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Hospital Discharge Papers

Assisted living is the fastest growing form of residential housing for older Americans.

New York Assisted Living Residences (ALR) are not a hospital, nursing home, continuing care retirement community, mental health facility, independent senior housing, or an adult care facility.

ALRs provide or arrange for housing, on site monitoring, and personal care services and/or home care services (either directly or indirectly), in a home-like setting to five or more adult residents unrelated to the assisted living provider.

Assisted living residents have the right to: Continue Reading 15 Rights of NY Assisted Living Residents

The End of Three Month Retroactive Coverage Puts Providers and Families At Risk according to the National Academy of Elder Law Attorneys.

Sec. 114(b) of the American Health Care Act would repeal retroactive coverage of Medicaid eligibility. This puts providers at risk of economic loss; strains family finances; and pits providers against family members for recoupment of expenses, potentially through litigation.

Family Caregivers Provide the Bulk of Care, Often until Exhaustion.

Many Americans take pride in caring for their families, including those that need long-term services and supports (LTSS). In economic terms, one study estimates that unpaid caregivers provide close to four times the amount of services than Medicaid LTSS.

Oftentimes, family members place themselves under extreme emotional, physical, and financial strain. Family caregivers often give up working full time to provide care, often foregoing saving for retirement, paying into Social Security, and resulting in economic insecurity over their life-times. Many families turn to public benefits only when they can no longer provide the care their loved one needs.

Current Law Allows for Up to Three Months of Retroactive Coverage.

As a condition of participating in the Medicaid program, states must provide retroactive Medicaid coverage up to three months prior to application, provided the individual with a disability could have qualified for benefits during that time frame. Sec. 114 of the American Health Care Act would end this retroactive coverage except for during the month of application.

Three Month Retroactive Coverage Protects Families and Providers Alike.

Often families hope to support their loved one with a disability as long as possible. They may have personally racked up significant expenses paying for that individual’s health and LTSS needs. Sometimes, admission to a nursing home happens suddenly after hospitalization. The individual may get directly discharged by the hospital to a nursing facility for rehabilitation. Medicaid eligibility rules are complex and the applications onerous.

By the time the adult child of the Medicaid beneficiary makes the application, it may be a month or so after admission to the nursing home. Yet, the nursing facility needs to ensure it gets compensated for providing services to that individual.

The adult child does not want to see his or her parent discharged because the parent lack funds. Retroactive coverage ensures the provider can collect payment for a beneficiary who meets the strict means-tested standards of Medicaid, but has not yet finalized the application process while receiving services.

Repeal of These Provisions Would Put Families at Risk of Lawsuits and Debt Collection.

Without retroactive coverage, from the perspective of the nursing home provider, they now have provided care without compensation. Depending on the contractual obligations of the family caregiver, the nursing facility could sue them by claiming they should have filed the Medicaid application more swiftly, holding them personally liable for payment of services.

This increase in litigation does not serve beneficiaries, their families, nor their providers. In the alternative, a nursing facility may require money paid in advance until Medicaid starts providing coverage.

This could put a tremendous financial strain on the families who may decide to hold off on admission, putting the beneficiary at risk for receiving care at the most appropriate setting.

As part of your estate planning, you should have “A Playbook for Managing Problems In The Last Chapter of Your Life” as described here by Judith Graham in Kaiser Health News. You can take steps to avoid a crisis in the remaining years of  your life.

CHICAGO — At least once a day, Dr. Lee Ann Lindquist gets an urgent phone call.

“Mom fell and is in the hospital,” a concerned middle-aged son might report.

“Dad got lost with the car, and we need to stop him from driving,” a distraught middle-aged daughter may explain.

“We don’t know what to do.”

Lindquist, chief of geriatrics at Northwestern University’s Feinberg School of Medicine, wondered if people could become better prepared for such emergencies, and so she designed a research project to find out.

The result is a unique website,, which helps older adults plan for predictable problems during what Lindquist calls the “last quarter of life” — roughly, from age 75 on.

Continue Reading Managing Problems: Last Chapter of Your Life

You are being discharged from a New York hospital after surgery.  How do you designate your daughter to be your caregiver when you return home to recuperate? What if your daughter needs instructions on how to care for you?

The Caregiver Advise, Record, and Enable (CARE) Act amended the New York Public Health Law to require that hospitals allow patients to formally designate a caregiver (such as a relative, partner, friend or neighbor) before they leave the hospital or are transferred to another facility . Hospitals are to provide the caregiver with instruction or training on how to perform tasks for the patient at home, such as changing bandages or administering medication . However, patients are not required to designate caregivers and caregivers are not obligated to perform after-care tasks for patients .

The patient must consent to disclose his or her health information to the caregiver . If the patient  designates a CARE Act caregiver, the hospital must:

(a)include the name and contact information of the caregiver in the patient’s discharge plan;

(b)attempt to notify the caregiver of the patient’s transfer to another health care facility;

(c)attempt to contact the caregiver prior to a patient’s discharge to his or her residence so that the caregiver can provide after-care assistance in accordance with the hospital’s instructions to the caregiver;

(d) as soon as possible prior (and if possible, 24 hours prior) to the patient’s discharge  consult with the identified caregiver along with the patient regarding the patient’s after-care needs at his or her residence; and

(e) offer caregivers written or verbal  instruction in all after-care tasks, taking into account the capabilities and limitations of the caregiver for patients being discharged to their home.

To be certain that your family members have access to your medical information should you become incapacitated, execute a health care proxy and living will.