1. Emergency Room Care- What Older Persons and Caregivers Need to Know
Ruth Leslie, Hospitals and Diagnostic & Treatment Centers

2. Emergency Departments Provide:
Emergency care
Diagnostic tests
Access to specialists
Decision to admit, transfer or discharge
Referrals to outpatient follow-ups: primary care, substance use, mental health, specialty care

3. Emergency care vs. Inpatient care vs. Outpatient care
Emergency department care – classified and billed as outpatient care
Emergent and urgent care
Observation – classified and billed as outpatient care
Ambulatory care
Inpatient care = higher level of care
Intensive care units
Medical/surgical beds

4. Observation Billed as an outpatient Observation can take place in –
An observation unit
An inpatient bed
An emergency department bay in a Critical Access Hospital (<25 beds)
Will not feel or look different than an inpatient admission

5. Observation
Hospitals are required to give patients a notice stating that they are in observation status with 24 hours of assignment
MOON=Medicare Outpatient Observation Notice (2016)
State statute (effective 1/19/2014)
Can have billing and placement issues if discharge to skilled nursing facility from the hospital (requires 3 midnight qualifying inpatient admission vs. observation)
Significant discussion and litigation on this point at the federal level

6. What Should you Bring to the ED:
Leave valuables at home!
A family member or friend
Insurance card
Bring current medication list – typed or written neatly
Health care proxy

7. CARE Act (Caregiver Advise, Record and Enable Act), effective April 23rd, 2016
Hospitals are required to ask if you have a caregiver
Patient can designate a caregiver
Caregiver does not have to be a spouse or family member-can be a neighbor or friend
The caregiver is entitled to education and information prior to discharge of the patient
Important to reduce readmission

8. “Your Rights as a Hospital Patient in NYS”
Booklet given to admitted patients
Information about rights as an inpatient including the Patient’s Bill of Rights and how to file a discharge appeal
How to file a complaint
Instructions/forms for DNR & Health Care Proxy
Available in English and 6 other languages

9. Veteran’s Bill (effective 12/8/16)
Benefits apply to all who have served in the military
Law makes clear that benefits are not dependent on war time service
If one has served, the hospital is obligated to provide information on Veteran’s benefits
“Information for Veterans concerning Health Care Options” fact sheet

10. Complaints – Patient’s Advocate
Patient’s Advocacy Office
Charged to assist patients
Can help when patient is in the hospital
Resolve issues before they become complaints
Investigate complaints lodged against the hospital

11. Complaint Intake Program
Intake telephone line
Complaint form – written

12. Discharge Appeal
The law requires that you receive advance notice in writing telling you:
the date the physician and/or hospital plans to discharge you;
how to appeal if you wish to remain in the hospital;
Quality Improvement Organization (QIO) for Medicare patients is Livanta =

13. Discharge Instructions
ED and Inpatient
Required to give instructions
What to do if symptoms come back
Refer back to MD if you have one
Is follow-up care needed?
Communicate with your primary care physician to notify them of any ED visit or admission

14. Questions? Division of Hospitals and Diagnostic & Treatment Centers