When Nursing Homes Fumble The Transfer Process...And What You Need To Know

By Brian R Wilson, Esq.

In the fairy tale movie classic " The Princess Bride," Miracle Max (played by Billy Crystal) is the medieval "pharmacist" responsible for concocting a magic potion to bring hero Wesley back to life from a "mostly dead" state. When asked to hurry the job, he snarkily replies: "You rush a miracle man, you get rotten miracles."

Such is often the case when hospital patients are transferred and become nursing home residents. The rush of the transfer process can sometimes expose nursing home residents to serious harm.

WHAT'S THE HURRY?

From The Hospital's Standpoint: 

When a Medicare patient is admitted to a hospital, the hospital's payment is based on the diagnosis or DRG ("diagnosis related group"), and NOT the number of days spent in the hospital. But there are special "transfer DRG's" that determine a hospital's payment for patients transferred to skilled nursing facilities like nursing homes.

It's complicated. But at the root of it is the possibility that a patient  transferred from a hospital may be due in part to payment and reimbursement rules as opposed to what is in the patient's  best medical interests.    

From The Nursing Home's Standpoint:

Any seasoned nursing home malpractice attorney is familiar with the term "census" or "census development." It refers to a nursing home's efforts to fill as many empty beds as possible. Simple math is the reason: more resident bodies in beds, more $$$. Nursing homes have departments and personnel dedicated to the recruitment and referral of patients from both hospitals and directly from the community. Their Marketing departments work directly with hospitals to stay top of mind for hospital referrals, and their Admissions departments are charged with screening admissions to make sure the nursing home can meet the residents' care needs upon admission.

That's all well and good, but in the rush to keep the census of admissions high, it can be a breeding ground for mistakes, shortcuts, and cutting corners. 

The Rushed Admission...  

The turnaround on a transfer from a hospital to a nursing home can be less than 24 hours. In a recent case I litigated, the nursing home was sent medical information regarding the patient's condition and medical needs, and accepted the patient for a future transfer within hours. So far, so good, but the patient was not transferred to the nursing home until late afternoon on a Friday--some 48 hours later.  Upon arrival, there was no oxygen in the room and no special breathing equipment per the hospital physicians' orders. It was a rushed transfer and admission, and things only got worse because of a series of choices by the nursing home about when to order necessary equipment.

The nursing home had a policy of not ordering certain respiratory equipment until after the patient arrived, for fear of being charged for delivery and use of the equipment in the event the patient did not arrive at the home for whatever reason. Unfortunately in this case, the equipment did not arrive until after the patient died, approximately 12 hours after admission.

 By the time a hospital patient is transferred to a nursing home, the nursing home is supposed to be familiar with the patient's specific care needs. Federal regulations require it: 

Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychological well-being, in accordance with the comprehensive assessment and the plan of care. 

In virtually every case, the hospital sends the physician's orders to the nursing home so that the nursing home can make sure the patient's specific care needs can be met. What's more, the patient typically shows up at the nursing home with a copy of the hospital physician's orders, in case they weren't transmitted before his or her arrival. Yet, despite clear orders and regulations, necessary equipment is sometimes not present when the patient arrives.


The Takeaway...

If your loved one is about to be transferred from a hospital to a nursing home, ask as many questions of the nursing home as you possibly can. Make sure you have a copy of the physicians' orders that will accompany your loved one to the nursing home, and have the hospital explain it to you and go over any abbreviations in the orders.

Make sure those orders make sense to you. And when you arrive at the nursing home, you'll have a good idea what their marching orders are, and what they should be doing to follow them. 










      

SPECIAL REPORT: AUTO INSURANCE POLICIES TO AVOID IN OHIO

To quote musical icon Neil Young, “You pay for this, but they give you that.” This adage seems to be the recent trend with auto insurance companies who sell policies in Ohio. Lurking in the fine print (that you never see until AFTER you write your premium check) are numerous traps, exclusions and limitations that render your “full coverage” policy worthless after a crash.

Here are a few examples of some recent policies we’ve seen that are infecting the marketplace and leaving injured Ohio auto accident victims on the side of the road.

1. 21st Century Insurance and Its “Opt Out” Underinsured (UIM) Coverage.

Almost all insurance companies sell uninsured motorists’ coverage (known as “UM”) and underinsured motorists’ coverage (“UIM”) together as a package deal. Consider UM and UIM coverage like a set of twins. The “UM” twin will provide coverage for your injuries and losses caused by an “uninsured” motorist. The “UIM” twin will cover your injuries and losses caused by “underinsured” motorists who carry minimal liability insurance. Almost all insurance companies sell UM/UIM coverage together (again, think “twins”). So will 21st Century. But it will also allow you to “opt out” of purchasing underinsured motorists’ coverage in Ohio. A simple example will explain why this is an incredibly stupid option for any insurance company to offer, and why you should avoid it like a hornet’s nest at a picnic.

Let’s say you’ve been hit by an uninsured drunk driver, shattered your ankle, needed surgery with plates and screws, missed five months of work, and racked up $40,000 in medical bills and $10,000 in lost wages.

If you purchased $100,000 in uninsured motorists’ (UM) coverage with your own insurance company, you can make a claim with them for up to $100,000. If your injury claim is worth $100,000, your company has to pay it. That’s why you purchased this coverage.

But what if the drunk driver had state minimum limits of $12,500? This means that the driver was underinsured, meaning he had some insurance but not enough to compensate you for all of your losses. If you purchased 21st Century’s policy and were sold only “uninsured motorists’ coverage,” you’re out of luck. All you can collect is $12,500 from the drunk driver because you “opted out” of UIM coverage. If you had both UM and UIM coverage, you could collect $12,500 from the drunk driver’s insurance company and $87,500 from your own company, for a total of $100,000.

A recent Ohio law change allows insurance companies to separate out UM from UIM coverage. But almost all insurance companies (except 21st Century) still sell it as a package deal, and it makes absolutely no sense to “split the twins” and sell UM but not UIM coverage.

Lesson: Your UIM coverage is just as valuable as your UM coverage. In fact, there are probably more underinsured drivers (with very little liability insurance) than those who are driving uninsured! For not spending $50.00 per year or less on UIM coverage, you are now out $87,500. Do the math – this is a no brainer. Avoid ANY company that tries to sell you UM and not UIM and vice versa!

2. First Acceptance Insurance.

All insurance companies will offer “med pay” coverage which will pay your auto accident medical bills up to the limits of your coverage, whether its $1,000 or $5,000 or whatever amount you purchase. Here’s how it normally works with almost every company but First Acceptance: you simply turn in the bill to your insurance company and they will pay it as long as it’s related to the crash.

Not First Acceptance. Their med pay coverage is a “reimbursement only” policy. Definition: you, as the injured person, have to pay for the bill out of your own pocket first and then First Acceptance will reimburse you!

Here’s the fallacy of this “coverage”: many folks who purchase First Acceptance policies are financially strapped to begin with. Most can’t afford to shell out $1,000 or $5,000 to pay medical bills out of their pocket.

Therefore, despite paying a separate premium for this coverage, you can’t access it unless you first pay your bills out of your own pocket. So what good is this coverage? Not much at all.

And there’s one other item of fine print in First Acceptance’s med pay “coverage”: there’s NO coverage for chiropractic care. Almost all other insurance companies’ medical payments coverage will pay for chiropractic care.

3. Conclusion.

Here’s the common denominator of these policies: purchasers of insurance do not know what questions to ask, and many are sold over the phone. As you can see, how these policies really work in reality can be complicated stuff. Unfortunately, insurance is sold on one guiding principle: price. Just turn on your TV and you’ll hear all about “saving you 15%,” “keeping you legal for less,” and other “discounts.”

The old saying that “you get what you pay for” really does not fit here. The real problem with buying car insurance is that you really don’t know what you’re buying (or better yet what you’ve been sold) until after you’ve been put in the ditch by an irresponsible driver.