By Caryn Tadema, Certified Concierge Care Advisor
Admission vs. Observation: Why It Matters for Seniors
Navigating healthcare systems can be confusing, especially when it comes to understanding the difference between “admission” and “observation” in a hospital setting. This distinction can have significant financial and medical implications for seniors, as illustrated by George’s story. Let’s explore why knowing the difference between these two statuses is critical for seniors and their families.
George’s Story: A Painful Lesson in Hospital Billing
George, a 90-year-old senior, spent five nights in a hospital room after experiencing a serious health episode. Despite receiving extensive care, he was classified under “observation” status rather than being “admitted” to the hospital. This classification meant:
- Medicare would not cover his rehabilitation costs.
- His out-of-pocket medical expenses were significantly higher than if he had been admitted.
Admission vs. Observation: What’s the Difference?
Admission
- Definition: A patient is formally admitted to the hospital by a physician’s order.
- Implications for Seniors: Admitted patients qualify for Medicare’s 3-day hospital stay requirement, which covers post-hospital skilled nursing care.
- Costs: Out-of-pocket expenses are typically lower due to coverage under Medicare Part A.
Observation
- Definition: Patients are under hospital care but are not officially admitted. Instead, they are classified as outpatients.
- Implications for Seniors: Observation status does not meet Medicare’s requirement for post-hospital rehabilitation coverage.
- Costs: Out-of-pocket expenses can be significantly higher since services fall under Medicare Part B, which has different deductibles and copayments.
Why This Distinction Impacts Seniors
Financial Strain
Seniors classified under observation status often face unexpected medical bills, making recovery more stressful and financially burdensome.
Limited Access to Rehabilitation
Without meeting Medicare’s 3-day rule for admission, seniors may struggle to afford the skilled nursing care they need after hospitalization.
Advocacy is Essential
Hospitals and insurance companies prioritize cost-saving measures, but this often leaves seniors and families navigating complex healthcare systems without proper guidance.
How Concierge Care Advisors Can Help
At Concierge Care Advisors, we are committed to advocating for seniors and their families. Our team helps you:
- Understand hospital classifications and their implications.
- Navigate Medicare and other insurance systems.
- Find appropriate post-hospital care options, including skilled nursing facilities or adult family homes.
Our services are free to the seniors we serve because we believe in our mission to support vulnerable adults.
Admission vs. Observation: Advocate for Better Senior Healthcare
George’s story is a cautionary tale about the importance of understanding hospital classifications like admission vs. observation. Families must be proactive in seeking guidance from knowledgeable professionals to navigate these complex systems and secure the care seniors need.
Are you or a loved one seeking support from a local elder care advisor? At Concierge Care Advisors, we provide expert guidance in healthcare navigation and senior placement services. Whether it’s understanding hospital statuses or finding the best care options, we are here to help. Visit our Contact Us page to connect with an elder care advisor and ensure the best outcomes for your family.
