Emergency Room Care- What

Older Persons and Caregivers

Need to Know
Ruth Leslie, Hospitals and Diagnostic &
Treatment Centers
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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
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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
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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
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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
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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
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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
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“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
• https://health.ny.gov/professionals/patients/patient_r
ights/
• Available in English and 6 other languages
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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
• https://veterans.ny.gov/sites/default/files/VA%20LOCATIONS.PDF
• https://health.ny.gov/professionals/hospital_administrator/lett
ers/2017/2017-02-16_dal_17-05_vets_law.htm
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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
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Complaint Intake Program

• Intake telephone line

• 1-800-804-5447
• Complaint form – written
• https://health.ny.gov/facilities/hospital/complaint/complaint_fo
rm.htm
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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 = 1-866-815-5440
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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
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Questions?

• Division of Hospitals and Diagnostic & Treatment

Centers
• 518-402-1004
• hospinfo@health.ny.gov