We went through this right around first of year with MIL, admitted (or was she
) to hospital on 12-26 and sent home 1-4. I was not there as my wife and BIL were for endless discussions about whether or not she was admitted or "under observation." We were a little mystified (having never been faced with this perceived precipitous decision before in her many, many admittances after falls and other maladies) at all the handwringing and debate, sympathies expressed by Dr.s that wanted to change her status but in the end they could not under severe penalties. WTF was all THIS all about? Since she did not require surgery (fracture in tibia) but was in pretty severe pain, they kept her there. It was like no one knew what to do with her and really wanted to be rid of her but didn't know how. DW and I didn't want her back because they had her immobilized with a crotch to ankle brace.
Last day, they took the brace off and put this incredibly looking brace with angle adjustments on it and called an ambulance to move her back to us, 60 miles away. Social worker advised us she would likely have to pay everything since she was only "under observation," but she could pay the bill...or not. They made a follow up visit, for this woman immobilized with this brace, for a Dr. in OUR town for four weeks later. So it was off to the grocery for depends and now our home was sleepy acres nursing home and DW had full time nursing duties. Let's say we were not happy.
After a day of this, we called the local MD office and said we could not wait, had to see him sooner than four weeks. Got appointment for next day. Oh. My. God. Very open and competent older orthopedist; took X-rays and laughed at the brace, threw it in corner and said "Wow...that cost SOMEBODY a lotta money!" Showed us the films of the small fracture and said she only needed a much smaller brace when she was walking, and she needed to be up and walking asap, not immobilized. We knew this ourselves, an 88 yo frail woman in bed for four weeks would never walk again. Oh, and then we had to FIGHT with the PT company the original hospital called for, the new MD wanted who he worked with and knew what he wanted. It was obvious everyone wanted this revenue stream.
Within a month she was using walker pretty much as had been, and now off all PT. Done. We're waiting for the bills, I did see one addressed to her from ambulance company but that's it, and have not heard how much if any it was for.
I know this was a long post, but my goodness the hospital screwed the pooch on this one. If there was no surgery, and they knew she'd have to pay for it, why didn't they tell her that and send her home STAT. As we left we felt like they'd just milked her, over prescribed that gargantuan brace, and also condemned her to immobility for life. Thank God we got the second opinion.
As to the original post re "under observation" who knows? She may yet get a bill for 10-20 grand. It will not be paid. Oh, I suppose we're not supposed to disclose where this happened but it was UNC CH.