Jafe-jafe ab lopitaal bu wóorul wala bu teel wala génne Rehabilitasioŋ ngir mag¶

Hopitaal yi ak barabi soins infirmiye yi (SNFs) ñu ngi liggéey ci jafe-jafe xaalis ak bariwaayu lall ngir wàññi diiru malaad yi. Famiy yi dañuy faral di jox këyitu génnug paj mi ay waxtu yu néew rek ñu koy yëgal, doonte mag ba leegi mënul taxaw te amul ndimbal, mu des ci jaxasoo bu metti, soxla garab yu ñuy dugal ci vesóo, wala amul ku koy toppatoo ci kër ga. Jël ab këru mag bu amul dal wala bu mënul yëngu ci benn oto boppam ndax kilifag lopitaal bi dafa wax ni jotu assurance bi jeexna bokk na ci sabab yi gëna waral daanu yu metti, pneumonie aspiration, njuumti ci garab, ak readmissions ci salle d'urgence ci diiru 48 waxtu.

Am nga yelleef yuñ mëna tëral ci Etats Unis, Royaume-Uni, Canada, Australie, ak ci Mbootaayu Orop ngir dakkal teela bàyyi malaad bi ci hopitaal bi, ba noppi fexe ñu xoolaat malaad bi balaa muy génn ci batimaa bi. Gunaaw boo génnee sa mbokk ci buntu hopitaal bi ba noppi nga siñe këyitu génne gi, sa kiliftéef ci wàllu yoon ak assurance bi lay tere dëkk ci saasi dafay jeex. Soo tëyee malaad bi ci lal bi, ba noppi nga woote sàrti appel yu mat sëkk ci saasi, yaa ngi forse barab bi mu toppatoo faju bu mat sëkk ci jamono ji doktër yi ci biti di xoolaat tablo bi wala ci jamono ji ñuy waajal rehabilitasioŋ malaad bu wóor.

Defal lii leegi¶

1. Bañ siñe këyitu génne malaad bi wala yóbbu malaad bi seen kër. Wax infirmiye bi, doktër bi, ak kiy waajal génne malaad bi ci anam wu tekkaaral te leer: "Li ñu nara génne malaad bi wóorul dara. Amu nu tàggat yaram, doole yaram, wala jumtukaay ngir tëye malaad bi ci kër ga, te tay dunu ko def." Sudee malaad bi mingi dundu jafe-jafe wérgi-yaram yu mën ko ray te liggéeykat yi nangu wuñu ko, wool ekipu Rapid Response Team bi ci biir hopitaal bi wala nga woo sa nimero urgence bi la gëna jege (911 ci Etats Unis ak Canada, 112 ci biir Union Européenne, 999 ci Royaume-Uni) wala nga xool nimero paj mu jamp.
2. Laajteel ci saasi yëgle buy wax ni yelleefu àppal la. Ci Etats Unis, bépp malaad bu am Medicare ak Medicare Advantage dafa wara am formileer ofisel bu tuddu Mesaas bu am solo bu jóge ci Medicare (Formulaire CMS-10065) ci hopitaal bi wala *Yegle buy wax ni Medicare amul àpp (Formulaire CMS-10065).
3. Woowal agence appel bi moom boppam balaa bis biñ tëral. Ci Etats Unis, woo nimero telefonu Mbootaay biy Yokkatal Kalite Faju (BFCC-QIO) biñ imprime ci yëgle bi balaa xaaju guddi ci bis bi ñuy génne lopitaal (wala ci midi bis bi ñuy jeexal paj mi). Ci Royaume-Uni, jokkool ak Serwiisu Xelal Malaad yi ak Jokkoo (PALS) ak Matron Ward; ci Canada, jokkool ak ki yor malaad yi ci hopitaal bi.
4. Fàttaliku ñu jàngatwaat Terapi Fisik ak Terapi Liggéey ci bis bi. Laajteel doktër bi lay faj mu komànde Terapi Fisik (PT) ak Terapi Liggéey (OT) ci wetu lall, jàngat fonctionel buy wax ci toxal taxaw, diggante doxantu, toxal ak yéeg eskalier. Sudee PT wala OT dañu wane ni malaad bi dafa soxla ñaari nit ñu jàppale ko wala mënul jëfandikoo eskalier yi ñuy jaar ngir dugg ci kër gi, dafay tere malaad bi génn ci kër gi.
5. Xool bu baax ndax malaad bi dafa nekk ci hopitaal bi (Malaad bu nekk ci hopitaal bi ak Seetlu bi). Sudee sa waajur mingi ci hopitaal bu Etats Unis ci ndigalu Traditional Medicare, laajal ki yor dosiye bi ndax dañu leen jàppee ni "Malaad bu nekk ci hopitaal bi" wala "Seetlu bu nekk ci biti." Sudee dañu leen tëye ci biir Observation ay fan yu bari, laaj ñu xoolaat ci saasi komite biy xoolaat jëfandikoo lopitaal bi ngir soppi dëkkuwaay bi ci Inpatient balaa ñu leen di bàyyi suko defee Skilled Nursing Facility (SNF) coverage mëna tàmbali.
6. Dugalal sa ñaawtéefi kaaraange ci done medikaal biy yàgg. Yonnee ab mesaas bu gàtt, dëggu jaaraleko ci portaalu malaad bi (lu melni MyChart) wala nga jox ab bataaxal infirmiye bi yor paj mi ak kilifag dosiye bi, nga lim bépp jafe-jafe buy tere nit ñi ñibbi seen kër.

flowchart TD
    A["Hopitaal wala reehabilitaasioŋ xamlenañu ni dina ñu genne mag ñi"] --> B{"Ndax mag ñi mën nañu toxal, dem ci WC, wann ak yor seen kër ci jàmm?"}
    B -->|"Waaw: Baseline defaraat nañu ko te jumtukaay bi pare na"| C["Matt jëflante ak garab yi ak jàppale 7 fan ci topp"]
    B -->|"Déedet: Dellu sa kër wóorul"| D["Baña siñe këyitu génn wala yóbbu malaad"]
    D --> E{"Ban xeetu barab ak sistem wërgu yaram?"}
    E -->|"Hopitaal bu Etats Unis (Medicare wala Njariñu Medicare)"| F["Laaj bataaxal bu am solo ci Medicare (CMS-10065)"]
    E -->|"Soins infirmiers / Rehabilitasioŋ bu xarañ ci Etats Unis (SNF)"| G["Yegle buy wax ni Medicare duñu ko fayee (CMS-10123)"]
    E -->|"UK NHS / Canada / Australie / Assurance privée"| H["Dosie tëye bu mat sëkk ci PALS, Ombudsman malaad, wala Xoolaat Jëfandikoo"]
    F --> I["Woowal BFCC-QIO (Acentra wala Livanta) balaa xaaju guddi ci bis bi ñuy génne"]
    G --> J["Woowal BFCC-QIO ci midi balaa ñuy jeex"]
    I --> K["Dellu ci saasi: Hopitaal bi mënul dàq wala faktiir ci poos bi ci diiru xoolaat"]
    J --> K
    H --> L["Laajte PT/OT escalier ak toxal audit ak ndaje pajum multidisipliner"]
    K --> L

Xam sudee génnug lopitaal wala reabilitasioŋ amul kaaraange ci wàllu paj¶

Ñiy waajal génne mag ñi ci hopitaal dañuy faral di jàppee stabilisation médical bi ci diagnostic bu njëkk bi ñu def ngir yónnee mag ñi seen kër. Doktër bi mën na gis ni pneumonie bi malaad bi di am mingi wér ginaaw biñu ko jëlee antibiotik, wala ni barab bi ñu ko dagg dafa set, te bàyyiwul xel ni juróomi fan yu mu nekkee ci lal taxna malaad bu am 82 at mënatul woon jog ci WC bi wala génn ci WC bi. delirium lopitaal ak jaxasoo bu gaaw.

Laata ngay nangu benn bis ngir génne malaad bi, xoolal malaad bi ci juróom benni wàll ci wàllu kaaraange ak liggéey. Sudee malaad bi jàllul ci benn ci tegtal yii, te barab bi defaruwul paj mi 24 waxtu ci bis bi wala ñu koy toppatoo ci kër ga, kon génne ko ci paj mi wóorul dara.

Ni ñuy defee appel ci saasi ngir ñu génne leen ci hopitaal Medicare (Etats Unis)¶

Ci Etats Unis, yoon federal (42 CFR Wàll 405, Wàll J) dafay may bépp benefisieer bu Medicare bu njëkk bi wala palaŋu Medicare Advantage bu prive yelleef ñu xoolaat ko ci anam wu gaaw, moom boppam balaa ñu koy bàyyi ci lopitaal bimu nekkee malaad.

Jéego 1: Laaj "Mesaas bu am solo bu jóge ci Medicare" (Formileer CMS-10065)¶

Hopitaal yi dañu wara joxe yëgle federal bu am ñaari xët bu tuddu Mesaas bu am solo bu jóge ci Medicare ci sa yelleef (Form CMS-10065) ñaari yoon ci bépp dëkkuwaay malaad: ci diiru 2 fan ci kalendriye bi ñu ko jëlee, ak itam diggante 4 ak 48 waxtu laata ñu koy génne.

Siñe Formulaire CMS-10065 tekkiwul ni nangu nga ni malaad bi mën na ñibbi; dafay wane ni jot nañu nimero telefonu appel bi. Sudee hopitaal bi daf la wax ci baat ni tay lañuy bàyyi sa waajur te joxewul la ñaareelu kopi Form CMS-10065 bimu bind nimero telefon BFCC-QIO, waxal kilifag dosiye bi: "Joxeewoo mesaas bu am solo bu baax bu bawoo ci Medicare. Ci sàrti CMS, génne gi mënul nekk ba keroog ñu koy bàyyi."

Woowal BFCC-QIO balaa xaaju guddi ci bis bi ñuy génne¶

Medicare dafay déggoo ak kuréel yu moom seen bopp yuy saytu doktër yi, ñu tuddee ko ** Mbootaay yiy Yokkatal Kalite Fajkat yi ak Famiy yi (BFCC-QIOs)** ngir jëflante ak ñiy gaawa bàyyi paj mi: Acentra Health ak Livanta. Nimero QIO bi nga mëna woo te doo fay, mingi ci xët 1 ci këyitu CMS-10065 (wala nga woo 1-800-MEDICARE ci 1-800-633-4227).

• Waxtu xaaju guddi gi: Woowal BFCC-QIO balaa xaaju guddi (11:59 PM) ci bis biñ nara génne malaad bi ak balaa malaad bi di génn ci batimaa bi.
• 24/7 bataaxal baat ak limu def ci net bi: BFCC-QIO liiñ yiy jël nit ñi dañuy dox 24/7. Bàyyi ab mesaas baat wala ab intake ci net bi balaa xaaju guddi ak tur malaad bi, nimero Medicare, tur hopitaal, ak sa nimero woote ci yoon tëju ci appel ci waxtu. Bindal timestamp bi ak nimero firnde bi.

3ème étape: Xam bu baax ni discharge bi di doxee ci saasi ak aar xaalis¶

Soo defee appel ci waxtu wi war balaa xaaju guddi, loolu mooy tax ñu bàyyi la ci saasi**: 1. Hopitaal bi mënul forse malaad bi mu dem: Lall bu fees, toppatoo infirmiye, ak pajum medsin dañu wara wéy ci diiru xoolaat QIO. 2. Amul benn lall bu génn ci sa poos ci diiru appel bi: Hopitaal bi mënul faktire malaad bi ci poos bi ngir bis yi mu nekk ci hopitaal bi doktër QIO yi di xoolaat tablo bi, doonte QIO bi dafa mujjee weddi sa appel. 3. Yegle bu leer ci génne (CMS-10066): Soo defee appel, hopitaal bi dafa wara joxe yëgle bu bind balaa midi ci ëlëg sa, di wax sabab yi tax ñu jàpp ni soxlaatul paj mu tar ci hopitaal bi.

4ème étape: Defal sa dosiye clinique directement reviseur QIO¶

Su BFCC-QIO woowaat (ci diiru 12 ba 24 waxtu), wax ci ay mbiri klinik yu jëm ci tablo biy wane ni pajum feebar bi amul dal wala soxla coppite bu wóorul: - "Malaad bi dafa am delirium hypoactif bu metti 48 waxtu ci ginaaw, mingi des ci suufu baseline cognitif, di sëqët suy wann lu ndoxe." - "Terapi physique bi dafa bind démb ni malaad bi soxla na ñaari nit ñu jàppale ko mu mëna toxu te mënul yéeg ci 6 escalier yi ngir dugg ci seen kër." - "Malaad bi 3 waxtu ci ginaaw la joge ci garab yi ñuy dugal ci deret ji dem ci garab yi ñuy jël ci gémmiñ, te ba leegi kenn xamul ndax dina mëna wéy ci 24 waxtu yi." - "Malaad bi dafa bëgg ñu yóbbu ko ci daara ju mag juy faj malaad yi (SNF), te kilifa yi yor paj mi amagul lall bu koy nangu."

Lan mooy xew su QIO jëlee dogalam¶

BFCC-QIO dafa wara xoolaat done pajum yi ba noppi jël dogal ci diir bu weesuwul 24 waxtu ginaaw bimu joxee dosiye hopitaal bi. - Appel approved: Yegleb génne malaad bi amul benn njariñ te Medicare dafay wéy ba malaad bi wér wala ñu toxal ko ci jàmm. - Appel biñu bañ: Amul dara luñu la wara fay ci 24 ba 48 waxtu yiñ xoolaat. Responsabilite bi génn ci sa poos mingi tàmbali 12:00 midi ci bis bi QIO la yëgal ni dañu la bañ. Def appel ba leegi mingi am 36 ba 48 waxtu yuñ mëna jëfandikoo ngir waajal jumtukaayi kër gi wala plasement rehab, te dina tax ñu laaj ci saasi Niveau 2 Reconsideration ci Contracteur Indépendant Qualified (QIC).

Medicare "Tolluwaayu Seetlu" vs. "Tolluwaayu Malaad" fiir¶

Benn jafe-jafe xaalis bu bari ci mag ñi ci Etats Unis mooy Medicare ñatti xaaju guddi malaad ak "Status Observation Outpatient." Mag mën na ñëw ci ambulance, nekk ci néegu hopitaal bi ci kaw, jot garab IV, ba noppi toog ñeenti guddi ci biir ordinatër Serwiis** moo gën ñu tëye malaad.

Lan moo waral tolluwaayu seetlu bi dafay tere fasilite infirmiye yu xarañ (SNF)¶

Ci Medicare Traditional Part A, Medicare du fay ludul ngir faj malaad bi ginaaw lopitaal bi (SNF) sudee malaad bi dañu ko tëye ci hopitaal bi lu mu néew ñetti xaaju guddi yu toppalante ** (te du ci bokk waxtu salle d'urgence ak xaaju guddi yi ñuy seetlu). Def 2 xaaju guddi ci seetlu ak 1 xaaju guddi nekk malaad bu amul benn coverage Medicare Traditional ngir SNF rehab, di fësal njaboot yi ci laaj yu ñuy fay 400 ba 700 dolaar bis bu nekk.

flowchart TD
    A["Senior ñu ngi ko tëye ci lalu hopitaal ci saalu pajum"] --> B["Laajteel infirmiye bi wala kilifag dosiye bi ci bis 1 bi: Ndax nekkin bi dafay nuru seetlu malaad bu mat sëkk wala bu nekk ci biti?"]
    B -->|"Status malaad bu mat sëkk"| C["Lim xaaju guddi yu toppalante ginaaw biñu defee santaane jël malaad ci hopitaal bi"]
    B -->|"Tolluwaayu seetlu malaad bi nekk ci biti"| D{"Ndax malaad bi defna lu ëpp 24 waxtu ci hopitaal bi?"}
    C --> E{"Lu mu neew 3 malaad yu toppalante ci xaaju guddi?"}
    E -->|"Waaw"| F["Dafa mëna am Medicare bu cosaan bi, pàcc A, barabu infirmiye bu xarañ (SNF)"]
    E -->|"Déedet"| G["Laajteel doktër bi ak xoolaat jëfandikoo gi ngir yokk àppu malaad bi sudee feebar bi daa sonn"]
    D -->|"Waaw: Lu ëpp 24 waxtu"| H["Laaj Formulaire MOON (Yegle buy seetlu malaad yi ci Medicare)"]
    H --> I["Laajteel Doktër bi lay toppatoo mu jokkool ak Xoolaat Jëfandikoo gi ngir soppi nekk Malaad bu tëdd ci sàrtu Ñaari Xaju Guddi"]
    I --> J{"Ndax malaad bi amna njariñu Medicare wala Medicare bu njëkk bi?"}
    J -->|"Njariñu Medicare"| K["Saytu ndax palaŋ bi dafay bàyyi sàrti 3 fan yi malaad yi tëral ngir reehabilitasioŋ SNF ci biir reso bi"]
    J -->|"Medicare bu njëkk"| L["Dosie appel buy delloo ginaaw wala bu gaaw ci sàrti Alexander v. Azar sudee denc nañu ko ci seetlu 3+ fan"]

Ni ñuy saytu ak di ñaawlu tolluwaayu seetlu bi balaa ñuy genni hopitaal bi¶

1. Suba bu nekk laajal laaj biy wane ni malaad bi di doxee: Xoolal bis bu nekk ak doktër bi koy toppatoo ak kilifag dosiye bi ndax malaad bi mingi ci ndigalu malaad bu mat sëkk wala ñu koy saytu ci biti.
2. Xool formileeru MOON (CMS-10495): Hopitaal yiy tëye malaad Medicare ci seetlu lu ëpp 24 waxtu dañu wara joxe Yegle buy seetlu malaad bu Medicare (MOON) ci diir bu weesuwul 36 waxtu.
3. Woo CMS ñaari xaaju guddi Regle ak Utilization Review: Ci CMS Two-Midnight Rule, sudee doktër bi dafa xaar malaad bi soxla pajum lopitaal ci diiru ñaari xaaju guddi, dafay baax ñu dalal malaad bi. Laajteel Doktër bi lay toppatoo ak Xoolaat Jëfandikoo gi (UR) Xoolaat Doktër bi ngir Xoolaat Kodu 44 ci saasi ngir soppi tolluwaayu Seetlu bi ci Inpatient bu mat sëkk balaa ñu koy bàyyi.
4. Jëfandikool Alexander v. Azar (CMS-4204-F) Yelleefu Appel Seetlu: Ñi am Medicare ñu jëlaat leen ci malaad yi ñu def ci Seetlu (wala ñu denc leen ci hopitaal 3+ fan te amul pàcc A SNF) amnañu yelleefu appel administratif federal jaaraleko ci QIO.
5. Xool Medicare Advantage 3-Day Regle Waivers: Lu ëpp 80 pursaa ci palaŋu Medicare Advantage (Part C) yi dañuy bàyyi 3 fan yi malaad bi wara nekk ci hopitaal ba noppi may ñu toxal ko ci reehabilitaasioŋ SNF bi ci biir reso bi.

Dakkal génnug paj mu teel ci Daaray infirmiye yu xarañ (SNF) wala santu rehabilitasioŋ¶

Lu tollu ci Bis 10 ba Bis 21 ci barabu infirmiye bu xarañ (SNF), dañuy faral di wax njaboot yi: "Medicare du fay ludul 20 fan, wala sa waajur dafa plateau ci terapi physique, kon coverage bi dafay jeex ci 48 waxtu." Ñari wax ji dañuy faral di juum ci yoon federal Medicare.

Léeboon 1: "Medicare du fay ludul 20 fan ci reabilitasioŋ"¶

Medicare Part A dafay fay ba 100 fan ci faju infirmiye bu xarañ ci diiru benefiis bu nekk fu malaad bi soxla infirmiye bu xarañ bis bu nekk wala terapi rehabilitasioŋ bu xarañ (PT, OT, wala Terapi Kaddu 5 fan ci ayu-bis bi). Bis 1 ba 20 dañuy àndaale ak $0 copay, waaye bis 21 ba 100 dañuy àndaale ak assurance buñ tëral bis bu nekk (Medigap Plans G wala F, wala Medicaid moo koy fay lépp). Ndax delloo xaalis bi dafay wàññeeku ginaaw ñetti ayu-bis, fasilite yi dañuy faral di fitnaal njaboot yi ñu teela genni doonte ñu ngi wéy di soxla xam-xam.

Léeboon bi: "Dañuy bàyyi sa waajur ndax dañu plateau" (Jimmo v. Sebelius Resemblement)¶

Rehabilitation yi dañuy faral di juum ci dakkal coverage sudee malaad bi am AVC, feebaru Parkinson, wala dementia dafa bàyyi wane njariñ yu gaaw ci dox. Ci wàllu déggoo bu federaal bi Jimmo v. Sebelius (Téere biy wax ni ñuy joxe njariñu Medicare, Chapitre 8), SNF bu Medicare ak wàllu faju ci kër nekkul ci ni malaad bi mënee yokku.

Ni ñuy ñaawee ab këru infirmiye bu xarañ (Formulaire NOMNC CMS-10123)¶

1. Laaj yëgle biy wax ni Medicare du la faj (NOMNC, Formileer CMS-10123): SNF dafa wara joxe formileer bii 2 fan ci kalendriye bi (48 waxtu) balaa faj Medicare di jeex.
2. Woowal BFCC-QIO balaa 12:00 waxtu ci bëccëg bis bi laataa coverage bi di jeex: Wuute ak appel lopitaal yi (xaju guddi ci bis bi ñuy génne), ci barabu infirmiye bu xarañ danga wara woo nimero BFCC-QIO ci NOMNC **balaa 12:00 waxtu ci bëccëg ci bis bi BEFOnds.
3. Laaj leeral yu leer ci ñàkka am paj mi (DENC, Formulaire CMS-10124): Soo defee appel, barab bi dafa wara joxe DENC bu bind buy wax sabab yi gëna jubal ci klinik bi ak ci loxo ngir dindi ko.
4. **Laaj 2ème niveau de reconsideration ak ndimbalu Ombudsman su ko soxlaa:**Suñu bañee appel QIO bu njëkk ci SNF, laajal ci saasi **Gaaw 72-waxtu 2e Contracteur Independent (QIC) te jokkool ak **Ombudsman **Long-T Sudee ab këru mag ñi dafay jéema dàq ab dëkk kat ci yónnee ko ER te baña nangu ñu delloo ko ("dumping hopitaal"), toppal sunu tegtal ci tortu ci këru mag ñi, càggante, ak dàq ci anam wudul yoon.

Aar ci wàllu génnug ndox ci àdduna bi: Royaume-Uni, Canada, Australie, ak EU¶

Bépp sistemu wérgi-yaram bu mag amna ay sàrt yuñ tëral yuy tere hopitaal yi bàyyi mag ñi ñu yor ci seen kër te amul benn palaŋu pajum buñu xool bu baax.

Royaume-Uni (NHS): PALS, génn ngir saytu, ak NHS wéyal pajum wérgi-yaram (CHC)¶

Ci wàllu NHS Angleterre Déglu Hopitaal ak Njàngalem Jàppale Dëkkandoo ak Sàrtu Toppatoo 2014, NHS wóolu dafay jëfandikoo ñeenti Déglu ngir Natt (D2A) yoon: Yoon 0 (delloosi bu yomb te amul soxla bu bees), Yoon 1th Pa2ment (Kër **2), rehabilitasioŋ bu yam ci lall), ak Yoon 3 (plasement soins infirmier bu 24 waxtu ci bis bi).

Sudee saal bi dafay jéema bàyyi mag ku néew doole ci Pathway 0 wala Pathway 1 balaa liggéeykat yiy toppatoo dañuy ñëw seeti ko: 1. Jokkool ak njiitu saal bi (soxna / infirmiye bi yor) ak Serwiisu Xelal Malaad yi ak Jokkoo (PALS) bu hopitaal bi ci saasi. 2. Wax ci bind: "Lii ab genn gu wóorul la. Ci wàllu Care Act 2014 ak NHS Discharge Guidance, deñuy laaj ab natt bu bari ci anam yu bari ngir Pathway 2 lall bu diggido, ab NHS Continuing Healthcare (CHC) Limu saytu bu mëna joxe balaa ab genn, ak benn famiy buy saytu Toppatoo 24 waxtu ci bis bi."

Doxal Sàrtu CARE: Sa yelleef ci yoonu etaa bi nga nekk kiy toppatoo sa njaboot¶

Lu ëpp 44 etaa ak territoire ci Etats Unis tëral nañu sàrtu CARE (Digal kiy toppatoo, bind, may) Sàrtu. Ci sàrtu CARE, hopitaal yi dañu wara def ñatti mbir balaa ñuy bàyyi malaad bi ci këram: 1. Bindal kiy toppatoo njaboot gi: Jox malaad bi ràññeekaay biñu koy jël mu tànn ki koy toppatoo ci tablo bi. 2. Yégal laata ngay bàyyi wala nga toxal la: Yégal ki lay toppatoo biñu bindee komànd bi laata ngay génn. 3. Joxe tàggat ci liggéey yi ci wàllu pajum : Joxe njàngale ci saasi ak jàngale ci làkk wu leer ci bépp liggéeyu pajum ci kër, lu ci melni faj ab góom bu amul doom, pikiir ci suufu der (lu melni insulin wala enoxaparin), joxe ñam ci tube, masin yuy joxe oxygen ci kër, ak

Ni ñuy jëfandikoo CARE Act ngir dakkal génnug yaram bu teel: Sudee infirmiye bi daf la jox seringe, sac kateter, wala gaze ngir góom te doo ko tàggat, baña siñe. Wax: "Ci sunu sàrtu CARE bu etaa bi, hopitaal bi dafa wara joxe njàngale ci saasi ba noppi xool ndax kiy toppatoo famiy bi mën na def bépp liggéeyu pajum ak yéegal malaad balaa ñu koy bàyyi. Kenn ci kër gi mënul yéegal malaad bi ci jàmm. Nanga def ci këyit ni Sàrtu CARE bi làaj tegu ñu ko."

Baatu-ci-baatu script ngir fësal ndaje lopitaal yu am doole¶

Yenn saa yi kilifay dosiye yi ci hopitaal yi dañuy wax ni "Medicare dina bàyyi fay, te dinga am 3,000 dolaar bis bu nekk," wala "Soo jëlee sa waajur balaa 15h00, dina nu yëgal mag ñi ñu bàyyi leen."

Xam dëgg gi nekk ci yoon: baña jël malaad ci hopitaal bu am lijjaassa buy liggéey 24 waxtu ci bis bi wala barabu infirmiye ndax amoo doole physique, tàggat yaram, wala barab bu wóor ngir toppatoo ko ci kër DU bàyyi mag. Ci biir hopitaal, malaad bi dafa wara nekk ci ndigalu doktër bu am lijjaassa bu koy toppatoo. Waaye, yóbbu mag ñi tëdd ci lal wala ñu delirium ci kër gu wóorul fuñu daanu mën na tax Serwiisu Aar Màgget (APS) amal lànket ci càggante.

Script 1: Su waajal génne doktër bi waxee "Doktër bi bind na komànd génne tay ci 2:00 PM"¶

"Sama waajur nekkul ci seen baseline fonctionnel wala cognitif te mënu ñu dem ci WC wala yéeg ci escalier yi ngir dugg ci seen kër. Kenn ci kër gi mënul leen yéeg. Danuy ñaawlu bu baax ni decharge bi wóorul. BFCC-QIO ngir ñu gaaw ci génne ko ci paj mi, nga woo doktër bi koy faj ak Terapi Fisio ngir ñu jàngat kaaraange gi ci toxal."

Script 2: Mesaas buñ bind ngir dugal ko ci portaalu malaad bi (MyChart)¶

"Ci: Doktër biy faj, infirmiye bi yor paj mi, ak ki yor paj mi / xoolaat jëfandikoo gi. Re: [Turu malaad bi, DOB, néeg]. Nanga def lii ci dosiye pajum permanent bi. Sunu famiy dafay yëgal ekipu fajkat bi ni li ñu nara bàyyi malaad bi ci kër gi ci [Bis] amul benn sikk ci wàllu paj. ci boppam te leer na ci xel. Fi ñu tolli nii, [Turu malaad bi] soxla na ñaari nit ñu koy jàppale ngir mëna taxaw, te mënul jëfandikoo garab yi wala dem ci WC moom kese. jàngat bu bees, seeti Geriatrics, ak yóbbu malaad yi ci daara ju mag jiy faj malaad yi Tambali nanu ñu gaaw ci génne malaad yi ci BFCC-QIO (Fàttaliku #[Nimero])."

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

"Please provide the written Notice of Medicare Non-Coverage (NOMNC, Form CMS-10123) immediately. Under the federal Jimmo v. Sebelius settlement and Chapter 8 of the Medicare Benefit Policy Manual, Medicare Part A SNF coverage does not require continuous improvement. Skilled therapy and nursing are covered whenever necessary to maintain current function or prevent deterioration. My parent still requires daily skilled physical therapy and nursing monitoring to prevent falls and contractures, and we are filing an expedited appeal with the BFCC-QIO before noon tomorrow."

What to do BEFORE you ever accept a valid discharge¶

Once the patient is medically stable or a safe rehab transfer or home care plan is finalized, complete this Five-Point Safe Exit Audit before leaving:

• 1. Line-by-Line Medication Reconciliation ("Brown Bag Audit"): Sit down with the discharge nurse or pharmacist and review every home medication alongside every new hospital prescription, confirming in writing: Continue at same dose, Change dose, Stop permanently, or Start new medication.
• 2. "Medications in Hand" Before Leaving: Ask the hospital's in-house outpatient pharmacy ("Meds-to-Beds" program) to fill and deliver all new prescriptions to the bedside before departure so you verify insurance prior authorizations and copays on the spot.
• 3. Durable Medical Equipment (DME) Physically Inside the Home: Verify that any ordered walker, bedside commode, shower chair, hospital bed, Hoyer lift, or oxygen concentrator is already inside the house before exit. For oxygen-dependent patients, review power outage preparation for oxygen concentrators, ventilators, and CPAP.
• 4. Written Home Health Agency Name, Phone Number, and First Visit Date: Get the exact name of the accepting Home Health Agency, their 24-hour phone number, and confirmation that the nurse's Start of Care (SOC) visit is scheduled within 24 to 48 hours.
• 5. Red-Flag Callback Number and 7-Day Follow-Up Appointment: Obtain a 24-hour clinical callback number for the discharging team, a printed Discharge Summary, and a follow-up appointment scheduled within 5 to 7 days. If your loved one falls at home, follow our guide on elderly fall recovery when unable to stand.

Laaj yi ñuy faral di laaj¶

Can a hospital call the police or charge me with elder abandonment if I refuse to pick up my parent who is unsafe to come home?¶

No, refusing to take physical custody of a medically unstable or functionally immobile patient from a licensed 24-hour hospital or skilled nursing facility because you cannot safely care for them at home does not constitute criminal elder abandonment. Inside a hospital, the patient is in a secure medical environment under the legal duty of care of licensed clinicians, whereas taking a dependent senior home to an unsafe environment without lifting help exposes them to severe injury. Stay calm, state in writing that you remain actively involved in their care planning, and explain that you are exercising your statutory right to appeal an unsafe discharge until safe rehabilitation or home care is arranged.

What happens if I miss the midnight deadline on the day of hospital discharge to call the Medicare QIO?¶

If you miss the midnight deadline on the scheduled day of discharge (or the 12:00 noon day-before deadline in a Skilled Nursing Facility) but the patient is still physically inside the facility, call the BFCC-QIO immediately anyway. Under federal Medicare regulations, the QIO will still accept a late appeal from an inpatient and conduct an independent medical review within 2 calendar days, although you lose automatic financial liability protection for the days while the late review is pending unless the QIO rules in your favor.

Does my parent have Medicare discharge appeal rights if they have a private Medicare Advantage plan instead of Original Medicare?¶

Yes, every beneficiary enrolled in a private Medicare Advantage (Part C) plan has the exact same federal statutory right to receive the Important Message from Medicare (in a hospital) or the Notice of Medicare Non-Coverage (in a skilled nursing facility) and to file an immediate, independent discharge appeal with the regional BFCC-QIO (Acentra Health or Livanta). Filing with the BFCC-QIO triggers the same automatic stay of discharge while independent QIO physicians review the medical record.

How do I get a hospital to change my parent from "Outpatient Observation" status to "Inpatient" status before they leave?¶

Ask to speak directly with the Attending Physician and the Hospital Utilization Review (UR) Physician Advisor while your parent is still in the hospital bed. Point out that your parent has crossed or is expected to cross two midnights requiring hospital-level care under the CMS Two-Midnight Rule, and request a formal Condition Code 44 review to convert their status from Outpatient Observation to formal Inpatient prior to discharge, or check whether their Medicare Advantage plan waives the 3-day inpatient rule for Skilled Nursing Facility rehab.

Saytu nañu ay balluwaay¶

• Centers for Medicare and Medicaid Services (CMS, United States): Medicare Claims Processing Manual, Chapter 30: Financial Liability Protections, Hospital Discharge Appeal Notices (Form CMS-10065), and Skilled Nursing Facility Fast-Track Appeals (NOMNC Form CMS-10123).
• Centers for Medicare and Medicaid Services (CMS, United States): Jimmo v. Sebelius Settlement Agreement Fact Sheet and Medicare Benefit Policy Manual Chapter 8 (Maintenance Coverage Standard).
• Centers for Medicare and Medicaid Services (CMS, United States): Medicare Appeals of Hospital Reclassifications from Inpatient to Outpatient Observation Status (CMS-4204-F / Alexander v. Azar).
• Department of Health and Social Care and NHS England (United Kingdom): Hospital Discharge and Community Support Guidance (Discharge to Assess Pathways 0 to 3 and Care Act 2014 Statutory Duties).
• AARP Public Policy Institute (United States): The CARE (Caregiver Advise, Record, Enable) Act Statutory Implementation Standards.

Gid yu jëm ci loolu¶

• Delirium lopitaal, jaxasoo bu gaaw, ak kàddu mag ñi
• Nursing home abuse, neglect, and illegal eviction
• Màgget ñi dañuy wér suñu mënu ñu taxaw
• Power outage for oxygen concentrators, ventilators, and CPAP
• Nimero urgence global