![]() Challenging Hospital Discharge Decisions - CANHRChallenging Hospital Discharge Decisions. Introduction. Hospital stays are difficult times for patients and their families, especially for those who need long term care upon discharge. Increasingly short hospital stays pose a tremendous challenge to families who have to arrange post- hospital care very quickly while also tending to their loved one's illness and emotional needs. Hospitals have important duties to help patients and their families find and arrange needed care, however, some do this better than others and these duties are often compromised by the desire (usually financial) to discharge patients quickly. You may find it is critical to know your rights and how to exercise them. This fact sheet describes California and federal requirements for safe discharge planning, Medicare coverage and appeal rights, and ways to prevent a premature or inappropriate discharge. Hospital Requirements Prior to Transfer to a Health Facility. The cases and matters on this page are categorized by the title of the ADA under which the respondent is covered (e.g., Employment, Title I: State and Local. A US based organization dedicated to the promotion and development of amateur sports. Event calendar, associations listings, insurance information, and contact. SOME INFORMATION FROM THE 5/16/16 CCR MENTAL HEALTH SUB-WORK GROUP MEETING AND ACCREDITATION ADVICE CCOFFA CLARIFICATION: I, Jerry Johnson, am the sole. Before a hospital can transfer a patient to another health facility, the hospital must make arrangements for admission to the health facility. Code of Regs. Section 7. The hospital must also have a determination from the patient’s physician that the transfer will not create a hazard to the patient. Code of Regs. Section 7. In addition, the hospital must give the patient or the person legally responsible for the patient a minimum of 2. Code of Regs. Section 7. Health and Safety Code Section 1. A new law (Senate Bill 6. You have these rights whether you are enrolled in the original Medicare plan or a Medicare health plan. Hospitals have a strong financial incentive to discharge Medicare patients as quickly as possible. Medicare generally pays hospitals flat rates based on the type of medical problem being treated. If the hospital spends less money on your care than Medicare pays, it makes money, and vice versa. To protect you from being discharged too quickly, Medicare gives you the right to appeal hospital discharge decisions. It also requires the hospital to provide any discharge planning services you need. Your Medicare Rights. At or near admission, a hospital must give you the Important Message from Medicare. This Medicare notice explains that you have the right: To receive Medicare covered services, including necessary hospital services and services you may need after discharge, if ordered by your doctor. You have a right to know about these services, who will pay for them, and where you can get them. To be involved in any decisions about your hospital stay, and know who will pay for it. To appeal if you think you are being discharged too soon. The notice also explains how to file an appeal. Notifying You of Your Rights. To make sure you are informed about your discharge rights in a timely manner, hospitals must usually give you the Important Message from Medicare twice, once upon admission and again before discharge. The hospital must first give you the Important Notice from Medicare at or near admission, but no later than two days after admission. At that time it must ask you to sign and date the notice. The hospital must give you the original copy of the signed notice and keep a copy for its records. Before you are discharged, the hospital must give you another copy of the Important Message from Medicare. It must give you this notice as far in advance of your discharge as possible, but no more than 2 days before your planned date of discharge. The second notice is not required during very short hospital stays if the original notice was given to you within two days of your planned discharge date. If the hospital gives you the second notice on the date of your discharge, it must deliver it to you at least four hours before your planned discharge. The hospital must deliver the Important Message from Medicare to you in person. However, if you cannot understand the notice, the hospital must deliver it to your representative and ask him or her to sign it. Your representative can be someone who has legal authority to act for you, a family member or close friend. Appealing Hospital Discharge Decisions. Your hospital, doctor, or Medicare health plan will inform you of your planned date of discharge. If you think you are not ready to leave the hospital, tell your doctor and the hospital staff immediately about your concerns. Ask your doctor to advocate for your interests. Sometimes hospitals and health plans pressure doctors to arrange quick discharges. You should request an appeal if your concerns about early discharge are not resolved. You can stay in the hospital and Medicare will continue to cover your stay as long as you file the appeal before you are discharged. Once you appeal, you will not have to pay for the services you receive during the appeal (except for charges like copays and deductibles). It is best to file your appeal on or just before the planned date of discharge. Ask for an . Livanta is a . Tell Livanta why you object to the planned discharge and provide any information that supports your appeal. For more information about Livanta or appeals, go to the Livanta web site at http: //bfccqioarea. After you file your appeal, the hospital (or your Medicare health plan) must give you a Detailed Notice of Discharge that explains the reasons it thinks you are ready to be discharged. The hospital will send a copy of your medical records to Livanta for its review. These appeals are completed quickly. Livanta will notify you and the hospital of its decision, usually within one day after it receives the necessary information. If Livanta finds that you are not ready to be discharged, Medicare will continue to cover your hospital stay. If Livanta finds you are ready to be discharged, Medicare will continue to cover your services until noon of the day after Livanta notifies you of its decision. Livanta must notify you of its decision by telephone and in writing. The written notice will describe additional options for appeal. Discharge Planning Services. Medicare certified hospitals must help patients arrange care needed after discharge. This service, called discharge planning, is usually provided by the hospital’s social work or discharge planning department. Contact the discharge planning department as soon as possible after admission. Discuss help and care you will need after discharge. Ask for recommendations and help in arranging necessary care and services. Request a copy of your written discharge plan and seek changes if necessary. Medicare certified hospitals must: Identify your anticipated discharge needs within 2. Provide discharge planning assistance for every patient; Identify discharge goals, your preferences, and services you need and their availability; Assess whether you can get needed care where you had been living; Share a list of nearby home health agencies or nursing homes if their services are indicated; Discuss evaluation results with you; Prepare and share with you a transfer summary that includes the treatment plan and instructions on post- hospital care; Use professional staff to deliver discharge planning services; Ensure that necessary care and services are delivered upon discharge; Prepare you and your family for discharge and your post- hospital care needs through education and counseling; Transfer or refer you, along with necessary medical information, to appropriate facilities, agencies or outpatient services, as needed, for follow–up care. Additional California hospital discharge planning requirements are established at California Health and Safety Code Sections 1. This information must include contact information for the area agency on aging serving your county of residence, local independent living centers, or other information appropriate to your wishes and needs. It must also identify affiliated health care providers so you will know if the hospital has a financial interest in the referral. The hospital cannot force you to go to any particular facility. Check CANHR’s website at www. You do not have to go to a facility that cannot meet your needs. Ask the hospital to help you gain admission to nearby facilities that meet your care standards. If you want Medicare or Medi–Cal to help pay for your care, now or in the future, limit your search to facilities that are certified by these programs. Medicare covers hospital stays until a skilled nursing facility bed is located. Ask to speak with the hospital Risk Manager and let them know you are unhappy with your discharge plan. If a hospital proposes an inappropriate discharge, you may refuse to go. Although you cannot stay in a hospital indefinitely, the hospital cannot discharge someone needing long term care until it arranges safe and adequate follow–up care. California state policy and some local ordinances prohibit hospitals from discharging their patients to homeless shelters or to the streets. Remember, if the hospital is proposing to transfer the patient to a health facility, like a nursing home, it must “have arrangements” made for the admission. So if the patient makes it clear to the receiving health facility that the patient will refuse admission, will not sign an admission agreement, and will not pay for any services, it is unlikely the hospital can claim that arrangements have been made. Filing Complaints. Call Livanta at 1–8. To make a complaint, call the district office of the DPH Licensing and Certification Division for your area. District office phone numbers are available on CANHR’s web site at http: //canhr. Call 1–8. 00–4. 34–0. HICAP office in your California County or go to www. Medicare and HICAP in California. Hospital - Wikipedia. During peacetime, hospitals can be indicated by a variety of symbols. For example, a white 'H' on a blue background is often used in the United States. During times of armed conflict, a hospital may be marked with the emblem of the red cross, red crescent or red crystal in accordance with the Geneva Conventions. A hospital is a health care institution providing patient treatment with specialized medical and nursing staff and medical equipment. The best- known type of hospital is the general hospital, which typically has an emergency department to treat urgent health problems ranging from fire and accident victims to a heart attack. A district hospital typically is the major health care facility in its region, with large numbers of beds for intensive care and additional beds for patients who need long- term care. Specialised hospitals include trauma centres, rehabilitation hospitals, children's hospitals, seniors' (geriatric) hospitals, and hospitals for dealing with specific medical needs such as psychiatric treatment (see psychiatric hospital) and certain disease categories. Specialised hospitals can help reduce health care costs compared to general hospitals. The medical facility smaller than a hospital is generally called a clinic. Hospitals have a range of departments (e. Some hospitals have outpatient departments and some have chronic treatment units. Common support units include a pharmacy, pathology, and radiology. Hospitals are usually funded by the public sector, by health organisations (for profit or nonprofit), by health insurance companies, or by charities, including direct charitable donations. Historically, hospitals were often founded and funded by religious orders, or by charitable individuals and leaders. However, there are various Catholic religious orders, such as the Alexians and the Bon Secours Sisters that still focus on hospital ministry in the late 1. Christian denominations, including the Methodists and Lutherans, which run hospitals. Middle Ages hospitals were almshouses for the poor, hostels for pilgrims, or hospital schools. Another noun derived from this, hospitium came to signify hospitality, that is the relation between guest and shelterer, hospitality, friendliness, and hospitable reception. By metonymy the Latin word then came to mean a guest- chamber, guest's lodging, an inn. The latter modern word derives from Latin via the ancient French romance word hostel, which developed a silent s, which letter was eventually removed from the word, the loss of which is signified by a circumflex in the modern French word h. The German word 'Spital' shares similar roots. The grammar of the word differs slightly depending on the dialect. In the United States, hospital usually requires an article; in the United Kingdom and elsewhere, the word normally is used without an article when it is the object of a preposition and when referring to a patient (. Hospitals usually are distinguished from other types of medical facilities by their ability to admit and care for inpatients whilst the others, which are smaller, are often described as clinics. General. Larger cities may have several hospitals of varying sizes and facilities. Some hospitals, especially in the United States and Canada, have their own ambulance service. District. In Germany specialised hospitals are called Fachkrankenhaus; an example is Fachkrankenhaus Coswig (thoracic surgery). A hospital may be a single building or a number of buildings on a campus. Many hospitals with pre- twentieth- century origins began as one building and evolved into campuses. Some hospitals are affiliated with universities for medical research and the training of medical personnel such as physicians and nurses, often called teaching hospitals. Worldwide, most hospitals are run on a nonprofit basis by governments or charities. There are however a few exceptions, e. China, where government funding only constitutes 1. Chinese sources seem conflicted about the for- profit/non- profit ratio of hospitals in China)Specialised hospitals can help reduce health care costs compared to general hospitals. For example, Narayana Health's Bangalore cardiac unit, which is specialised in cardiac surgery, allows for significantly greater number of patients. It has 3. 00. 0 beds (more than 2. American hospital) and in pediatric heart surgery alone, it performs 3. In some countries like UK exists the clinical attachment system that is defined as a period of time when a doctor is attached to a named supervisor in a clinical unit, with the broad aims of observing clinical practice in the UK and the role of doctors and other healthcare professionals in the National Health Service (NHS). Clinics. Clinics generally provide only outpatient services. Departments or wards. Hospitals may have acute services such as an emergency department or specialist trauma centre, burn unit, surgery, or urgent care. These may then be backed up by more specialist units such as the following: In addition, there is the department of nursing, often headed by a chief nursing officer or director of nursing. This department is responsible for the administration of professional nursing practice, research, and policy for the hospital. Nursing permeates every part of a hospital. Many units or wards have both a nursing and a medical director that serve as administrators for their respective disciplines within that specialty. For example, in an intensive care nursery, the director of neonatology is responsible for the medical staff and medical care while the nursing manager/director for the intensive care nursery is responsible for all of the nurses and nursing care in that unit/ward. Some hospitals have outpatient departments and some have chronic treatment units such as behavioral health services, dentistry, dermatology, psychiatric ward, rehabilitation services, and physical therapy. Common support units include a dispensary or pharmacy, pathology, and radiology. On the non- medical side, there often are medical records departments, release of information departments, information management (a. IM, IT or IS), clinical engineering (a. In ancient Greece, temples dedicated to the healer- god Asclepius, known as Asclepieia functioned as centres of medical advice, prognosis, and healing. Fa Xian, a Chinese Buddhist monk who travelled across India ca. The heads of the Vaisya . All the poor and destitute in the country, orphans, widowers, and childless men, maimed people and cripples, and all who are diseased, go to those houses, and are provided with every kind of help, and doctors examine their diseases. They get the food and medicines which their cases require, and are made to feel at ease; and when they are better, they go away of themselves. This text, which describes the building of a hospital is dated by Dominik Wujastyk of the University College London from the period between 1. B. C. Wujastyk, the description by Fa Xian is one of the earliest accounts of a civic hospital system anywhere in the world and, coupled with Caraka's description of how a clinic should be equipped, suggests that India may have been the first part of the world to have evolved an organised cosmopolitan system of institutionally- based medical provision. This is the earliest documentary evidence we have of institutions specifically dedicated to the care of the sick anywhere in the world. While their existence is considered proven, there is some doubt as to whether they were as widespread as was once thought, as many were identified only according to the layout of building remains, and not by means of surviving records or finds of medical tools. Following the First Council of Nicaea in A. D. 3. 25 construction of a hospital in every cathedral town was begun. Among the earliest were those built by the physician Saint Sampson in Constantinople and by Basil, bishop of Caesarea in modern- day Turkey. Called the . Thus in- patient medical care in the sense of what we today consider a hospital, was an invention driven by Christian mercy and Byzantine innovation. By the twelfth century, Constantinople had two well- organised hospitals, staffed by doctors who were both male and female. Facilities included systematic treatment procedures and specialised wards for various diseases. Shapur I. A large percentage of the population were Syriacs, most of whom were Christians. Under the rule of Khusraw I, refuge was granted to Greek. Nestorian Christian philosophers including the scholars of the Persian School of Edessa (Urfa) (also called the Academy of Athens), a Christian theological and medical university. These scholars made their way to Gundeshapur in A. D. 5. 29 following the closing of the academy by Emperor Justinian. They were engaged in medical sciences and initiated the first translation projects of medical texts. Later after Islamic invasion, the writings of Mankah and of the Indian doctor Sustura were translated into Arabic at Baghdad's House of Wisdom. During this period, hospitals were mainly confined to the domestic household or existed as small, military hospitals with the function of caring to the sick, travellers, and of the long- term infirm. During the Early Middle Ages (4. Christianity had a great effect on the practice of medicine. Church- sponsored hospitals began to appear already after A. D. 3. 50, but they primarily furnished bed and board and seldom ventured into actual treatment. Over the next seven centuries, the hospitals gradually passed from Church to monastic control. Soon many Christian monasteries became centers of accumulation of the medical knowledge and practical experience in Europe. Around 5. 29 A. D. Benedict of Nursia (4. A. D.), later a Christian saint, the founder of western monasticism and the Order of St.
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