Under Observation vs Inpatient

Updated 8/2017

"Under Observation” vs “Inpatient” Hospital Admission Jeopardizes Coverage

Two words may mean all the difference in whether or not a Medicare patient qualifies for expensive rehab and other post-hospitalization services or not. They may also determine if you will be covered for in-hospital services.

NBC's Kate Snow told a tale of a woman admitted "for observation" for a broken leg which was actually treated while she was an in-patient. However, that label technically made her an out-patient and "that means that Medicare won't cover her rehab in a nursing facility which costs $28,000." Snow reported further "the number of patients in this status increased more than 6,000 since last year, and just this year, many more individuals were patients in hospital for three days or more but were not eligible for costly rehab coverage." All due to the "for observation" on the admission form.

She went on to report "the representative for most of the hospitals in the country says they're being squeezed by Medicare. In-patients cost more so Medicare aggressively audits the classification given." 

Advocates say patients who end up in the hospital need to make sure they're admitted under a doctor's order as in-patients, not as patients "for observation," particularly if rehab services will be needed. The only way to be sure is to ask.

Benadryl Risks

If you are 65 years of age or older, you need to be aware of the risks of the over-the-counter anti-histamine benadryl. It's found in many common remedies, including most sleep aids with PM in the name.

Why is this a poblem?

A class of drugs known as anticholinergic drugs has been closely tied with cognitive impairment and an increased risk of dementia. This group of drugs, which includes the common over-the-counter medication Benadryl, as well as Demerol, Dimetapp, Dramamine, Paxil, and Unisom, are easily available over-the-counter or by prescription. They are sold as sleep aids, decongestants as well as being prescribed for chronic diseases including hypertension and cardiovascular disease.

The active ingredient in Benadryl known as diphenhydramine is also found in Nytol, and almost every OTC cold or flu remedy designated with a PM. Taking this medication with anti-depressants, muscle relaxants, some pain medications or with another drug having similar ingredients will possibly magnify the effects.

For seniors, every-day side effects of something regularly taken for allergies or sleep aids may be particularly pronounced and yet remain unnoticed. These can include: blurry vision, dry mouth, temporary confusion and increased risk of falls.

A study released in 2016 was conducted in cooperation with the Alzheimer's Disease Neuroimaging Initiative and the Indiana School of Medicine, Indiana University Memory and Aging Study. It was published in JAMA/Neurology in April 2016 was reported by multiple media outlets including CNN.

The study examined the physical changes that serve as the catalyst for cognitive decline. The investigators looked at 451 people, with an average age of 73. Sixty of them were taking at least one medication with medium or high anticholinergic activity.

The investigators concluded that the use of anticholergenic medication among older adults should likely be discouraged if alternative therapies are available.

Always check with your doctor before discontinuing any medication, and ask your pharmacist if any over-the-counter medication that has this ingredient is appropriate for your use.

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Unused Medication Disposal

Whatever you do, don't flush your unused meds, prescriptions or over-the-counter drugs, down the toilet. Don't wash them down the drain, either. Medications are affecting the drinking water supply (they are not removed in the purification process), and the health of fishes and animals that live in the oceans.

Some medications (particularly opioids) may come with specific disposal instructions. For the rest, you can ask at your pharmacy (some of which have pre-paid envelopes for this), hospital, local fire department or contact your city offices for regularly open disposal sites. Some pharmacies, senior centers and residences have drop-boxes clearly marked for medication disposal. Be sure to remove your personal information from the packaging. Watch for local drug take-back events.

If no medicine take-back programs or DEA-authorized collectors are available in your area, the FDA recommends the following simple steps to dispose of most medicines in the household trash:

Mix medicines (do not crush tablets or capsules) with an unpalatable substance such as dirt, kitty litter, or used coffee grounds;
Place the mixture in a container such as a sealed plastic bag;
Throw the container in your household trash;
Scratch out all personal information on the prescription label of your empty pill bottle or empty medicine packaging to make it unreadable, then dispose of the container.