crucial to minimize the risks associated with being in a hospital setting. Behaviors associated with Alzheimer’s disease and its symptoms can be more severe in a hospital environment. Unfamiliar people will be conducting tests at odd hours of the day and night. There could be some tests and procedures that may not need to occur at all. An alternative solution may be an option. Always ask on behalf of your loved one if a test/procedure is absolutely necessary.

Here are some key issues that need to be addressed:

Notify the medical personnel interacting with your loved one that he/she has Alzheimer’s. Many Alzheimer’s patients will not understand why they are in a hospital. This will add to the confusion and increase the stress level for all involved. Your loved one may become anxious, agitated and uncooperative. The medical staff may react negatively to this which will turn a bad situation to worse within minutes. Make sure that it is communicated to all shifts that your loved one has Alzheimer’s disease. Remind them that verbal communication is difficult for your loved one so they may feel pain or discomfort without verbalizing the symptom. Medical personnel need to look for other signs of pain or discomfort.

Try to get a private room. This will minimize noise and activity occurring in the room.

Be cognizant that the TV can increase the anxiety level for an Alzheimer’s patient. You may want to have it turned off a majority of the hospital stay.

Using the bathroom will be a major problem in a hospital environment. You should know where the nearest bathroom is and provide assistance to your loved one in locating it on a regular basis.

Once admitted, there could be tubes inserted into their body which will be a foreign object to an Alzheimer’s patient. The patient may try to remove tubes on their own.

Many Alzheimer’s patients will not understand or remember how to use a call button while lying in their hospital bed.

Bedside rails may be confusing to an Alzheimer’s patients as well as a safety issue if they attempt to climb over the rails.

The food selection and eating process at a hospital will be very different from what they are used to and can be difficult for an Alzheimer’s patient. Medical staff will not stay in the room to assist your loved one in eating.

60% of people living with Alzheimer’s wander. This is a common occurrence in hospitals so supervision is required at all times. 

It is unfortunate that a hospital stay may be necessary for a person living with Alzheimer’s. Safety and security should be your main concerns. Always assume that more help will be required for your loved one in a hospital setting than in their own home. If you keep this in mind and proactively manage the situation, the outcome will be more positive for you, your loved one, and the medical staff.


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Take Extra Precaution In July If You Must Be Hospitalized

Posted by admin on July 4, 2011   |   No Comments

July is a time to celebrate the midpoint of summer, commemorate our country’s independence and to be extra vigilant if you must be hospitalized. Every year starting July 1 newly graduated medical students converge on teaching hospitals to begin their first year of residency training. Many reports have found that medical errors increase by approximately 10% in July. This is commonly called the ‘July Effect’. It is important to note that a majority of these medical errors are medication errors and not errors that may occur during a medical procedure. Once you are transitioned to your hospital room, this is when you, your family members and/or your patient advocate, need to be especially attentive. Many interns do not always get the supervision that they need when they venture out into their new profession during the month of July. There are thousands of drugs and many more drug interactions that can occur. Many drug names sound alike when pronounced as well as look the same. Furthermore, the correct dosage can easily be confusing to the inexperienced intern who is inundated with new information on an hourly basis. It is very important for the patient and their families to double check all medicines and dosages if you must be in a teaching hospital during the month of July. Do not be shy or intimidated by your surroundings. Speak up if you have concerns or questions about your medications. It can save your life or your loved one’s life.

Campaign Zero, an organization that provides patient safety education for patients and their families, has developed some excellent checklists that can be very useful during this time. Click here to view the checklists. You can also visit http://www.campaignzero.org for more information.

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Beware of Summer Tick Bites and Misdiagnosis!

Posted by admin on June 20, 2011   |   No Comments

Summertime entices us to extend our outdoor activities which can make us more likely to be on the receiving end of a tick bite. There are several tick-borne infectious diseases that can dramatically affect your health if you do not receive medical treatment immediately. Rocky Mountain Spotted Fever, ehrlichiosis, tularemia and Lyme disease are bacterial infections transmitted by ticks. The most common tick-borne illness in the U.S. is Lyme disease. Although it has been around since the turn of the century, it derived its name in 1975 when multiple children in Old Lyme, Connecticut were affected by the Borrelia Burgdorferi bacteria found in deer ticks. 

Lyme disease can be prevented if early detection and antibiotics are given immediately. Don’t allow a physician to tell you that it is not possible for you to have Lyme disease in your geographic area. Lyme disease has been documented in every U.S. state.

Unfortunately, many people may not know that they received a tick bite to initiate a diagnosis and the treatment process. Furthermore, since Lyme disease is known as ‘the great imitator’ its symptoms mimic other chronic illnesses such as arthritis, chronic fatigue, fibromyalgia, heart problems, and neurological disorders like Bell’s Palsy, depression, and obsessive-compulsive disorder. Lyme bacteria bores into tissue, joints and the central nervous system. It migrates and affects many systems in your body so discomfort will spread beyond the original tick bite location. Symptoms are cyclical so approximately every 4 weeks you may experience symptoms when the bacteria replicates. To add to the confusion of diagnosis, Lyme disease can also be asymptomatic so that no noticeable symptoms may appear.

To further complicate the diagnosis and treatment process, ticks can carry more than one disease so a bite can cause co-infections. Antibiotics for one infection may not be effective for another infection.

Unfortunately, testing for Lyme disease is not always accurate. The most common forms of testing identify antibodies in your system. Antibodies are proteins that your body produces when it detects an antigen, a foreign substance (ie. bacteria) in your system. The ELISA test (enzyme-linked immunosorbent assay) is frequently used even though it misses 30% of the positives. If an ELISA test is performed, it is best to confirm its results with a Western blot test. However, both of these tests look for antibodies produced by your immune system. If your system has not produced antibodies it does not necessarily mean you do not have the antigen. Antibodies will not develop the first 4 weeks upon receiving the bite. In addition, if you wait several years to get tested, your immune system will not produce antibodies. An antigen capture test is becoming a more reliable diagnostic test for Lyme disease. It checks for the presence of the Lyme bacteria with or without the antibodies being present.

What type of doctor should be involved in your diagnosis and treatment? Ideally, a Lyme Literate Doctor or a Rheumatologist will provide a timely, accurate diagnosis and treatment. Other physicians may not be aware of the inaccuracies of the common diagnostic tests and they tend to be more conservative with the antibiotics prescribed to effectively eradicate the bacteria. 2-3 weeks of antibiotics is not enough to kill the bacteria before it replicates. Since some insurance companies may not pay for treatment if a positive test has not been received it is critical for your health and your bank account to avoid being misdiagnosed.

For more information about Lyme disease, My Lyme Guide is an excellent resource book and organizing tool to help you manage your illness. http://www.mylymeguide.com









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How to Improve Your Own Safety When Lying In Hospital Bed

Posted by admin on May 24, 2011   |   No Comments

Patient safety has always been a hot topic in a hospital setting. Hospital-acquired infections affect 1 in 10 patients and kill approximately 100,000 patients per year in the U.S. 1 in 5 Medicare patients are readmitted within 30 days. Hopefully, these statistics will change once Value-Based Purchasing takes effect starting in October 2012. This provision in the new Affordable Care Act will directly affect a hospital’s reimbursement from Medicare. Hospitals will be evaluated based on performance measures including patient satisfaction. All information pertaining to hospital-acquired infections, recommended procedures and outcomes for heart attacks, heart failure, pneumonia, and surgical care will be available to the public to aid in selecting a hospital.

As a patient, you will see hospitals starting to ramp up their safety measures so they will receive high ratings in their measured categories and more money from Medicare. You will also begin to see new products on the market available to hospitals as well as patients to improve outcomes, reduce readmissions and increase patient satisfaction.

The Patient Pod™ is a product that just launched this month. As an independent Patient Advocate, I’m a huge proponent for empowering patients and their families to improve their health and safety. The Patient Pod™ was developed by Pat Mastors, a hospital Patient Advocate and former medical reporter. Her passion for patient safety was amplified when her father died of complications from a hospital-acquired infection.  

The Patient Pod™ gives patients the ability to have some control over the safety of their medical environment while lying in their hospital bed or sitting in a wheelchair. It keeps a patient’s personal items within reach so falls are not as likely to occur. This also reduces the amount of time the call button is pushed to get assistance in obtaining personal items. Overuse of the call button can result in a delayed response in future situations that do require an immediate response. The Patient Pod™ includes sanitizer products and a TV remote control covering as it reduces the number of people that will touch personal belongings. Since patient items tend to get lost in the hospital, this product minimizes loss of personal items. The Patient Pod™ also personalizes the patient to medical staff by allowing space for family photos and a place to communicate special needs/requests if family is not present at all times.

As I have said before, you may or may not approve of the new Affordable Care Act. However, one cannot dismiss the improved procedures and products that will result from some of the provisions found in this law.

For more information about The Patient Pod™, visit http://www.thepatientpod.com/

For more information about Value-Based Purchasing, visit http://www.healthcare.gov/news/factsheets/valuebasedpurchasing04292011b.html



The Power of Music Over Alzheimer’s

Posted by admin on April 12, 2011   |   No Comments

“A friend is someone who knows the song in your soul and sings it back to you when you’ve forgotten the words.”   Author Unknown

I heard this quotation at the Colorado Chapter of the Alzheimer’s Association. It is true on so many levels. Although research shows that memories can be recalled and triggered by familiar music, I don’t think formal research needed to be conducted to tell us. Music evokes emotion and can be a powerful catalyst for memories to be brought up to the surface. This is true for those living with dementia and for those of us that aren’t.

Proper usage of music for Alzheimer’s patients can be very beneficial when dealing with behavioral issues and to attain a special connection with someone that otherwise would be difficult to achieve. However, you need to know the most effective music selection for that specific person for the connection and benefits to be observed. This depends on the current stage of the disease process as well as their ‘life story’. For example, someone may be 80 years old and grew up during his/her teenage years listening to Frank Sinatra or Les Brown. However, if they are in the Late Stage of the disease process, they will respond better to music from their early childhood. Furthermore, if you explore their life story, you may find that he/she was raised by their grandmother who was an extraordinary pianist. In that case, instrumental piano music may be the best choice for activating memories and getting a response. Since communicating with an individual affected by Alzheimer’s can be very difficult, it is helpful and rewarding to take the time to find out details from their life story.  

It has been proven that music is distributed and processed across the entire brain and not just in a single area. So when brain cells die, other brain cells can still respond to the music. Health professionals and caregivers can essentially rescue a person living with dementia with the proper use of music. Music stimulates and provides a respite to daily challenges and frustrations. The calming effect of music is therapeutic as we all have experienced at one time or another.

The Alzheimer’s Association offers classes on the effective use of music therapy in addition to many other courses that improve communication and enrich the lives of caregivers and individuals living with dementia. In Colorado, we are very fortunate to have a well managed Chapter with exceptional instructors and a broad curriculum to educate everyone touched by this degenerative disease.

National Week Honors Private Professional Patient Advocates

Posted by admin on March 14, 2011   |   No Comments

Private Professional Patient Advocates Week has started and is in full force. Beginning March 13th through March 19th patient advocates across the country are being recognized for their commitment to patient-centered health care. Independent patient advocates serve patients and their caregivers. What does a patient advocate do? Specifically, we help individuals to be proactive with their health planning and their care.

  • We can help you prepare for and participate with you during a doctor’s appointment
  • We can consult with you about a recent diagnosis.
  • We can help ensure patient safety during your hospitalization.
  • We can provide care coordination between your multiple providers during your illness.
  • We can ensure that you are receiving health care and financial assistance benefits as well as support services that you are eligible to receive.
  • We can advise you and your family on treatment options, home care services, and insurance issues.
  • We can improve communication with your medical providers and family members to ensure that appropriate actions are being taken in a timely manner.
  • If your loved one is located far away, you will have peace of mind knowing that his or her care is being managed professionally to ensure positive results.

To learn more about Private Professional Patient Advocates Week and to read success stories, visit  http://pppadvocatesweek.com/profiles/index.htm



Give the Gift of Healing to Those You Love for Valentine’s Day

Posted by admin on February 10, 2011   |   No Comments

I participated in a 7 week course entitled, “The Seven Levels of Healing”. This is a program available to cancer patients and their families to offer support and navigation through all phases of the cancer journey. It was developed by Jeremy Geffen, MD, of Boulder, Colorado, and author of The Journey Through Cancer: Healing and Transforming the Whole Person.

Treating cancer is more than just utilizing the most innovative treatments and assembling the best oncology team for your specific diagnosis. For true healing to occur, the whole person needs to be addressed. The mental, emotional, spiritual and physical components of each person affected by the disease needs to be explored, nurtured and celebrated.   

As a caregiver and independent patient advocate, I found each week to be enlightening, inspiring, and educational. For the cancer patients and their participating family members in attendance, it was obvious that they looked forward to these weekly sessions and they had a new approach to their overall treatment plans.

Each week a new level of the cancer patient’s personal journey is explored. 

Level 1 – Education and Information

Level 2 – Connection with Others

Level 3 – The Body as a Garden

Level 4 – Emotional Healing

Level 5 – The Nature of Mind

Level 6 – Life Assessment

Level 7 – The Nature of Spirit

Health professionals throughout Colorado and other participating states are being trained to facilitate this free course to cancer patients and their families. Ask your local hospital if they offer the program. If not, you can contact Geffen Visions International to find out the closest facility to you that offers this exceptional program. http://www.geffenvisions.com/

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