Council on Aging Director Informs Medicare Recipients About Observation Status

The following letter was provided by Mary Ann Sullivan, Director of the Milton Council on Aging, about Medicare and Observation Status.

As Director of the Milton Council on Aging and a very strong advocate for seniors, I feel compelled to share with you some very important information concerning your Medicare health coverage.  Have you heard the term “Observation Status?"  

It is not a term you will find in your Medicare handbook or be told about if you are in the ER of a hospital but it is extremely important that you understand it.

I would like to share with you the following scenario. A Medicare beneficiary comes to the ER after a fall or some other acute event. They are taken from the ER to a regular hospital floor where they are treated just like any other patient. They stay overnight in a hospital bed, wear a wristband, are served hospital food, given medication, tested, monitored, etc. 

Their family thinks they are a regular hospital admission and, when they are finally well enough to be sent to a rehab or skilled nursing facility for further help, they learn that Medicare will not provide coverage because they did not have a “qualifying” three day inpatient stay.  They must then choice between paying privately for skilled care, (often $15,000/month), or foregoing the skilled care they need.

Medicare policy states that observation care is generally not suppose to last for longer than 24 hours and, in rare cases, up to 48 hours. Recently, a Milton senior was under “observation” for 96 hours before she was told of her status. It is also not required that Medicare gives these patients notice of their status and hospitals don’t readily give this information without being asked.           

It is so important that anytime you are brought to an ER and sent up to a floor you need to ask, "am I on observation status?"  The only exception to asking this question would be if you are on Medicaid and then everything is covered.

To say that those of us who work with the elderly are furious about this issue is an understatement.  Recently, a class action lawsuit was filed against the Secretary of Health & Human Services that seeks to end this unfair practice. 

But as we all know, things like this don’t get changed very easily. Please take the time to contact your Congressman or Senator to ask them to take a stand against this violation of our senior citizens. Most of these seniors have done the right thing by paying into the system, only using it when they needed it.  Yet, when they need it most, the system does not work for them but against them.