By Caryn Tadema, Certified Concierge Care Advisor
George was 90 years old. He had been a client of mine for 7 years. We became so close that when he had to leave the assisted living community he had lived at for 7 years, we moved him into our home.
He was getting ready for bed one Saturday night and suddenly fell forward. It was like watching a movie in slow motion. I watched helplessly as he fell face first onto the floor with no attempt to break his fall.
After hours of tests it was determined that George went into A Fib and passed out. He had a concussion, a broken nose and a dislocated shoulder. He spent five nights in the hospital. It was recommended that he go to a skilled nursing facility for therapy and rehabilitation after leaving the hospital. However, Medicare would not cover the cost. The reason is that he was not “admitted” to the hospital. Though he spent 5 days/nights at the hospital, in a patient room, receiving care from Doctors, nurses, therapists, etc. His status was “Observation,” not “Admitted”. He did not meet the 3-day hospital stay requirement for Medicare to cover the cost of his much-needed rehabilitation. In addition, his out of pocket medical costs for “Observation,” status were astronomical compared to the out of pocket costs had he been admitted.
Since then, I have seen this happen time and time again. Insurance Companies are trying to save money, hospitals are trying to avoid re-admission fines, and the consequences are that seniors are being cheated out of the benefits they have spent their lifetime accruing.
The need for an advocate has never been more critical: without it, families are navigating uncharted waters without a guide. Concierge Care Advisors was founded on the mission of advocating for vulnerable adults and their families. Our Services are free to the Seniors we serve. We aren’t hired; we are called to our mission. Please make sure you have advice and help from a knowledgeable professional when a crisis happens so that you and your loved one have the best opportunity for recovery as well as navigation through our complex medical care systems.