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When benefits are gone, so are the patients

For some hospitals, guardianship has become one answer to the difficult question of how to controlskyrocketing medical costs.

The insurance industry, which once paid for sick people to stay in the hospital until theywere well enough to go home, now tries to dictate how many days a patient should remain in ahospital bed.

Private insurers typically say an old person with a simple hip fracture, for example, should stayin the hospital no more than seven days, said Carol Taylor, director of utilization management atAventura Hospital and Medical Center in Dade.

Medicare, the government insurer for the elderly, allows up to a 10-day stay and pays ahospital a flat fee of $7,000 for taking care of someone with a broken hip, she said.

But an elderly person with a mending hip is likely to remain weak and confused, unable towalk to the bathroom alone, much less go to the store to buy groceries, for several weeks.

That's a dilemma for Taylor, who runs the department responsible for discharging patientssafely once they no longer require acute medical care and the hospital can no longer be reimbursedfor their stay.

"We're sitting here with a patient who's a nonrevenue patient in the hospital," Taylor said.

A relatively unskilled home health aide may be all that wobbly elderly patients need tohelp them go home alone safely. The cheapest cost just $75 or $80 a day, but they aren't usuallycovered adequately by insurance policies, Taylor said.

"None of the insurers cover them adequately for patients who live alone," Taylor said."Medicare pays for a home health aide for an hour and a half three times a week. So what does thispoor person do the other 23 hours a day and the rest of the week?"

Many insurers will pay for an elderly person to spend a month in a nursing home after hipsurgery.

But nursing homes often refuse to accept a sick elderly person unless there is someone -- arelative or a guardian -- who can sign them in and guarantee payment, Taylor said.

Taylor's solution, when she cannot find a relative to help out and a hospital psychiatristdetermines it's appropriate, is to pay a guardian or attorney $1,200 to sign the patient out. Shedoes it sparingly and with some regret, she said.

"Some of these people in the hospital setting are a lot different than they are going to bethree weeks down the road when they've gotten out of the hospital. . . . They may come out of theirconfusion.

"But the problem is they can't stay here any longer.

"On the hospital level, it'simportant to act quickly. . . . Hopefully, it's not too quick for the patient's sake."

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