ST. PAUL, Minn. – Minnesota is taking action on a health care trend that's leaving some of the state's senior citizens with unexpected medical bills after a hospital stay.

For Medicare to cover the cost of certain services, the patient must be officially admitted, not just classified with an observation status.

The approved legislation requires hospitals to inform patients of their status and the potential ramifications within 24 hours.

That knowledge is vital, says AARP of Minnesota volunteer Vikki Casey Steward, whose 83-year-old mother had a recent hospital stay and ended up with a surprise bill.

"She was never informed that she was being put on observation status as opposed to being admitted in the hospital,” Casey Steward relates. “She had her own room, as normal of a hospital stay as anything had ever been. And this is the first time in 18 years as a Medicare patient she received a bill from the hospital."

According to a study by AARP, the use of the observation status by hospitals has greatly increased in recent years, along with the average length of time patients spend in observation.

In Minnesota, more than 800,000 people rely on Medicare for their health coverage.

In addition to being able to plan post-discharge treatment based on their Medicare eligibility, Linda Nelsen, chief executive officer with Benedictine Living Community of St. Peter, says patients who know their designation and believe it should be changed can then request that while hospitalized.

"So it could be someone's in the hospital more than two days and they could qualify, but they're not aware of it at this point,” she explains. “This legislation will then inform them so that they can get that changed and it's a benefit they're eligible for and they should get."

There's also been a national push on the issue with a bill being considered by Congress. It would require any time spent under observation to count towards the three-day in-patient stay, which is required for Medicare to pay for skilled nursing care after hospital discharge.




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More people are providing care at home for aging family members or those with disabilities - and a new study says they face mounting financial and emotional challenges in the process.

The report from AARP and the National Alliance for Caregiving finds more than 63 million Americans are now family caregivers, an increase of 20 million from 10 years ago. Nearly half of those surveyed face major financial hardships such as debt, lost income or food insecurity.

Bandana Shrestha, AARP Oregon's state director, said the work is getting more complex, adding to the stress.

"People are living with many chronic diseases, which may mean that people are managing multiple medications, they may have other medical demands on them," she said, "and a lot of this is being taken care of by family caregivers."

Oregon's 470,000 family caregivers, whom Shrestha calls the "backbone of the state's long-term care system," receive better support than most states. She cited policies such as paid family leave and programs such as Oregon Project Independence, which provides limited in-home services.

Alma Valencia is part of the "sandwich generation," caring for both her children and her aging mother with dementia. Valencia said she left a fashion career and its financial stability to care for her mother full time - and thinks one of the hardest parts is the isolation and stress.

"Caregiving isn't just a personal matter; it's a national issue," she said. "We need paid leave. We need financial relief. We need training. We need time to breathe."

Shrestha noted that on top of reducing paid work hours, family caregivers spend about $7,200 yearly on medical expenses. She said this is an area where lawmakers could help.

"They are forgoing a retirement savings, Social Security," she said, "so we have to do something in terms of offsetting those things."

She said AARP is supporting a bill in Congress focused on providing a tax credit for family caregivers, called the "Credit for Caring Act," which has more than 50 bipartisan co-sponsors.

More seniors in Washington state are facing financial strain or even losing their homes and seven local organizations will expand support for them with help from new grants.

Funds from AARP Washington's Community Challenge grants support quick projects to create more age-friendly communities.

Lauren McGowan, executive director of Local Initiatives Support Corporation Puget Sound, one of the grant recipients, said the $15,000 will help seniors get property tax relief, for which many do not realize they qualify, or need help in applying.

"We want to make sure that families have access to those resources so that they can stay in their homes, age in their homes healthy and well, and then pass along their homes to the next generation," McGowan outlined.

The group expects to help more than 5,000 low- and moderate-income older adults in King, Snohomish and Pierce counties. McGowan noted the average household can save thousands of dollars a year if they qualify for property tax relief.

Marcelo Pratesi, development director for Habitat for Humanity in Whatcom County, another grant recipient, said they will use the money to help 10 low-income homeowners over age 50 with repairs they cannot afford or manage. The project will enhance accessibility, health and safety, enabling them to age in place.

Pratesi added in North Whatcom County, the need is high.

"They don't have anywhere else to go to," Pratesi pointed out. "For us to be able to walk in there and build a wheelchair ramp or put in grab bars, or make bathrooms more accessible in general, it's going to be really great."

The Community Challenge Grants awarded more than $63,000 for projects across Washington state this year, part of AARP's national community investment, which has awarded more than $4 million to hundreds of organizations.


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A former Wisconsin mayor said the new federal budget will only worsen the current aging crisis families like hers have already been facing.

Analysis from the Congressional Budget Office suggests President Trump's budget bill will trigger automatic cuts to Medicare due to an expected increase in the national deficit.

Judy Karofsky, a former mayor of Middleton, said it would affect hospice services and end-of-life programs already in need of greater funding. She explained when her mother was 99, the local hospice agency determined she was not dying soon enough and abruptly discontinued her services. She explained how it also triggered her eviction from the assisted living facility where she was at the time.

"This happens in this country," Karofsky emphasized. "My mother was 99-and-a-half when that was decided. We were on our own for a matter of months. She did die within the next six months, just before she turned 100. It was cruel!"

Karofsky stressed cuts to Medicare would rob many of the most vulnerable Americans, like her mother, of their right to a dignified death.

Hospice provides patients and families with pain relief, medical equipment, nursing care and spiritual support. Studies show hospice saves Medicare and families money by reducing overall health care spending. Karofsky said without it, families are faced with financial burdens few can bear.

"I thought before I was involved with my mom's hospice care, that hospice was a charity," Karofsky noted. "I understand now that every hour of help, every service, every product that's brought to a hospice recipient is reimbursed through Medicare and every hospice agency is beholden to Medicare."

The number of Americans aged 65 and older is expected to more than double over the next 40 years.

Karofsky argued the issue of underregulated assisted living facilities will worsen the current aging crisis across the country. In her book, "DisElderly Conduct, The Flawed Business of Assisted Living and Hospice," Karofsky recounted her mother's negative experience at six assisted living facilities in Wisconsin and called for action to address the ongoing crisis.


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