Elderly family member “outpatient observation”

[Anonymous]

Elderly family member with a UTI was admitted to the ER Wednesday night, feverish, very weak and unsteady, and delirious. They decided almost immediately to admit but didn’t have a room so she spent 24 hours in the ER before moving up on Thursday afternoon.

We have had someone there almost continuously, but during some time when someone stepped out a person came in and told her that when she is better she will go to rehab and had her sign a paper that says she is in outpatient observation. She didn’t mention this to anyone, I found the paper when I was tidying up late at night.

I am hoping they mean the night in the ER was outpatient and she is now inpatient, because Medicare will only pay for rehab if you were inpatient.

Any experience? And why, when she is clearly delirious, would they have her sign anything significant when she has had someone with her almost the whole time. Literally this must have been when someone went to the cafeteria for a few minute.

[Anonymous]

Nurse here.

1. Is her DPOA activated? If not, the case worker who had her sign the form likely just looked at the chart, saw it wasnt activated, and had her sign. Likely had no idea about her change in mentation.
2. If it is activated, the DPOA needs to talk to the social worker
3. The DPOA or whoever is helping manage care if its not activated should talk to the social worker about the inpatient status. Its an easy thing to fix if it needs to be coded differently for insurance. There is an "observation" level of admissions even when on a unit, so you definitely want to make sure things are coded right.
4. If DPOA isnt active, definitely talk to the doctor about activating it

[Anonymous]

Anonymous wrote:Nurse here.

1. Is her DPOA activated? If not, the case worker who had her sign the form likely just looked at the chart, saw it wasnt activated, and had her sign. Likely had no idea about her change in mentation.
2. If it is activated, the DPOA needs to talk to the social worker
3. The DPOA or whoever is helping manage care if its not activated should talk to the social worker about the inpatient status. Its an easy thing to fix if it needs to be coded differently for insurance. There is an "observation" level of admissions even when on a unit, so you definitely want to make sure things are coded right.
4. If DPOA isnt active, definitely talk to the doctor about activating it

Thank you! I did not know we had to activate it.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Nurse here.

1. Is her DPOA activated? If not, the case worker who had her sign the form likely just looked at the chart, saw it wasnt activated, and had her sign. Likely had no idea about her change in mentation.
2. If it is activated, the DPOA needs to talk to the social worker
3. The DPOA or whoever is helping manage care if its not activated should talk to the social worker about the inpatient status. Its an easy thing to fix if it needs to be coded differently for insurance. There is an "observation" level of admissions even when on a unit, so you definitely want to make sure things are coded right.
4. If DPOA isnt active, definitely talk to the doctor about activating it

Thank you! I did not know we had to activate it.

Sometimes doctors will do it if the confusion is obvious. But sometimes they don't really spend enough time with the patient to really get to the "huh. Clearly they actually don't understand what's going on". I've had it happen to me! They can answer all my orientation questions fine and maybe sometimes they'd trip up a little but not significantly so. And then the more time I'd spend with them the more small things would show that made their confusion more obvious.

So yes, if she's truly not in the state of mind to understand things, talk with the doctor about getting the DPOA activated.

[Anonymous]

There is something about "outpatient observation" that triggers a billing staff member to hunt-down a signature. I don't know much about it, but we experienced this with someone who wasn't elderly.

We wouldn't sign because to us it sure "looked" like the patient was an admitted patient. Patient was in a hospital bed, on a hospital floor. Any insight from anyone?

[Anonymous]

Observation status is technically outpatient ( so for someone with straight Medicare, this would be covered by part B. If your loved one has straight Medicare, they cannot go to rehab, because they’d have to be an inpatient for 3 midnights (and Medicare has strict criteria for inpatient status). Sometimes people convert from outpatient to inpatient, if their status changes and they then meet intent criteria. If your loved one has managed care Medicare (otherwise known as Medicare Advantage), they do NOT need a 3 midnight stay - but the discharge planner will need to get authorization from the insurance company (they generally submit your lived one’s clinical information, with proof that there is a skilled need that can be better managed in a rehab, versus outpatient/home.

[Anonymous]

^ and then they meet *inpatient* criteria. Sorry for typos!

[Anonymous]

Different nurse here. I think the rules must have changed recently because we had an email about it that I just skimmed since it's not that pertinent to my job. We have patients on the floor that are observation and inpatient. Everything is the same from our point of view. The billing is different

https://www.medicare.gov/what-medicare-covers/what-part-a-covers/inpatient-or-outpatient-hospital-status#:~:text=Observation%20services%20are%20hospital%20outpatient,another%20area%20of%20the%20hospital.