The 4-day rule

f you are a Medicare patient and reach the 4th day of hospitalization, a plan is launched to jettison you out of the hospital, stat.  Why?  You cost money.
As an older adult, it takes longer to heal and recover from illness.  But the hospital doesn’t care about age inequities as you are a costly liability that eats into their profit.
Understandably, you want to be ready to go home at some point, but no matter what, the onslaught begins around the 4th hospital day when you are told:

  • You don’t fit criteria for further hospital admission;
  • You have to go to a nursing home;
  • Medicare will not pay your hospital bill, and you are responsible;
  • Care is futile, and you should go on palliative, hospice, or comfort care.

Discharge arrangements must eventually be made, but most of the time it is done prematurely while you are still very ill.
(You have inalienable rights: see Doctor’s Diary August 28, 2018 – “Know your Medicare rights.”)
As terrible as it sounds, and no matter how sick you are, you and your advocate must be prepared when they apply the 4-day rule.
Good luck on the 5th day.
Gene Uzawa Dorio, M.D.
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