When it comes to discharging elders to nursing homes from hospitals, the more you know about the discharge process, the safer you or your loved one will be. To discharge planners (also known by the cleaner term, case mix managers) like the ones at Methodist Hospital in Brooklyn, it means little more than finding an empty bed in any nursing home (regardless of quality) within 50 miles of the hospital. This blog post is not about the perils of poor discharge planning in hospitals. For that you can visit my website at www.myelderadvocate.com. This post outlines the process that must be followed by all hospitals according to Federal Law. YOU MUST KNOW THIS or hire an elder advocate to protect you. Discharge planning involves: ™ Determining the appropriate post-hospital discharge destination for a patient Identifying what the patient requires for a smooth and safe transition from the acute care hospital/ post-acute care facility to his or her discharge destination Beginning the process of meeting the patient’s identified pre- and post-discharge needs. When the discharge planning process is well executed and there are no unavoidable complications or unrelated illnesses or injuries, the patient may continue progressing toward the goals of his or her plan of care after discharge. Discharge Planning Medicare-participating acute care hospitals/post-acute care facilities must identify patients who need or have requested a discharge plan at an early stage of their hospitalization. The discharge planning process must be thorough, clear, comprehensive, and understood by acute care hospital/post-acute care facility staff as well as the patient and/or the...

Nursing homes in New York State have been accused of using ‘guardianship petitions’ as a means to coerce elderly residents into paying outstanding fees. A startling expose in the New York Times this week discusses a number of instances where nursing homes have requested courts to transfer guardianship away from the family. Ostensibly these requests are prompted by family feuds, suspected embezzlement or just the absence of relatives to help secure Medicaid coverage. However, judges, legal experts, and others well versed in the guardianship process claim that often the petitions are used as a means of duress. In a guardianship case last year involving a 94-year-old resident in a Jewish aged care facility, New York Supreme Court judge Alexander John Hunter issued a scathing 11-page critique of the motivations behind the petition made by the nursing home’s management. “It would be an understatement to declare that this court is outraged by the behavior exhibited by the interested parties — parties who were supposed to protect the person, but who have all unabashedly demonstrated through their actions in connection with the person that they are only interested in getting paid,” he wrote. In a more recent case, this time involving a family who refused to pay exorbitant rates to a Catholic nursing home, a court evaluator threw out the guardianship petition and questioned the motivations of the facility. The family spent US$10,000 in legal fees fighting the case. Some nursing homes argue that guardianship petitions are the best way to resolve disputes about payment for care. The...