Kalubalanci Asibiti mara lafiya ko wanda bai riga ya kai ba ko Gyaran Matsala ga Babban¶

Asibitoci da ƙwararrun wuraren jinya (SNFs) suna aiki ƙarƙashin matsananciyar kuɗi da ƙarfin gado don rage tsawon zaman haƙuri. Iyalai akai-akai ana ba da takaddun fitarwa tare da ƴan sa'o'i kaɗan na sanarwa, ko da babban balagagge ba zai iya tsayawa ba tare da taimako ba, ya kasance cikin ruɗani, yana buƙatar magungunan jijiya, ko kuma bashi da amintaccen mai kulawa a gida. Ɗaukar babban gida mai rashin kwanciyar hankali ko aiki a cikin abin hawa na sirri saboda mai kula da shari'ar asibiti ya ce lokacin inshora ya ƙare yana ɗaya daga cikin manyan abubuwan da ke haifar da faɗuwar bala'i, ciwon huhu, kurakuran magunguna, da sake buɗe dakin gaggawa cikin sa'o'i 48.

Kuna da haƙƙin aiwatar da doka a cikin Amurka, United Kingdom, Kanada, Ostiraliya, da ko'ina cikin Tarayyar Turai don dakatar da fitar da wuri da tilasta yin bita na asibiti mai zaman kansa kafin majiyyaci ya bar ginin. Da zarar ka fitar da masoyinka daga ƙofar asibiti kuma ka sanya hannu kan taƙaitawar fitarwa, ikonka na doka da kariyar inshora ta atomatik ta ɓace. Ta hanyar ajiye majiyyaci a kan gado da kiran ƙa'idodin ƙa'idar sallamar a kan tabo, kuna tilasta wurin don kula da cikakkiyar kulawar likita yayin da likitocin waje ke nazarin ginshiƙi ko yayin da aka shirya gyara majinyacin lafiya.

Yi wannan yanzu¶

1. Kin sanya hannu kan takardar sallamar ko kai majinyacin gida. Ka gaya wa ma'aikacin jinya, likita, da mai tsara shirin sallamar cikin nutsuwa da sarari: "Wannan fitar da aka yi ba shi da lafiya. Ba mu da horon likita, ƙarfin jiki, ko kayan aiki don kiyaye wannan majiyyaci a gida, kuma ba za mu ɗauke su yau ba." Idan majiyyaci a halin yanzu yana fuskantar matsalar rashin lafiya mai haɗari da rayuwa wanda ma'aikatan ke yin watsi da su, kira Ƙungiyar Ba da Amsa ta gaggawa ta cikin asibitin ko kira lambar gaggawa ta gida (911 a Amurka da Kanada, 112 a cikin Tarayyar Turai, 999 a cikin United Kingdom) ko duba. lambobin gaggawa.
2. Nemi rubutaccen sanarwa na sallamar haƙƙoƙin roƙon gaggawa. A Amurka, kowane majiyyaci na Medicare da Medicare dole ne ya karɓi fom ɗin hukuma mai taken Sako mai Muhimmanci daga Medicare (Form CMS-10065) a asibiti ko * Sanarwa na Kula da Lafiya (Form CMS-10123)* a wurin ƙwararrun ma'aikatan jinya kafin a sallame su.
3. Kira hukumar roko mai zaman kanta kafin wa'adin doka ta cika. A Amurka, a kira lambar waya ta Ƙungiyar Ci gaba da Kulawa da Kulawa ta Ƙungiyar (BFCC-QIO) da aka buga akan sanarwar kafin tsakar dare a ranar da za a sallame asibiti (ko da tsakar rana kafin ƙarshen ɗaukar hoto). A cikin Ƙasar Ingila, tuntuɓi Sabis na Shawarwari da Haɗin Kai (PALS) da Ward Matron; a Kanada, tuntuɓi Ombudsman na marasa lafiya na Asibiti.
4. Nace a sake nazarin Jiki na Jiki da Sana'a na rana guda. Tambayi likitan da ke zuwa ya ba da umarnin aikin aikin jiyya na jiki (PT) da kuma aikin jinya (OT) wanda ke rufe wurin canja wurin zama-to-tsaye, nisan motsa jiki, hawan matakala, da canja wurin bayan gida. Idan takardun PT ko OT waɗanda majiyyaci na buƙatar taimako na mutum biyu ko kuma ba za su iya amfani da matakan shiga gida ba, fitar da gida ya hana a asibiti.
5. Bincika matsayin shigar majiyyaci (Inpatient vs. Observation) Idan iyayenku suna asibitin Amurka a ƙarƙashin Medicare na Gargajiya, tambayi mai kula da shari'ar ko an lasafta su a matsayin "Mai jinƙai" ko "Binciken Marassa lafiya." Idan an ajiye su a ƙarƙashin Matsayin Dubawa na kwanaki da yawa, nemi kwamitin Bitar Amfani da Asibiti ya yi bitar su nan take don canza zaman zuwa Inpatient kafin a sallame su don haka ya haifar da ɗaukar hoto na Ƙwararrun Ƙwararru (SNF).
6. ** Sanya ƙin yarda da amincin ku a cikin rikodin likita na dindindin.** Aika taƙaitaccen saƙon gaskiya ta hanyar hanyar sadarwa ta lantarki (kamar MyChart) ko mika wasiƙar da aka rubuta zuwa Cajin Nurse da Manajan Case wanda ke jera kowane takamaiman aiki da shingen likita na dawowa gida.

flowchart TD
    A["Asibiti ko gyarawa suna ba da sanarwar sallamar manyan da ba su da kwanciyar hankali"] --> B{"Shin babba zai iya canjawa wuri lafiya, bayan gida, haɗiye, da sarrafawa a gida?"}
    B -->|"Ee: An dawo da tushe kuma an shirya kayan aiki"| C["Cikakkun sulhu na magani da jadawalin bibiyar kwanaki 7"]
    B -->|"A'a: Ba shi da lafiya komawa gida"| D["Ƙi sanya hannu kan takaddun fitarwa ko majinyacin jigilar kaya"]
    D --> E{"Wane irin kayan aiki da tsarin kiwon lafiya?"}
    E -->|"Asibitin Amurka (Medicare ko Amfanin Medicare)"| F["Bukatar Muhimmin Saƙo daga Medicare (CMS-10065)"]
    E -->|"Ƙwararriyar Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararru )"| G["Sanarwa na Buƙatar Marasa Kariyar Medicare (CMS-10123)"]
    E -->|"UK NHS / Kanada / Ostiraliya / Inshora mai zaman kansa"| H["Riƙe fayil na yau da kullun tare da PALS, Ombudsman mara lafiya, ko Bita na Amfani"]
    F --> I["Kira BFCC-QIO (Acentra ko Livanta) kafin tsakar dare a ranar fitarwa"]
    G --> J["Kira BFCC-QIO da tsakar rana kafin ɗaukar hoto ya ƙare"]
    I --> K["An jawo zama ta atomatik: Asibiti ba zai iya korar ko lissafin daga aljihu ba yayin bita"]
    J --> K
    H --> L["Bukatar PT/OT matakala da kuma canja wurin duba tare da taron kula da multidisciplinary"]
    K --> L

Gane lokacin da asibiti ko sallamar ba shi da lafiya a asibiti¶

Masu tsara fitar da asibiti sukan yi la'akari da daidaitawar likita na ganewar asibiti na farko a matsayin kawai abin da ake bukata don aika dattijo gida. Likita na iya lura cewa ciwon huhu na majiyyaci yana inganta akan maganin rigakafi na baka ko kuma tiyatar da aka yi musu ta yi kama da tsabta, yayin da gaba daya ke kula da gaskiyar cewa kwana biyar na kwanciya barci ya bar majiyyaci mai shekaru 82 ya kasa tashi daga bayan gida ko kuma ba ta da lafiya. hayyacin asibiti da rudani kwatsam.

Kafin amincewa da kowace ranar fitarwa, kimanta majiyyaci a cikin yankuna shida na haƙiƙa na asibiti da aminci na aiki. Idan mai haƙuri ya gaza ko da ɗaya daga cikin waɗannan sharuɗɗan kuma wurin bai shirya kulawar cibiyoyi na sa'o'i 24 ba ko ci gaba da aikin jinya na gida, fitarwa ba shi da haɗari.

Yadda ake shigar da karar gaggawar sallamar asibitin Medicare (Amurka)¶

A {asar Amirka, dokar tarayya (42 CFR Sashe na 405, Sashe na J) yana ba kowane mai cin gajiyar da Original Medicare ke rufewa ko kuma wani tsarin fa'ida na Medicare mai zaman kansa haƙƙin gaggauce, bitar likita mai zaman kanta kafin a sallame shi daga zaman asibiti.

Mataki 1: Neman "Muhimmin Saƙo daga Medicare" (Form CMS-10065)¶

Asibitoci dole ne su isar da sanarwar tarayya mai shafi biyu mai taken Muhimmin Saƙo daga Medicare Game da Haƙƙinku (Form CMS-10065) sau biyu a duk lokacin zaman marasa lafiya: a cikin kwanakin kalanda 2 na shiga, da kuma tsakanin sa'o'i 4 zuwa 48 kafin fitarwa.

Shiga Form CMS-10065 ** baya nufin kun yarda cewa mai haƙuri yana shirye ya koma gida; kawai yana yarda da karɓar lambar wayar roko. Idan asibitin ya gaya maka da baki cewa ana sallamar iyayenka a yau ba tare da ba ka kwafin na biyu na Form CMS-10065 da ke jera lambar wayar BFCC-QIO ba, gaya wa manajan shari'ar: "Ba ka isar da saƙo mai mahimmanci na ƙarshe daga Medicare ba. A ƙarƙashin dokokin CMS, wannan fitarwa ba zai iya ci gaba ba har sai an ba da sanarwar rubutacciya."

Mataki 2: Kira BFCC-QIO kafin tsakar dare a ranar fitarwa¶

Kwangilar Medicare tare da ƙungiyoyi masu bitar likitoci masu zaman kansu da ake kira ** Ƙungiyoyin Inganta Ingantattun Kulawa na Cibiyar Kula da Iyali (BFCC-QIOs)** don ɗaukar roƙon sallama cikin sauri: Acentra Health da Livanta. Ana buga lambar QIO kyauta na jiharku akan Shafi na 1 na Form CMS-10065 (ko kira 1-800-MEDICARE a 1-800-633-4227).

• ** Ƙayyadaddun Ƙayyadaddun Tsakar Daren: *** Kira BFCC-QIO ** kafin tsakar dare (11:59 PM) a ranar da aka tsara za a yi fitarwa ** da ** kafin majiyyaci ya bar ginin ***.
• 24/7 Saƙon murya da Ƙididdiga ta Lissafin Kan layi: Layin shan BFCC-QIO yana aiki 24/7. Barin saƙon murya ko abun sha akan layi kafin tsakar dare tare da sunan majiyyaci, lambar Medicare, sunan asibiti, da lambar dawo da kiran ku bisa doka suna kulle roko akan lokaci. Yi rikodin tambarin lokaci da lambar tabbatarwa.

Mataki 3: Fahimtar tsayawa ta atomatik na fitarwa da kariyar kuɗi¶

Aiwatar da ƙararrakin da ya dace kafin tsakar dare yana haifar da ** tsayawa ta atomatik *: 1. Asibitin ba zai iya tilasta majiyyaci barin: Cikakken gadon marasa lafiya, kulawar jinya, da jiyya dole ne su ci gaba yayin nazarin QIO. 2. Alhakin gadon da ba a aljihu ba a lokacin roko: Asibitin ba zai iya biyan majiyyaci daga aljihu na karin kwanakin marasa lafiya ba yayin da likitocin QIO ke duba ginshiƙi, ko da a ƙarshe QIO ya musanta roƙon ku. 3. ** Cikakkun Sanarwa na Cirewa (CMS-10066): Da zarar kun ɗaukaka ƙara, dole ne asibiti ya isar da rubutacciyar sanarwa da tsakar rana ta gaba mai bayyana takamaiman dalilan asibiti da suka yi imanin cewa ba a buƙatar kulawar gaggawa ta asibiti.

Mataki 4: Sanya shari'ar ku ta asibiti kai tsaye ga mai bitar QIO¶

Lokacin da BFCC-QIO ta kira ku (a cikin sa'o'i 12 zuwa 24), faɗi takamaiman bayanan asibiti daga ginshiƙi da ke nuna rashin lafiyar likita ko buƙatun canji mara aminci: - "Majinyacin ya kamu da rashin lafiya mai tsanani sa'o'i 48 da suka gabata, ya kasance ƙasa da tushen fahimi, kuma yana tari lokacin da yake hadiye ruwa." - "Cibiyar Jiki ta rubuta jiya cewa majiyyaci na buƙatar taimakon mutum 2 don canja wurin kuma ba zai iya hawa matakan 6 zuwa cikin gidansu ba." - "Majinyacin ya canza daga cikin jini zuwa magungunan baka kawai awanni 3 da suka gabata, kuma ba a tabbatar da kwanciyar hankali na awa 24 ba." - "Mai lafiya yana buƙatar canjawa wuri zuwa wurin jinya ƙwararrun ma'aikatan jinya (SNF), kuma gudanar da shari'ar bai sami gado mai karɓa ba."

Mataki 5: Me zai faru lokacin da QIO ta ba da shawarar ta¶

Dole ne BFCC-QIO ta sake duba bayanan likita kuma ta yanke shawara a cikin awanni 24** na karɓar fayil ɗin asibiti. - An Amince da Roko: Sanarwar sallamar ta ɓace kuma ɗaukar hoto na Medicare yana ci gaba har sai majiyyaci ya daidaita ko ya canja wuri lafiya. - An ƙi ɗaukaka ƙara: Ba ku bin komai na awa 24 zuwa 48 na bita. Alhaki daga aljihu yana farawa ne a 12:00 na rana a ranar kalanda BAYAN QIO ya sanar da kai game da musun. Aiwatar da roko har yanzu yana tabbatar da sa'o'i 36 zuwa 48 da aka rufe don shirya kayan aikin gida ko wurin gyarawa, kuma yana ba da damar sake dubawa nan da nan Mataki na 2 ga Ƙwararrun Kwangila mai zaman kansa (QIC).

Matsayin Kulawa na Medicare vs. "Matsayin Jiki" tarko¶

Wani abin girgiza kudi akai-akai ga tsofaffi a Amurka shine ** Dokar Kula da marasa lafiya ta Medicare Uku da Tsakar dare ** da ** "Matsalar Kulawar Mara lafiya."

Me yasa Matsayin Dubawa ya toshe Ma'aikatar Jiyya ta Kware (SNF).¶

Ƙarƙashin Sashin Medicare na Gargajiya A, Medicare kawai yana biyan kuɗin gyaran ƙwararrun ma'aikatan jinya (SNF) bayan asibiti idan an shigar da mara lafiya a matsayin **Mai jinƙai aƙalla tsakar dare uku a jere *** (ban da sa'o'in ɗakin gaggawa da Kula da tsakar dare). Bayar da tsakar dare 2 a cikin Kulawa da 1 tsakar dare a matsayin mara lafiya yana haifar da sifili na Medicare na Gargajiya don sake fasalin SNF, yana fallasa iyalai ga buƙatun biyan masu zaman kansu na dala 400 zuwa 700 kowace rana.

flowchart TD
    A["Babban wanda aka sanya shi a gadon asibiti akan sashin lafiya"] --> B["Tambayi ma'aikacin jinya ko mai kula da shari'a a ranar 1: Matsayin Ma'aikacin Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙimar Halitta ce?"]
    B -->|"Matsayin Asibiti na Gaskiya"| C["Ƙididdigar tsakar dare a jere bayan umarnin shigar da marasa lafiya na yau da kullun"]
    B -->|"Matsayin Duban Mara lafiya"| D{"Shin majiyyaci ya kasance a asibiti fiye da awanni 24?"}
    C --> E{"Akalla tsakar dare 3 na marasa lafiya a jere?"}
    E -->|"Ee"| F["Ya Cancanci Ga Sashe na A Ma'aikatar Jiyya ta Gargajiya (SNF)."]
    E -->|"A'a"| G["Tambayi likita da Bita na Amfani don tsawaita zaman marasa lafiya idan rashin kwanciyar hankali a asibiti"]
    D -->|"Ee: Sama da awanni 24"| H["Form ɗin Buƙatar Watan (Sanarwar Kula da Marasa lafiya ta Medicare)"]
    H --> I["Tambayi Likitan Halarci don tuntuɓar Bita na Amfani don canzawa zuwa Marassa lafiya ƙarƙashin Dokar Tsakar Dare Biyu"]
    I --> J{"Shin mara lafiya yana da Amfanin Medicare ko Original Medicare?"}
    J -->|"Amfanin Medicare"| K["Bincika idan shirin ya yi watsi da dokar marasa lafiya na kwana 3 don gyaran hanyar sadarwa ta SNF"]
    J -->|"Asalin Medicare"| L["Fayil mai ɗaukaka ko gaggawar roko a ƙarƙashin dokokin Alexander v. Azar idan an kiyaye shi a cikin kwanaki 3+"]

Yadda ake tantancewa da ƙalubalantar matsayin Observation kafin barin asibiti¶

1. Yi tambayar matsayin kowace safiya: Tabbatar da kullun tare da likitan da ke halarta da manajan shari'a ko majiyyacin yana ƙarƙashin umarnin marasa lafiya na yau da kullun ko Kulawar Mara lafiya.
2. Kallon fom ɗin WATA (CMS-10495): Asibitocin da ke ajiye majinyacin Medicare a Kulawa sama da sa'o'i 24 dole ne su ba da sanarwar Medicare Outpatient Observation Notice (MOON) cikin awanni 36.
3. ** Kira Dokar Tsakar Dare Biyu ta CMS tare da Bita na Amfani:** A ƙarƙashin CMS **Dokar Tsakar Dare Biyu ***, idan likita yana tsammanin majiyyaci ya buƙaci kulawar asibiti a cikin akalla tsakar dare biyu, shigar da marasa lafiya ya dace. Tambayi Likitan Halarci da **Mai Bita na Amfani (UR) Mai ba da Shawarar Likita *** don sake dubawa nan take Lambar Sharadi na 44 don canza Matsayin Dubawa zuwa Majiɓinci na yau da kullun kafin fitarwa.
4. Yi amfani da Alexander v. Azar (CMS-4204-F) Haƙƙin Duban Rarraba: Masu cin gajiyar Medicare waɗanda aka sake rarraba su daga Inpatient zuwa Lura (ko kuma a ajiye su a asibiti 3+ kwanaki ba tare da ɗaukar Sashe na A SNF ba) suna da haƙƙin gudanarwa na gudanarwa ta tarayya ta hanyar QIO.
5. Bincika Ribar Medicare Waivers na kwana 3: Sama da kashi 80 na masu zaman kansu ** Amfanin Medicare (Sashe na C)** tsare-tsaren sun ba da izinin zaman marasa lafiya na kwanaki 3 da ba da izinin canja wuri kai tsaye zuwa hanyar sadarwar SNF rehab.

Dakatar da fitar da wuri daga Ƙwararrun Ma'aikatan jinya (SNF) ko cibiyar gyarawa¶

Around Day 10 to Day 21 in a Skilled Nursing Facility (SNF), families are often told: "Medicare only pays for 20 days, or your parent has plateaued in physical therapy, so coverage ends in 48 hours." Both claims are frequently false under federal Medicare law.

Labari na 1: "Medicare kawai ya shafi kwanaki 20 na farfadowa"¶

Medicare Sashi na A yana rufe ** har zuwa kwanaki 100 na ƙwararrun Ma'aikatan jinya a kowane lokacin fa'ida** muddin majiyyaci yana buƙatar ƙwararrun ƙwararrun ma'aikatan jinya ko ƙwararrun gyaran gyare-gyare (PT, OT, ko Maganin Magana aƙalla kwanaki 5 a mako). Kwanaki 1 zuwa 20 suna ɗaukar kwafin kuɗin dalar Amurka 0, yayin da Kwanaki 21 zuwa 100 ke ɗaukar kuɗin kuɗin yau da kullun na doka (wanda Medigap Plans G ko F, ​​ko Medicaid ya rufe). Saboda biyan kuɗin da aka biya bayan makonni uku, kayan aiki sukan matsa wa iyalai su fice da wuri duk da ƙwararrun buƙatun da ke gudana.

Tatsuniya ta 2: “Muna sallamar iyayenku ne saboda sun yi yawa” (The Jimmo v. Sebelius Settlement)¶

Wuraren gyara sau da yawa ba daidai ba suna ƙare ɗaukar hoto lokacin da majiyyaci da bugun jini, cutar Parkinson, ko dementia suka daina nuna saurin ci gaba a cikin nisan tafiya. Ƙarƙashin sulhu na aji-aiki na tarayya Jimmo v. Sebelius (** Manual Policy Benefit Policy, Babi na 8 ***), Medicare SNF da kewayon Kiwon Lafiyar Gida BA ya dogara da yuwuwar majiyyaci don ingantawa.

Yadda za a yi ƙarar Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararru (Form CMS-10123)¶

1. ** Bukatar Sanarwa na Rashin Kariya (NOMNC, Form CMS-10123):** Dole ne SNF ta isar da wannan rubutaccen fom ** aƙalla kwanakin kalanda 2 (awanni 48)** kafin ɗaukar hoto na Medicare ya ƙare.
2. Kira BFCC-QIO da karfe 12:00 NA RANA kafin rufewa: Ba kamar roƙon asibiti (tsakar dare a ranar fitarwa ba), a cikin Ƙwararrun Ma'aikatan jinya dole ne ku kira lambar BFCC-QIO akan NOMNC ** da karfe 12:00 na rana a ranar kalanda KAFIN ɗaukar hoto ya ƙare**.
3. ** Buƙatar Cikakkun Bayani na Rashin Rufewa (DENC, Form CMS-10124):** Da zarar kun ɗaukaka ƙara, wurin dole ne ya isar da rubutaccen DENC yana ambaton ainihin dalilan asibiti da na hannu na ƙarewa.
4. ** Neman Sake Tunani Level 2 da Taimakon Ombudsman idan an buƙata:** Idan an ƙi roƙon QIO na farko a cikin SNF, nan da nan nemi ** Sake duba matakin Sa'o'i 72 na gaggawa** daga Ma'aikacin Kwantiraɗi mai zaman kansa (QIC) kuma tuntuɓi ** Ombudsman na Jiha na ku*** da masu ba da shawara. Idan gidan jinya ya yi ƙoƙarin korar mazaunin ta hanyar aika su zuwa ga ER da ƙin sake karantawa ("zubawar asibiti"), bi jagorarmu akan. cin mutuncin gidan reno, sakaci, da korar da ba bisa ka'ida ba.

Kariyar fitarwa ta duniya: United Kingdom, Canada, Australia, da EU¶

Kowane babban tsarin kiwon lafiyar jama'a yana da ka'idoji na doka waɗanda ke hana asibitoci sallamar tsofaffi masu dogaro ba tare da ingantaccen tsarin kulawa ba.

Ƙasar Ingila (NHS): PALS, Ƙaddamarwa don Aunawa, da Ci gaba da Kiwon Lafiya na NHS (CHC)¶

Karkashin NHS Ingila Fitar da Asibiti da Jagorar Tallafin Al'umma da * Dokar Kulawa ta 2014*, amintattun NHS suna amfani da hanyoyi guda huɗu na Discharge to Assess (D2A) hanyoyin: Hanyar 0 (sauƙaƙin fitarwa ba tare da sabon buƙatu ba), ** Hanyar 1 ** (Gida tare da gyarawar al'umma), ** Hanyar gyare-gyaren al'umma, ** Hanyar 24. Hanya 3 (wurin kula da jinya na awa 24 na dindindin).

Idan wata unguwa ta yi ƙoƙarin sallamar wani babba mai rauni a kan Pathway 0 ko Pathway 1 kafin a shirya ma'aikatan kulawa su ziyarci: 1. Tuntuɓi Manajan Ward (Sister/Caji Nurse)** da Shawarar Marasa lafiya da Sabis na Sadarwa (PALS) nan take. 2. Jihohi a rubuce: *"Wannan fitarwa ce marar aminci. A ƙarƙashin Dokar Kulawa ta 2014 da Jagorar Fitarwa ta NHS, muna buƙatar ƙima mai yawa don kulawar tsaka-tsakin gadaje na Hanyar 2, Lissafin Ci gaba na Kiwon Lafiya (CHC) na NHS kafin a fitar da shi, da kuma Ƙimar Kulawa ta tabbatar da cewa 'yan uwa ba za su iya ba da kulawar 24-*ho ba. "

Ƙaddamar da Dokar CARE: Haƙƙin dokar jihar ku a matsayin mai kula da iyali¶

Sama da jihohi da yankuna 44 na Amurka sun kafa dokar CARE (Shawarar Kulawa, Rikodi, Kunnawa). A ƙarƙashin Dokar CARE, dole ne asibitoci su yi ayyuka uku kafin a sallami majiyyaci zuwa gida mai zaman kansa: 1. Yi rikodin Mai Kula da Iyali: Bayar da majiyyaci dama a lokacin shigarta don zaɓe mai kula da dangi a cikin ginshiƙi. 2. ** Sanar da Kafin Zazzagewa ko Canja wuri:** Sanar da wanda aka zaɓa da zaran an rubuta odar fitarwa da kuma kafin fita. 3. ** Bayar da Live, Horon Hannu don Ayyukan Likita:** Ba da nunin raye-raye da koyarwar yare akan duk ayyukan likitancin gida, gami da kulawar rauni mara kyau, alluran da ba a fata ba (kamar insulin ko enoxaparin), ciyarwar bututu, iskar oxygen na gida da injin tsotsa, da amintaccen kujera zuwa kujera ko Hoyer.

Yadda ake amfani da Dokar CARE don dakatar da fitar da wuri: Idan ma'aikaciyar jinya ta miko miki sirinji, jakar catheter, ko gauze mai rauni ba tare da horon hannu ba, ki sa hannu. Ka ce: *"A karkashin dokar CARE ta jihar mu, dole ne wannan asibitin ya ba da umarni kai tsaye tare da tabbatar da cewa mai kula da iyali yana iya yin duk aikin likita da dagawa kafin a sallame shi. Babu wanda zai iya daga majiyyaci lafiya a gida. Da fatan za a rubuta cewa ba a cika sharuddan Dokar CARE ba."

Rubutun shawarwari na kalma-zuwa-kalmomi don tarurrukan asibiti masu matsananciyar matsin lamba¶

Masu kula da harakokin asibiti wani lokaci suna da'awar cewa "Medicare zai daina biya kuma za ku bi bashin dala 3,000 a rana," * ko kuma * "Idan ba ku karbi iyayenku ba da karfe 3:00 na yamma, za mu ba da rahoton watsi da dattijo."

Sanin gaskiyar shari'a: ƙin ɗaukar majiyyaci daga asibiti na awa 24 mai lasisi ko wurin jinya saboda rashin ƙarfin jiki, horo na likita, ko muhalli mai aminci don kula da su a gida ** BA watsi da dattijo ba ne**. A cikin asibiti, majiyyaci yana ƙarƙashin aikin doka na kulawar likitocin da ke da lasisi. Akasin haka, ɗaukar babban gida mai gadaje ko mai ban sha'awa zuwa gidan da ba shi da tsaro inda suka faɗi zai iya haifar da binciken sakaci na Adult Protective Services (APS).

Rubutun 1: Lokacin da mai tsara fitarwa ya ce "Likita ya rubuta odar sallamar da karfe 2:00 na rana a yau"¶

• "Iyayena ba su kasance a cikin aikin su ba ko kuma tushen fahimtar su kuma ba za su iya shiga cikin ɗakin bayan gida ba ko hawa matakan shiga cikin gidansu. Ba kowa a gida da ke da ikon ɗaga su. Mun ƙi yarda da wannan fitarwa a matsayin rashin lafiya. Da fatan za a ba ni Muhimmin Saƙo daga Medicare (Form CMS-10065) a yanzu don haka zan iya kiran BFCC-QIO da aka ba da izini ga likita da kuma gyara shafin yanar gizon. sake auna amincin canja wuri."*

Rubutun 2: Saƙon da aka rubuta don liƙa a cikin tashar majinyata ta lantarki (MyChart)¶

• "Don: Halartar Likita, Caji Nurse, da Case Management / Amfani Review. Re: [Patient Name, DOB, Room]. Da fatan za a haɗa wannan bayanin kula a cikin dindindin na likita. yana da rudani, kuma ba zai iya sarrafa magunguna ko bandaki shi kaɗai #[Lambar])."*

Script 3: When a Skilled Nursing Facility (SNF) says "Your parent has plateaued in physical therapy"¶

• "Don Allah a ba da sanarwar da aka rubuta na Medicare Non-Coverage (NOMNC, Form CMS-10123) nan da nan. A karkashin tarayya Jimmo v. Sebelius sulhu da Babi na 8 na Medicare Benefit Policy Manual, Medicare Part A SNF ɗaukar hoto ba ya buƙatar ci gaba da ci gaba. Ana rufe ƙwararrun ƙwararru da reno a duk lokacin da ya cancanta don kula da aikin yau da kullum ko hana kulawar iyaye na yau da kullum. faɗuwa da kwangila, kuma muna shigar da ƙarar ƙara zuwa ga BFCC-QIO kafin la'asar gobe."*

Abin da za ku yi KAFIN ku taɓa karɓar fitarwa mai inganci¶

Da zarar majiyyaci ya kasance lafiyayyen lafiya ko kuma an gama amintaccen canja wuri ko tsarin kula da gida, kammala wannan ** Binciken Fitar Lafiyar Maki Biyar** kafin barin:

• 1. Layi-Layi Magani Sulhu ("Brown Bag Audit"): Zauna tare da ma'aikacin jinya ko likitan magunguna kuma ku duba kowane magani na gida tare da kowane sabon takardar magani na asibiti, yana mai tabbatarwa a rubuce: ** Ci gaba a daidai adadin **, ** Canja kashi ***, Dakata dindindin, ko **Fara sabon magani.
• 2. "Magungunan Hannu" Kafin Tashi: Tambayi kantin magani na cikin gida na asibiti ("Meds-to-Beds" shirin) don cikewa da isar da duk sabbin takardun magani zuwa gefen gado kafin tashi don tabbatar da izinin inshora kafin izini da biyan kuɗi a nan take.
• 3. Kayan Aikin Kiwon Lafiya (DME) A Jiki Cikin Gida: Tabbatar da cewa duk wani mai tafiya da aka ba da oda, abin hawa na gado, kujera mai shawa, gadon asibiti, Hoyer lift, ko iskar oxygen yana cikin gidan kafin fita. Ga marasa lafiya masu dogaro da iskar oxygen, bita shirye-shiryen kashe wutar lantarki don masu tattara iskar oxygen, masu ba da iska, da CPAP.
• 4. Rubuce Sunan Hukumar Lafiya ta Gida, Lambar Waya, da Ranar Ziyara ta Farko: Samu ainihin sunan Hukumar Kiwon Lafiyar Gida mai karɓa, lambar wayarsu ta awanni 24, da kuma tabbatar da cewa an tsara ziyarar ma'aikaciyar jinya ta Start of Care (SOC) cikin awanni 24 zuwa 48.
• 5. Lamban Kiran Jajayen Tuta da Wa'adin Biyu na Kwanaki 7: Sami lambar dawowar asibiti na awa 24 don ƙungiyar masu fitar da kaya, buga Takaitacciyar Takaitacciyar Watsawa, da alƙawari mai biyowa wanda aka tsara cikin kwanaki 5 zuwa 7**. Idan ƙaunataccenka ya faɗi a gida, bi jagorarmu akan tsofaffi sun farfaɗo idan sun kasa tsayawa.

Tambayoyin da ake yawan yi¶

Shin asibiti na iya kiran ’yan sanda ko kuma za su iya tuhume ni da watsi da dattijo idan na ƙi ɗaukar iyayena waɗanda ba su da lafiya su dawo gida?¶

A'a, ƙin ɗaukar nauyin jikin mara lafiyar lafiya ko maras lafiya mara motsi daga asibiti mai lasisi na awanni 24 ko ƙwararrun ma'aikatan jinya saboda ba za ku iya kula da su lafiya a gida ba ba ya zama watsi da dattijo mai laifi. A cikin asibiti, majiyyacin yana cikin amintaccen muhallin likita ƙarƙashin aikin doka na kulawar likitocin da ke da lasisi, yayin da ɗaukar babban gida mai dogaro zuwa yanayin da ba shi da tsaro ba tare da ɗaga taimako yana fallasa su ga mummunan rauni ba. Ku kwantar da hankalinku, ku bayyana a rubuce cewa kun ci gaba da kasancewa da himma a cikin shirin kulawarsu, kuma ku bayyana cewa kuna aiwatar da haƙƙin ku na shari'a don ɗaukaka sallama mara kyau har sai an shirya gyara ko kula da gida.

Me zai faru idan na rasa ranar ƙarshe na tsakar dare a ranar sallamar asibiti don kiran Medicare QIO?¶

Idan kun rasa ranar ƙarshe na tsakar dare a ranar da aka tsara (ko 12:00 na rana-kafin ranar ƙarshe a cikin Wuraren Ƙwararrun Ƙwararru) amma har yanzu majiyyaci yana cikin jiki a cikin wurin, kira BFCC-QIO nan da nan. A ƙarƙashin dokokin Medicare na tarayya, QIO har yanzu za ta karɓi ƙarar ƙarar daga majiyyaci kuma ta gudanar da bita na likita mai zaman kanta a cikin kwanakin kalanda 2, kodayake ka rasa kariyar abin alhaki ta kuɗi ta atomatik na kwanakin yayin da ƙarshen bita ke jiran sai dai idan QIO ya ƙa'ida don jin daɗin ku.

Shin iyaye na suna da haƙƙoƙin sallamar Medicare idan suna da tsarin Amfani na Medicare mai zaman kansa maimakon Original Medicare?¶

Ee, kowane mai cin gajiyar da ya yi rajista a cikin Tsarin Amfani na Medicare mai zaman kansa (Sashe na C) yana da haƙƙin haƙƙin ƙa'idar tarayya daidai don karɓar Saƙo mai mahimmanci daga Medicare (a asibiti) ko Sanarwa na Ba da ɗaukar hoto (a cikin ƙwararrun ma'aikatan jinya) da kuma shigar da ƙarar korar kai tsaye, mai zaman kanta tare da yankin BFCC-QIO (Acentra Health ko Livanta). Shiga tare da BFCC-QIO yana haifar da tsayuwar fitarwa ta atomatik yayin da likitocin QIO masu zaman kansu ke duba rikodin likita.

Ta yaya zan sami asibiti don canza mahaifana daga matsayin "Outpatient Observation" zuwa matsayin "Mai jinƙai" kafin su tafi?¶

Nemi yin magana kai tsaye tare da Likitan Halarci da Mai ba da Shawarar Amfani da Asibiti (UR) Likita yayin da iyayenku ke kwance a gadon asibiti. Nuna cewa iyayenku sun ketare ko kuma ana tsammanin za su haye tsakar dare biyu suna buƙatar kulawar matakin asibiti a ƙarƙashin Dokar Tsakar dare Biyu ta CMS, kuma ku nemi sake duba yanayin yanayi na 44 don canza matsayinsu daga Kulawa da Mara lafiya zuwa marasa lafiya na yau da kullun kafin a sallame su, ko kuma duba ko shirin su na Medicare Advantage ya ba da umarnin kula da marasa lafiya na kwanaki 3 ga ƙwararrun ma'aikatan jinya.

An duba tushe¶

• Cibiyoyin Medicare da Sabis na Medicaid (CMS, Amurka): * Manual Gudanar da Da'awar Medicare, Babi na 30: Kariyar Lamunin Kuɗi, Sanarwa na Ƙarfafawa na Asibiti (Form CMS-10065), da Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararru (Form CMS-10123)*.
• Cibiyoyin Kula da Medicare da Sabis na Medicaid (CMS, Amurka): Jimmo v. Sebelius Yarjejeniyar Matsawa Tabbataccen Tabbataccen Takaddun Shaida da Manufofin Amfanin Medicare Babi na 8 (Maintenance Coverage Coverage).
• Cibiyoyin Medicare da Sabis na Medicaid (CMS, Amurka): * Ƙoƙarin Ƙwararrun Ƙwararrun Ƙwararrun Asibiti daga Majiɓinci zuwa Matsayin Kula da Mara lafiya (CMS-4204-F / Alexander v. Azar)*.
• Ma'aikatar Lafiya da Kula da Jama'a da NHS Ingila (United Kingdom): * Fitar da Asibiti da Jagorar Tallafawa Al'umma (Fitar da Hanyoyi 0 zuwa 3 da Dokar Kulawa ta 2014 Dokokin Dokoki)*.
• Cibiyar Manufofin Jama'a ta AARP (Amurka): CARE (Bayar da Shawarar Kulawa, Rikodi, Taimakawa) Ka'idodin Aiwatar da Doka.

Jagora masu alaƙa¶

• Lalacewar asibiti, rudani kwatsam, da kuma babban shawara
• Cin zarafin gidan reno, sakaci, da korar da ba bisa ka'ida ba
• Tsofaffi sun farfaɗo lokacin da ya kasa tsayawa
• Ƙarfin wutar lantarki don masu tattara iskar oxygen, masu ba da iska, da CPAP
• Lambobin gaggawa na duniya