Surviving a Parent's Trip to the Hospital and Beyond: What to know before you go.

You find your mom on the floor in her bathroom at home. She complains of hip pain and has been there for a few hours. You make the call and a few hours later she has been admitted to the hospital with a hip fracture. Now what?

Insurance: If your loved one has Medicare or a HMO that manages Medicare benefits, the hospital stay is mostly covered. Medicare recipients will pay a $992 deductible for 2007 for hospital stays of 1-60 days. If a HMO is involved, check with the benefits administrator for specific deductibles or co-pays.

Legal Documents: If you haven't done it already, now would be a great time to have legal documents prepared for health care decisions. The most widely used form is called the Advance Directive for Health Care. This form allows your loved one to appoint someone to make decisions about health care if they are unable to do so, as well, this form also addresses end-of-life decision making. While you are helping your loved one with this document, fill one out for yourself!

Your mom has been in the hospital for two days now, and the discharge planner is telling you that she needs to leave the hospital in two days! To top if off, you have been presented with a list of in-patient rehab centers for discharge and you are expected to pick one!

Skilled Nursing Facilities (SNF): Medicare and HMO's will cover rehab centers- with a catch. Medicare recipients must have a three night hospital stay and receive a doctor's order to receive 'skilled' care in order to qualify for admission to rehab. The doctor will make a decision based on several aspects of a patient's rehab potential. HMO benefits vary greatly, check with the benefits administrator for specific requirements. .

Medicare has a great website for users to compare rehab centers based on their yearly state inspection results and other quality indicators, www.medicare.gov/NHcompare. You will also find helpful checklists to assist in your search. Select a few; go for a tour. Talk to health care professionals who can share their experiences with these facilities.

The 100-day myth: Many families leave the hospital believing their loved one will be able to stay in the rehab center for a full 100 days. It is a rare case that a resident uses their full 100 days of Medicare during a rehab stay. Medicare does not cover long term care, it is simply an insurance benefit. Medicare will cover a rehab center as long as your loved one continues to benefit from the skilled services they are receiving. Medicare does not have representatives that make this decision, instead, the decision to continue with rehab from one day to the next, is decided by the interdisciplinary team at the rehab center working with your loved one. In the case of HMO recipients, the HMO does employ case managers who keep in close contact with the rehab centers and decide when a resident is no longer eligible for skilled benefits. In either case, once it has been determined that your loved one no longer qualifies for skilled benefits, you will be presented with a Notice of Medicare Provider Non-Coverage aka, a denial letter. By law, Medicare beneficiaries must have 72 hours notice of non coverage; HMO's vary between 48-72 hours depending on the HMO.

Appeals: Once your loved one has been presented with a denial letter, several options are available. If you do not agree with the non-coverage decision, you can appeal it. You will find appeal information within the Non-Coverage letter, specific to the Medicare insurance provider. If you do agree with the non-coverage decision, it is time to make decisions about the next move for your loved one. Hopefully, you and your loved one have been discussing the plans to return home after the rehab stay. The rehab social worker can help you arrange for equipment and services to ease the transition of returning home. If returning home is not an option for your loved one, you now face a myriad of options for community based care.

Amie Clark, Founder of The Senior List
www.TheSeniorList.com