An unsafe discharge: the steps that actually hold

This quietly decides whether Medicare will pay for rehab afterward. Ask the team, and ask in writing, whether your parent is a hospital inpatient or under observation. Observation is billed as outpatient, and those days do not count toward the three-day inpatient stay that Medicare rehab coverage requires. If it has been more than a day, ask for the written observation notice, called the MOON. If they are under observation, ask the doctor to reconsider admitting them as an inpatient.

Every Medicare inpatient gets a notice called An Important Message from Medicare, once near admission and again before discharge. It explains your right to appeal a discharge and gives the phone number to do it. If you have not seen it, ask the nurse or the discharge planner. This is the piece of paper the appeal runs on.

This is the step that pauses a discharge, when your parent is an admitted inpatient. If they got the Important Message from Medicare, call the Medicare quality review office, the BFCC-QIO, and ask for a fast appeal, no later than the planned discharge day and before they leave. For Washington that office is Acentra Health, at 1-888-305-6759. While the appeal is open, they generally cannot discharge and your parent is not on the hook for the extra days, and even an appeal that loses usually buys a day or two. If they are under observation, this appeal does not apply, so use step 1 to push for inpatient admission and escalate through the doctor and Patient Relations in step 4.

Tell the team: I do not believe a safe discharge has been arranged, and I cannot safely care for them at home. I am asking the discharge planner to be involved, and I am filing an appeal. If you hit a wall, ask for Patient Relations (sometimes called the patient advocate) and for Risk Management. Those are the in-hospital offices that move things. The Long-Term Care Ombudsman covers nursing homes and assisted living, not hospitals, so save that for later if your parent moves into one.

A diagnosis alone does not unlock a covered rehab stay, and neither does a positive urine test. The core requirements are a three-day inpatient hospital stay, where observation days do not count, and a documented need for daily skilled nursing or therapy, at a Medicare-certified facility, with Part A days left. A Medicare Advantage plan can set different rules. Ask the team to write down the skilled needs your parent has, since that record is what the rehab facility bills against.

Washington's SHIBA program gives free, unbiased Medicare counseling and can walk you through the appeal and the observation question. 1-800-562-6900.