Ka gɛlɛya don dɔgɔtɔrɔso la min tɛ lakana walima min ma mɛn joona walima ka bɔ kɛnɛyaso la mɔgɔkɔrɔba dɔ ye¶

Dɔgɔtɔrɔsow ni dɔgɔtɔrɔso setigiw (SNF) bɛ baara kɛ wariko ni dilan seko degunba kɔnɔ walasa ka banabagatɔw ka sigi waati surunya. Tuma caman na, denbayaw bɛ bɔli sɛbɛnw di u ma ni u ye lɛri damadɔ dɔrɔn kɛ, hali ni baliku kɔrɔba tɛ se ka jɔ hali bi ni dɛmɛ tɛ, ni a hakili ɲagamina kosɛbɛ, ni a mago bɛ furaw la jolisira fɛ, walima ni ladonbaga lakananen tɛ a bolo so. Ka mɔgɔkɔrɔbaw ka so min furakɛcogo tɛ sabati walima min tɛ se ka lamaga, i yɛrɛ ka mobili kɔnɔ, bawo dɔgɔtɔrɔso koɲɛnabɔla dɔ y’a fɔ ko asiransi waati tɛmɛna, o ye sababuba dɔ ye min bɛ kɛ sababu ye ka binkanni jugu kɛ, ka sɔgɔsɔgɔninjɛ bila mɔgɔ la, ka furaw fili, ani ka mɔgɔ bila kɛnɛyaso kɔrɔtɔlenw na sanga 48 kɔnɔ.

Sariyasenw ka josariyaw b’aw bolo minnu bɛ se ka waleya Ameriki, Angletɛri, Kanada, Ɔsitarali ani Erɔpu tɔnba bɛɛ kɔnɔ, walasa ka kɛnɛyaso bɔli dabila ka kɔn a waati ɲɛ ani ka dɔgɔtɔrɔso lajɛ yɛrɛmahɔrɔnyalen wajibiya sani banabagatɔ ka bɔ boon kɔnɔ. Ni i ye i diyanyemɔgɔ bɔ dɔgɔtɔrɔso da la ni wotoro ye, ka i bolonɔ bila bɔli sɛbɛn na, i ka sariya fanga ani i ka asiransi otomatiki to lakanani bɛ tunun. Ni i ye banabagatɔ to dilan kan ani ka bɔli sariyakolow wele o yɔrɔ la, i bɛ o yɔrɔ wajibiya a ka furakɛli dafalen mara ka a sɔrɔ kɛnɛyabaarakɛlaw bɛ o jatebɔsɛbɛn lajɛ walima ni banabagatɔw ladonni lafiyalen labɛnna.

Aw bɛ o kɛ sisan¶

1. Aw ka ban ka aw bolonɔ bila bɔli sɛbɛnw na walima ka banabagatɔ ta ka taa so. Aw ye a fɔ dɔgɔtɔrɔso baarakɛla, dɔgɔtɔrɔ ani bɔli bolodabaga ye ni hakilisigi ye ani ka jɛya ko: "Nin bɔli laɲininen in tɛ lakana ye. Furakɛcogo degeliw, farikolo fanga, walima minɛnw t'an bolo walasa ka banabagatɔ in to a ka lafiya so kɔnɔ, wa an tɛna u ta bi."(Alimankan na) Ni banabagatɔ bɛ furakɛli gɛlɛya dɔ la sisan min bɛ se ka a ka ɲɛnamaya bila farati la, baarakɛlaw tɛ min jate, aw bɛ dɔgɔtɔrɔso kɔnɔna jaabi teliya jɛkulu wele walima ka aw ka sigida kɔrɔtɔko nimɔrɔ wele (911 Ameriki ani Kanada, 112 Erɔpu tɔnba bɛɛ kɔnɔ, 999 Angletɛri) walima ka a lajɛ kɔrɔtɔko nimɔrɔw.
2. Aw ka kunnafoni sɛbɛnnen ɲini joona, min bɛ tali kɛ bɔli la appeal rights kan. Ameriki jamana na, Medicare ni Medicare Advantage banabagatɔ bɛɛ ka kan ka sɛbɛn ofisiyali sɔrɔ min tɔgɔ ye ko An Important Message from Medicare (Form CMS-10065) dɔgɔtɔrɔso la walima Notice of Medicare Non-Coverage (Form CMS-10123) dɔgɔtɔrɔso la min bɛ se kosɛbɛ dɔgɔtɔrɔso la sani a ka bɔ kɛnɛyaso la.
3. Aw bɛ wele bila appeal agency yɛrɛmahɔrɔnyalen ma sani sariya ka waati dantigɛlen ka se. Ameriki jamana na, aw bɛ Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) telefɔni nimɔrɔ wele min sɛbɛnnen bɛ kunnafoni kan sani su tilancɛ ka se dɔgɔtɔrɔso bɔli don na (walima ka se midi ma don min na sani rehab coverage ka ban). Angletɛri jamana na, aw bɛ se ka kuma banabagatɔw ka ladilikan ni jɛɲɔgɔnya baarada (PALS) ani Ward Matron fɛ; Kanada jamana na, aw bɛ taa dɔgɔtɔrɔso banabagatɔw ka lafasalitɔn fɛ.
4. Aw bɛ aw jija ka farikoloɲɛnajɛ ni baarakɛyɔrɔ furakɛli jateminɛ kokura don kelen na. Aw bɛ a ɲini dɔgɔtɔrɔ min bɛ dɔgɔtɔrɔso la, a ka yamaruya di dilan kɛrɛfɛ farikoloɲɛnajɛ (PT) ni baarakɛcogo jateminɛ (OT) baarakɛcogo jateminɛ ma, min bɛ tali kɛ sigili ni jɔli la, taama janya, ɛrɛzɛnsun jiginni, ani ɲɛgɛn jiginni. Ni PT walima OT y’a jira ko banabagatɔ mago bɛ mɔgɔ fila ka dɛmɛ na walima ko a tɛ se ka baara kɛ ni so dondaw ye, o la, so kɔnɔ bɔli man ɲi kɛnɛyaso la.
5. Aw bɛ banabagatɔ doncogo jateminɛ (Dɔnkilida ni Kɔlɔsili). Ni aw bangebaga bɛ Ameriki dɔgɔtɔrɔso la Traditional Medicare kɔnɔ, aw bɛ ko ɲɛnabɔbaga ɲininka n’u jatera “Dɔgɔtɔrɔso ladonni” walima “Kɔlɔsili kɛnɛma” cogo labɛnnen na. Ni u maralen bɛ Kɔlɔsili cogoya la tile caman kɔnɔ, aw bɛ a ɲini dɔgɔtɔrɔso baarakɛcogo lajɛ jɛkulu fɛ u ka segin a kan joona walasa ka sigili wuli ka kɛ Inpatient ye sani u ka bɔ kɛnɛyaso la walasa Sɔgɔsɔgɔninjɛ seko ni dɔnko (SNF) ka furakɛli ka daminɛ.
6. Aw ka aw ka lakana sɔsɔliw bila furakɛli sɛbɛn banbali kɔnɔ. Aw bɛ cikan surun, tiɲɛnen ci banabagatɔw ka ɛntɛrinɛti yɔrɔ fɛ (i n’a fɔ MyChart) walima ka bataki sɛbɛn di Charge Nurse and Case Manager ma, min bɛ baarakɛcogo ni furakɛli gɛlɛya kɛrɛnkɛrɛnnen bɛɛ sɛbɛn walasa ka segin so.

flowchart TD
    A["Hospital or rehab announces imminent discharge of unstable senior"] --> B{"Can the senior safely transfer, toilet, swallow, and manage at home?"}
    B -->|"Yes: Baseline restored and equipment ready"| C["Complete medication reconciliation and schedule 7-day follow-up"]
    B -->|"No: Unsafe to return home"| D["Refuse to sign discharge papers or transport patient"]
    D --> E{"What type of facility and health system?"}
    E -->|"US Hospital (Medicare or Medicare Advantage)"| F["Demand Important Message from Medicare (CMS-10065)"]
    E -->|"US Skilled Nursing / Rehab (SNF)"| G["Demand Notice of Medicare Non-Coverage (CMS-10123)"]
    E -->|"UK NHS / Canada / Australia / Private Insurance"| H["File formal hold with PALS, Patient Ombudsman, or Utilization Review"]
    F --> I["Call BFCC-QIO (Acentra or Livanta) before midnight on discharge day"]
    G --> J["Call BFCC-QIO by noon the day before coverage ends"]
    I --> K["Automatic stay triggered: Hospital cannot evict or bill out-of-pocket during review"]
    J --> K
    H --> L["Demand PT/OT stair and transfer audit plus multidisciplinary care conference"]
    K --> L

Recognizing when a hospital or rehab discharge is clinically unsafe¶

Hospital discharge planners often treat medical stabilization of the primary admission diagnosis as the sole requirement for sending an older adult home. A physician may note that a patient's pneumonia is improving on oral antibiotics or that their surgical incision looks clean, while completely overlooking the fact that five days of bedrest have left an 82-year-old patient unable to stand up from a toilet or clear of dɔgɔtɔrɔso deliriya ni hakili ɲagami barikama.

Before agreeing to any discharge date, evaluate the patient across six objective clinical and functional safety domains. If the patient fails even one of these criteria and the facility has not arranged 24-hour institutional care or continuous professional home nursing, the discharge is unsafe.

How to file an immediate Medicare hospital discharge appeal (United States)¶

In the United States, federal law (42 CFR Part 405, Subpart J) grants every beneficiary covered by Original Medicare or a private Medicare Advantage plan the right to an expedited, independent medical review before being discharged from an inpatient hospital stay.

Step 1: Demand "An Important Message from Medicare" (Form CMS-10065)¶

Hospitals must deliver the two-page federal notice titled An Important Message from Medicare About Your Rights (Form CMS-10065) twice during every inpatient stay: within 2 calendar days of admission, and again between 4 and 48 hours before discharge.

I bolonɔbila sɛbɛn CMS-10065 o tɛ kɔrɔ ye ko i sɔnna a ma ko banabagatɔ labɛnnen don ka taa so; a bɛ sɔn dɔrɔn ko a ye appelé telefɔni nimɔrɔ sɔrɔ. Ni dɔgɔtɔrɔso y’a fɔ i ye daɲɛ fɛ ko i bangebaga bɛ bɔ kaso la bi, k’a sɔrɔ a ma sɛbɛn CMS-10065 sɛbɛn filanan di i ma, min kɔnɔ BFCC-QIO telefɔni nimɔrɔ bɛ sɛbɛn, i k’a fɔ ko ɲɛmɔgɔ ye ko: "I ma Cikan Nafama laban sɛbɛn min bɛ se ka kɛ ka bɔ Medicare fɛ. CMS sariyaw kɔnɔ, o bɔli tɛ se ka taa ɲɛ fo ni kunnafoni sɛbɛnnen ka di i ma."(Alimankan na)

Taabolo 2nan : Aw bɛ BFCC-QIO wele ka kɔn su tilancɛ ɲɛ, bɔli don na¶

Medicare ye bɛnkansɛbɛn kɛ ni dɔgɔtɔrɔw ka lajɛ jɛkulu yɛrɛmahɔrɔnw ye minnu bɛ wele ko Nafa sɔrɔbagaw ni denbaya cɛmancɛ ladonni jogoɲumanya jɛkuluw (BFCC-QIOs) walasa ka bɔli teliya ɲininiw ɲɛnabɔ: Acentra Health ani Livanta. Aw ka jamana ka QIO nimɔrɔ fu sɛbɛnnen bɛ sɛbɛn CMS-10065 ɲɛ 1 na (walima aw bɛ telefɔni 1-800-MEDICARE wele telefɔni 1-800-633-4227 la).

• The Critical Midnight Deadline: Call the BFCC-QIO before midnight (11:59 PM) on the scheduled day of discharge and before the patient leaves the building.
• 24/7 Voicemail and Online Filing Counts: BFCC-QIO intake lines operate 24/7. Leaving a voicemail or online intake before midnight with the patient's name, Medicare number, hospital name, and your callback number legally locks in the appeal on time. Record the timestamp and confirmation number.

Step 3: Understand the automatic stay of discharge and financial protection¶

Filing a timely appeal before midnight triggers an automatic stay of discharge: 1. The hospital cannot force the patient to leave: Full inpatient bed, nursing care, and medical treatments must continue during the QIO review. 2. Zero out-of-pocket bed liability during the appeal: The hospital cannot bill the patient out-of-pocket for the extra inpatient days while QIO doctors review the chart, even if the QIO ultimately denies your appeal. 3. Detailed Notice of Discharge (CMS-10066): Once you appeal, the hospital must deliver a written notice by noon the next day stating the specific clinical reasons they believe acute hospital care is no longer needed.

Step 4: Make your clinical case directly to the QIO reviewer¶

When the BFCC-QIO calls you back (within 12 to 24 hours), state specific clinical facts from the chart showing medical instability or unsafe transition needs: - "The patient developed acute hypoactive delirium 48 hours ago, remains below cognitive baseline, and coughs when swallowing liquids." - "Physical Therapy documented yesterday that the patient requires a 2-Person assist to transfer and cannot climb the 6 steps into their home." - "The patient switched from intravenous to oral medications only 3 hours ago, and 24-hour stability has not been verified." - "The patient requires transfer to an inpatient Skilled Nursing Facility (SNF), and case management has not secured an accepting bed."

Step 5: What happens when the QIO issues its decision¶

The BFCC-QIO must review the medical records and issue a decision within 24 hours of receiving the hospital file. - Appeal Approved: The discharge notice is voided and Medicare coverage continues until the patient stabilizes or transfers safely. - Appeal Denied: You owe nothing for the 24 to 48 hours of the review. Out-of-pocket liability begins at 12:00 noon on the calendar day AFTER the QIO notifies you of the denial. Filing the appeal still secures 36 to 48 covered hours to arrange home equipment or rehab placement, and allows an immediate Level 2 Reconsideration request to the Qualified Independent Contractor (QIC).

The Medicare "Observation Status" vs. "Inpatient Status" trap¶

A frequent financial shock for older adults in the United States is the Medicare Three-Midnight Inpatient Rule and "Outpatient Observation Status." A senior can arrive by ambulance, occupy an upstairs hospital room, receive IV medications, and stay for four nights while classified in the billing computer as an Outpatient receiving Observation Services rather than an admitted Inpatient.

Why Observation status blocks Skilled Nursing Facility (SNF) rehab coverage¶

Under Traditional Medicare Part A, Medicare only pays for post-hospital Skilled Nursing Facility (SNF) rehabilitation if the patient was formally admitted as an Inpatient for at least three consecutive midnights (excluding emergency room hours and Observation midnights). Spending 2 midnights in Observation and 1 midnight as an Inpatient yields zero Traditional Medicare coverage for SNF rehab, exposing families to private-pay demands of 400 to 700 dollars per day.

flowchart TD
    A["Senior placed in a hospital bed on a medical ward"] --> B["Ask nurse or case manager on Day 1: Is status Formal Inpatient or Outpatient Observation?"]
    B -->|"Formal Inpatient Status"| C["Count consecutive midnights after formal inpatient admission order"]
    B -->|"Outpatient Observation Status"| D{"Has patient been in hospital more than 24 hours?"}
    C --> E{"At least 3 consecutive Inpatient midnights?"}
    E -->|"Ɔwɔ"| F["Qualifies for Traditional Medicare Part A Skilled Nursing Facility (SNF) rehab"]
    E -->|"Ayi"| G["Ask physician and Utilization Review to extend Inpatient stay if clinically unstable"]
    D -->|"Yes: Over 24 hours"| H["Demand MOON Form (Medicare Outpatient Observation Notice)"]
    H --> I["Ask Attending Physician to contact Utilization Review to convert to Inpatient under Two-Midnight Rule"]
    I --> J{"Does patient have Medicare Advantage or Original Medicare?"}
    J -->|"Medicare Advantage"| K["Check if plan waives the 3-day inpatient rule for in-network SNF rehab"]
    J -->|"Original Medicare"| L["File retroactive or expedited appeal under Alexander v. Azar rules if kept in Observation 3+ days"]

Kɔlɔsili cogoya jateminɛ ani ka gɛlɛya don cogo min sani i ka bɔ dɔgɔtɔrɔso la¶

1. Aw bɛ cogoya ɲininkali kɛ sɔgɔma o sɔgɔma: Aw bɛ a sɛgɛsɛgɛ don o don ni dɔgɔtɔrɔ ye min bɛ aw ladon ani ni a ka ko ɲɛnabɔbaga ye ni banabagatɔ bɛ dɔgɔtɔrɔso la walima kɛnɛyaso kɔkanna kɔlɔsili sariya kɔnɔ.
2. Aw ye MOON sɛbɛn (CMS-10495) kɔlɔsi: Dɔgɔtɔrɔso minnu bɛ Medicare banabagatɔ bila kɔlɔsili la sanga 24 ni kɔ kɔnɔ, olu ka kan ka Medicare kɛnɛyaso kɔkanna kɔlɔsili kunnafoni (MOON) di sanga 36 kɔnɔ.
3. Aw bɛ CMS Su tilancɛ sariya wele ni baarakɛcogo lajɛ ye: CMS Su tilancɛ sariya kɔnɔ, ni dɔgɔtɔrɔ b’a jira ko banabagatɔ mago bɛ dɔgɔtɔrɔso ladonni na su tilancɛ fila kɔnɔ, banabagatɔ doncogo bɛnnen don. Aw ye Dɔgɔtɔrɔ min bɛ taa dɔgɔtɔrɔso la ani Dɔgɔtɔrɔso ladilikɛla min bɛ baara kɛ ni baarakɛcogo lajɛ (UR) ye ɲini u ka Condition Code 44 seginnkanni teliya la walasa ka Kɔlɔsili cogoya sɛmɛntiya ka kɛ Inpatient formal ye sani aw ka bɔ dɔgɔtɔrɔso la.
4. Aw bɛ baara kɛ ni Alexander v. Azar (CMS-4204-F) Kɔlɔsili Appeal Right ye: Medicare nafa sɔrɔbaga minnu tilalen don kokura ka bɔ Inpatient la ka taa Observation la (walima minnu maralen bɛ dɔgɔtɔrɔso la tile 3+ ni Part A SNF coverage tɛ) olu bɛ ni fédéral administratif appeal rights ye QIO sababu fɛ.
5. Aw ye Medicare Advantage tile 3 sariya bɔli lajɛ: Kɛmɛsarada la 80 ni kɔ ka Medicare Advantage (Part C) labɛnw bɛ tile 3 ladonni wajibiyalen bila ka taa dɔgɔtɔrɔso la ani ka yamaruya di ka mɔgɔw bila ka taa SNF ka kɛnɛyaso kɔnɔ.

Ka bɔli dabila joona ka bɔ Sɔgɔsɔgɔninjɛ seko ni dɔnko yɔrɔ (SNF) walima kɛnɛyaso la¶

Tile 10 fo Tile 21 lamini na, Sɔgɔsɔgɔninjɛ seko ni dɔnko yɔrɔ la (SNF), a ka c’a la, a bɛ fɔ denbayaw ye ko: "Medicare bɛ tile 20 dɔrɔn de sara, walima i bangebaga ye plateau kɛ farikoloɲɛnajɛ la, o la, furakɛli bɛ ban sanga 48 kɔnɔ." Tuma caman na, o fɔlen fila bɛɛ ye nkalon ye ka kɛɲɛ ni fédéral Medicare sariya ye.

Miiriya 1: "Medicare bɛ tile 20 dɔrɔn de kɛ rehab la".¶

Medicare Part A covers up to 100 days of Skilled Nursing Facility care per benefit period as long as the patient requires daily skilled nursing or skilled rehabilitation therapy (PT, OT, or Speech Therapy at least 5 days a week). Days 1 to 20 carry a $0 copay, while Days 21 to 100 carry a daily statutory coinsurance (covered in full by Medigap Plans G or F, or Medicaid). Because reimbursement tapers after three weeks, facilities often pressure families to exit early despite ongoing skilled needs.

Miiriya 2nan: "An bɛ i bangebaga bila ka bɔ baara la bawo u ye plateau" (The Jimmo v. Sebelius Settlement)¶

Tuma caman na, furakɛli yɔrɔw bɛ furakɛli dabila cogo jugu la ni banabagatɔ min bɛ ni jolida, Parkinson ka bana walima hakiliɲagami ye, o ye tɔnɔ teliya jirali dabila taama na. Fɛdɛrali ka jɛkulu ka bɛnkansɛbɛn kɔnɔ min tɔgɔ ye ko Jimmo ni Sebelius (Medicare Benefit Policy Manual, Chapter 8), Medicare SNF ani Home Health coverage TƐ bɔ banabagatɔ ka seko la ka ɲɛtaa sɔrɔ.

Cogo min na i bɛ se ka sɛgɛsɛgɛli kɛ sɔgɔsɔgɔninjɛ seko ni dɔnko yɔrɔ tigɛlen dɔ kan (NOMNC Formulaire CMS-10123)¶

1. Aw ka Medicare Non-Coverage (NOMNC, Form CMS-10123) kunnafoni ɲini): SNF ka kan ka nin sɛbɛn sɛbɛn in di a ka dɔgɔn kalandriya tile 2 (lɛrɛ 48) sani Medicare ka coverage ka ban.
2. Aw bɛ BFCC-QIO wele ka kɔn 12h waati ɲɛ tile min na sani furakɛli ka ban: A tɛ i n’a fɔ dɔgɔtɔrɔso weleli (su tilancɛ la bɔli don na), Sɔgɔsɔgɔninjɛ seko ni dɔnko yɔrɔ la, aw ka kan ka BFCC-QIO nimɔrɔ wele NOMNC kan ka se 12:00 ma tilegan fɛ kalandriya don na SANI furakɛli ka ban.
3. A ɲini ka ɲɛfɔli dafalen ɲini min bɛ kɛ ka ɲɛsin furakɛli ma (DENC, Formulaire CMS-10124): Ni aw ye appelé kɛ, o yɔrɔ ka kan ka DENC sɛbɛn di min bɛ kɛnɛyaso ni bolola kun tigitigiw fɔ ka ɲɛsin baara dabila ma.
4. Aw ye Level 2 Segin-ka-bɔnye ni Ombudsman dɛmɛ ɲini ni aw mago bɛ a la: Ni QIO ka appelé fɔlɔ banna SNF kɔnɔ, aw bɛ teliya ka Spedited 72-Hour Level 2 Reconsideration ɲini ka bɔ Setigi yɛrɛmahɔrɔnyalen (QIC) fɛ ani ka kuma aw ka jamana ka Long-Term Care Ombudsman ani SHIP ladilikɛlaw fɛ. Ni mɔgɔkɔrɔbaw ka so dɔ y’a ɲini ka duguden dɔ gɛn ka bɔ yen, k’u bila ER la ani ka ban ka don kokura ("dɔgɔtɔrɔso dumping"), aw ka tugu an ka gafe ɲɛ mɔgɔkɔrɔbaw ka so tɔɲɔli, dɛsɛ, ani mɔgɔw gɛnni ka bɔ u ka so sariya siratigɛ la.

Dugukolo kan jibɔ lakanani: Angletɛri, Kanada, Ɔsitarali ani EU¶

Foroba kɛnɛyakoba bɛɛ bɛ ni sariyaw ye minnu bɛ dɔgɔtɔrɔsow bali ka mɔgɔkɔrɔba minnu bɛ u bolo, k’a sɔrɔ u ma ladonni bolodacogo sɛgɛsɛgɛ.

United Kingdom (NHS): PALS, Discharge to Assess, and NHS Continuing Healthcare (CHC)¶

Under NHS England's Hospital Discharge and Community Support Guidance and the Care Act 2014, NHS trusts use four Discharge to Assess (D2A) pathways: Pathway 0 (simple discharge with no new needs), Pathway 1 (home with community reablement), Pathway 2 (24-hour bedded intermediate rehabilitation), and Pathway 3 (permanent 24-hour nursing care placement).

If a ward tries to discharge a frail senior on Pathway 0 or Pathway 1 before care workers are scheduled to visit: 1. Contact the Ward Manager (Sister / Charge Nurse) and the hospital's Patient Advice and Liaison Service (PALS) immediately. 2. State in writing: "This is an unsafe discharge. Under the Care Act 2014 and NHS Discharge Guidance, we require a multi-disciplinary assessment for Pathway 2 bedded intermediate care, an NHS Continuing Healthcare (CHC) Checklist prior to discharge, and a Carer's Assessment verifying that family members cannot provide 24-hour lifting care."

Enforcing the CARE Act: Your state law rights as a family caregiver¶

Over 44 US states and territories have enacted the CARE (Caregiver Advise, Record, Enable) Act. Under the CARE Act, hospitals must perform three duties before discharging a patient to a private home: 1. Record the Family Caregiver: Offer the patient the opportunity at admission to designate a family caregiver in the chart. 2. Notify Before Discharge or Transfer: Notify the designated caregiver as soon as a discharge order is written and prior to exit. 3. Provide Live, Hands-On Training for Medical Tasks: Provide a live demonstration and plain-language instruction on all home medical tasks, including sterile wound care, subcutaneous injections (such as insulin or enoxaparin), tube feedings, home oxygen and suction machines, and safe bed-to-wheelchair or Hoyer lift transfers.

How to use the CARE Act to halt a premature discharge: If the nurse hands you syringes, a catheter bag, or wound gauze without hands-on training, refuse to sign. Say: "Under our state's CARE Act, this hospital must provide live instruction and verify that a family caregiver is physically able to perform all medical and lifting tasks before discharge. No one at home can lift the patient safely. Please document that the CARE Act prerequisite has not been met."

Word-for-word advocacy scripts for high-pressure hospital meetings¶

Hospital case managers sometimes claim that "Medicare will stop paying and you will owe 3,000 dollars a day," or "If you do not pick up your parent by 3:00 PM, we will report elder abandonment."

Know the legal truth: refusing to pick up a patient from a licensed 24-hour hospital or nursing facility because you lack the physical strength, medical training, or safe environment to care for them at home is NOT elder abandonment. Inside a hospital, the patient is under the legal duty of care of licensed clinicians. Conversely, taking a bedbound or delirious senior home to an unsafe house where they fall can trigger an Adult Protective Services (APS) neglect investigation.

Script 1: Ni bɔli bolodabaga ko "Dɔgɔtɔrɔ ye bɔli yamaruya sɛbɛn bi 14h waati".¶

"Ne bangebaga tɛ u ka baarakɛcogo walima u ka hakililata basigilen na, wa a tɛ se ka wuli ka taa ɲɛgɛn na lafiya la walima ka yele sennasanbara la ka don u ka so kɔnɔ. Mɔgɔ si tɛ so kɔnɔ farikolo la, min tɛ se k'u kɔrɔta. An bɛ sɔsɔli kɛ cogo la min bɛ nin bɔli in sɔsɔ k'a fɔ ko a lakananen tɛ. Aw ye Cikan Nafama di n ma ka bɔ Medicare fɛ (Formulaire CMS-10065) sisan yɛrɛ walasa n ka se ka BFCC-QIO wele walasa ka bɔli teliya ɲinini kɛ, ani ka dɔgɔtɔrɔ min bɛ taa dɔgɔtɔrɔso la ani Farikoloɲɛnajɛ furakɛli ɲɛ walasa ka segin ka jiginni lakanani jateminɛ."

Script 2: Cikan sɛbɛnnen ka nɔrɔ banabagatɔw ka ɛntɛrinɛti yɔrɔ la (MyChart) .¶

"To: Attending Physician, Charge Nurse, and Case Management / Utilization Review. Re: [Banabagatɔ tɔgɔ, DOB, So]. Aw ye nin sɛbɛn in don furakɛli sɛbɛn banbali kɔnɔ. An ka denbaya bɛ ladonni jɛkulu ladɔnniya cogo labɛnnen na ko so bɔli laɲinilen [Date] la, o tɛ lakana ye kɛnɛyako ta fan fɛ. Sani nin bana in ka kɛ, [Banabagatɔ tɔgɔ] tun bɛ taama a yɛrɛma ani a hakili tun jɛlen don. Sisan, [Banabagatɔ tɔgɔ] bɛ mɔgɔ fila ka dɛmɛ de wajibiya walasa ka jɔ, hakili ɲagami jugumanba bɛ a la, wa a tɛ se ka furaw walima ɲɛgɛnw ɲɛnabɔ a kelen na, ladonbaga si tɛ se ka [Banabagatɔ tɔgɔ] kɔrɔta so kɔnɔ walima ka kɔlɔsili kɛ sanga 24 kɔnɔ, wa furakɛli minɛn minnu bɛ mɛn, olu ma lase an ma joona PT/OT lakanani sɛgɛsɛgɛli la, ka taa dɔgɔtɔrɔso la Sɔgɔsɔgɔninjɛ seko ni dɔnko yɔrɔ An ye sɛgɛsɛgɛli daminɛ joona ka bɔ dɔgɔtɔrɔso la ni BFCC-QIO (Sigida #[Number]) ye."

Script 3: Ni Skilled Nursing Facility (SNF) dɔ y'a fɔ ko "I bangebaga ye plateau kɛ farikoloɲɛnajɛ furakɛli la".¶

"Aw ye Medicare Non-Coverage (NOMNC, Form CMS-10123) kunnafoni sɛbɛnnen di joona. Jimmo v. Sebelius ka bɛnkansɛbɛn fédéral kɔnɔ ani Medicare Part A SNF coverage sapitiri 8nan kɔnɔ, Medicare Part A SNF coverage tɛ ɲɛtaa sabatili wajibiya. Furakɛli ni sɔgɔsɔgɔninjɛ setigiw bɛ sara tuma o tuma ni a mago bɛ a la walasa ka baara kɛ sisan walima ka tiɲɛni bali. Ne bangebaga bɛ a ɲini hali bi don o don farikoloɲɛnajɛ setigiw ni sɔgɔsɔgɔninjɛ kɔlɔsili walasa ka bin ni sɔgɔsɔgɔninjɛ bali, wa an bɛ ka teliya ka wuli BFCC-QIO la ka kɔn sini midi ɲɛ."

Aw ka kan ka min kɛ SANI aw ka sɔn don dɔ bɔli ma min bɛ se ka kɛ¶

Ni banabagatɔ sabatira furakɛli la walima ni a ka kɛnɛya sabatili walima a ladonni bolodalen don ka ban, aw bɛ nin Five-Point Safe Exit Audit dafa sani aw ka taa:

• 1. Furakɛcogo bɛnkan tilennen ("Brown Bag Audit"): Aw bɛ aw sigi ni dɔgɔtɔrɔso baarakɛla walima furakɛlikɛla ye ka so kɔnɔ fura bɛɛ lajɛ dɔgɔtɔrɔso sɛbɛn kura bɛɛ kɛrɛfɛ, ka a sɛmɛntiya sɛbɛn fɛ: Aw bɛ taa a fɛ a tata hakɛ kelen na, aw bɛ a tata hakɛ Changer, Aw bɛ a dabila kudayi, walima Aw bɛ fura kura daminɛ.
• 2. "Fura minnu bɛ bolo la" Sani aw ka taa: Aw bɛ dɔgɔtɔrɔso kɔnɔ furakɛliso la ("Meds-to-Beds" porogaramu) ɲini u ka furasɛbɛn kura bɛɛ fa ani ka u lase dilan kɛrɛ fɛ sani aw ka taa walasa aw ka asiransi ka yamaruyaw sɛgɛsɛgɛ ka kɔn o ɲɛ ani ka fara ɲɔgɔn kan o yɔrɔ la.
• 3. Dɔgɔtɔrɔso minɛn minnu bɛ mɛn (DME) farikolo la So kɔnɔ: Aw ye a lajɛ ni taamakɛlan, dilan kɛrɛfɛ komodi, dumunikɛminɛn, dɔgɔtɔrɔso dilan, Hoyer lift, walima oksizɛni fɛnɲɛnamafagalan min yamaruyara, o bɛɛ bɛ so kɔnɔ kaban sani aw ka bɔ. Banabagatɔ minnu bɛ oksizɛni ta, aw bɛ segin a kan kuran tiɲɛni labɛnni oksizɛni sɛnɛfɛnw, fiɲɛbɔlanw, ani CPAP kama.
• 4. So kɔnɔ kɛnɛyaso tɔgɔ sɛbɛnnen, telefɔni nimɔrɔ ani taama fɔlɔ don: So kɛnɛyaso min sɔnna a ma, o tɔgɔ tigitigi sɔrɔ, u ka telefɔni nimɔrɔ min bɛ kɛ sanga 24 kɔnɔ, ani a jirali ko dɔgɔtɔrɔso baarakɛla ka Ladonni daminɛ (SOC) taama bolodara sanga 24 fo sanga 48 kɔnɔ.
• 5. Darapo bilenman weleli nimɔrɔ ani tile 7 tuguni lajɛ: Aw bɛ kɛnɛyaso weleli nimɔrɔ sɔrɔ sanga 24 kɔnɔ, ka ɲɛsin kɛnɛyaso lasegin jɛkulu ma, Bɔli kuncɛlen sɛbɛnnen, ani tuguni lajɛ min bolodara tile 5 fo tile 7 kɔnɔ. Ni aw diyanyemɔgɔ binna so kɔnɔ, aw bɛ tugu an ka ɲɛjiralan kɔ mɔgɔkɔrɔbaw ka bin kɛnɛyali ni u tɛ se ka jɔ.

Ɲininkali minnu bɛ kɛ tuma caman na¶

Yala dɔgɔtɔrɔso dɔ bɛ se ka polisiw wele walima ka ne jalaki maakɔrɔw bilali la ni ne banna ka n bangebaga ta min lakananen tɛ ka na so wa?¶

Ayi, ka ban ka banabagatɔ dɔ farikolo ladonni ta min tɛ sabati furakɛli siratigɛ la walima min tɛ se ka lamaga, ka bɔ dɔgɔtɔrɔso la min ka lakɔliso sɛbɛn bɛ a bolo, min bɛ baara kɛ sanga 24 kɔnɔ walima dɔgɔtɔrɔso la min bɛ se kosɛbɛ, bawo i tɛ se k’u ladon lafiya la so kɔnɔ, o tɛ kɛ maakɔrɔw bilali ye kojugukɛla dɔ fɛ. Dɔgɔtɔrɔso kɔnɔ, banabagatɔ bɛ furakɛli yɔrɔ lakananen na, dɔgɔtɔrɔ minnu ka lakɔliso sɛbɛn bɛ u bolo, olu ka ladonni sariya siratigɛ la, k’a sɔrɔ ka taa ni mɔgɔkɔrɔba dɔ ye min bɛ a bolo, ka taa yɔrɔ la min tɛ lakana ye, k’a sɔrɔ a ma dɛmɛ kɔrɔta, o bɛ jogin jugumanba bila u la. Aw ye aw hakili sigi, k’a fɔ sɛbɛn fɛ ko aw sen bɛ u ka ladonni bolodacogo la kosɛbɛ, ani k’a ɲɛfɔ ko aw bɛ aw ka sariya sirataama ka taa a fɛ ka taa bɔli la min tɛ lakana ye, fo ka se ka kɛnɛya sabatili walima so ladonni labɛn.

Mun bɛ kɛ ni ne ye su tilancɛ waati dantigɛlen tɛmɛn dɔgɔtɔrɔso bɔli don na walasa ka Medicare QIO wele?¶

Ni aw tɛmɛna su tilancɛ waati dantigɛlen na bɔli don bolodalen na (walima tilelafana 12h waati sani aw ka waati dantigɛlen kɛ Sɔgɔsɔgɔninjɛ Setigiw ka yɔrɔ la) nka banabagatɔ farikolo bɛ o yɔrɔ kɔnɔ hali bi, aw bɛ BFCC-QIO wele joona cogo o cogo. Fɛdɛrali Medicare sariyaw kɔnɔ, QIO bɛna sɔn hali bi ka taa kɔfɛ ka bɔ dɔgɔtɔrɔso la ani ka furakɛli yɛrɛmahɔrɔnya lajɛ kɛ kalandriya tile 2 kɔnɔ, hali ni i bɔnɛna wariko jalaki lakanani otomatiki la tile minnu kɔnɔ, k’a sɔrɔ kɔfɛ seginnkanni bɛ sen na fo ni QIO ye sariya kɛ i ta fan fɛ.

Yala ne bangebaga bɛ Medicare ka bɔli appeal josariyaw sɔrɔ ni u ka Medicare Advantage bolodalen ye u yɛrɛ ye sanni ka kɛ Original Medicare ye wa?¶

Ɔwɔ, nafa sɔrɔbaga bɛɛ min tɔgɔ sɛbɛnna Medicare Advantage (Part C) bolodalen kɛrɛnkɛrɛnnen dɔ la, o jo kelen tigitigi bɛ fédéral ka sariya kɔnɔ, ka Cikan Nafama sɔrɔ ka bɔ Medicare fɛ (dɔgɔtɔrɔso dɔ la) walima ka Medicare Non-Coverage Laseli (sɔgɔsɔgɔninjɛ setigiw ka yɔrɔ la) ani ka teliya la, a yɛrɛmahɔrɔnyalen bɔli weleli kɛ marabolo BFCC-QIO (Acentra Health walima Livanta) fɛ. Ni i ye sɛbɛn di BFCC-QIO ma, o bɛ bɔli kɛ otomatiki kelen na, k’a sɔrɔ QIO dɔgɔtɔrɔ yɛrɛmahɔrɔnw bɛ furakɛli sɛbɛnw lajɛ.

Ne bɛ se ka dɔgɔtɔrɔso dɔ sɔrɔ cogo di ka n bangebaga Changer ka bɔ "Outpatient Observation" cogo la ka taa "Inpatient" cogo la sani u ka taa?¶

A ɲini ka kuma ni dɔgɔtɔrɔ min bɛ taa dɔgɔtɔrɔso la ani dɔgɔtɔrɔso baarakɛcogo lajɛ (UR) dɔgɔtɔrɔ ladilikɛla fɛ k’a sɔrɔ i bangebaga bɛ dɔgɔtɔrɔso dilan kan hali bi. Aw k’a jira ko aw bangebaga ye su tilancɛ fila tigɛ walima ko a ka kan ka tɛmɛ minnu bɛ ladonni wajibiya dɔgɔtɔrɔso la CMS ka su tilancɛ sariya kɔnɔ, ani ka Condition Code 44 lajɛ cogo labɛnnen ɲini walasa k’u ka cogoya sɛmɛntiya ka bɔ kɛnɛyaso kɔkanna kɔlɔsili la ka taa kɛnɛyaso la sani u ka bɔ kɛnɛyaso la, walima k’a lajɛ ni u ka Medicare Advantage bolodalen bɛ tile 3 dɔgɔtɔrɔso la sariya bɔ dɔgɔtɔrɔso la ka ɲɛsin Sɔgɔsɔgɔninjɛ seko ni dɔnko ɲɛnabɔli ma.

Sosow sɛgɛsɛgɛra¶

• Centres for Medicare and Medicaid Services (CMS, Etazuni): Medicare ka ɲininiw ɲɛnabɔli gafe, tilayɔrɔba 30: Nafolo jalaki lakanani, dɔgɔtɔrɔso bɔli laseli kunnafoniw (Formulaire CMS-10065), ani Skilled Nursing Facility Fast-Track Appeals (NOMNC Form CMS-10123).
• Centres for Medicare and Medicaid Services (CMS, Etazuni): Jimmo ni Sebelius ka bɛnkansɛbɛn tiɲɛni sɛbɛn ani Medicare nafaw politiki gafe Sapitiri 8 (Ladonni dafalen sariya).
• Centres for Medicare and Medicaid Services (CMS, Etazuni): Medicare Appeals of Hospital Reclassifications ka bɔ dɔgɔtɔrɔso la ka taa kɛnɛyaso kɔkan kɔlɔsili cogoya la (CMS-4204-F / Alexander v. Azar).
• Kɛnɛya ni sigida ladonni minisiriso ani NHS Angletɛri (Angletɛri): Dɔgɔtɔrɔso bɔli ni sigida dɛmɛni bilasiralikan (Dɔgɔtɔrɔso bɔli ka siraw jateminɛ 0 ka se 3 ma ani ladonni sariya 2014 sariyasenw).
• AARP Foroba Politiki baarada (Amerika): CARE (Ladonbagaw ka ladilikan, sɛbɛnni, seko) sariya sariyasenw waleyali sariyaw.

Gafe minnu bɛ tali kɛ o ko la¶

• Dɔgɔtɔrɔso kɔnɔnafili, hakili ɲagami barikama, ani mɔgɔkɔrɔbaw ka lafasali
• Mɔgɔkɔrɔbaw ka so tɔɔrɔli, u ma u janto u la, ani u gɛnni ka bɔ u ka so cogo la min tɛ sariya kɔnɔ
• Mɔgɔkɔrɔbaw bɛ bin ka kɛnɛya ni u tɛ se ka jɔ
• Kuran tiɲɛni oksizɛni sɛnɛfɛnw, fiɲɛbɔlanw ani CPAP la
• Duniya kɔnɔ kɔrɔtɔko nimɔrɔw