A few months after my mother's 95th birthday, she fell at her home and hit her head, requiring stitches and blood transfusions. She has not been the same since.
She had to celebrate her 20th wedding anniversary with her husband, who recently died, at a rehabilitation center.
She needs 24/7 care and will never go home again.
Even though she is on Medicare, her care center stay is not covered. Why? Because the hospital declared her first night as "observation."
Never miss a local story.
She was admitted at 2:25 a.m., thereby missing the "two midnights" requirement for Medicare to pay for the usual next step for seniors after discharge: rehabilitation. If a patient is admitted for that minimum, he or she is eligible for 100 days of skilled nursing care. Because my mother was not, we pay out-of-pocket.
What I initially thought was an individual dilemma is a nationwide problem, one under the radar until this mysterious status determination results in a rapid drain of family resources.
Many Medicare matters are complex, but this situation has a simple solution: a one-sentence bill with bipartisan support -- the Improving Access to Medicare Coverage Act of 2013. More than 30 major organizations are in favor, including the American Medical Association and AARP.
According to the bill's language, it would amend the Social Security Act "to count a period of receipt of outpatient observation services in a hospital toward satisfying the three-day inpatient hospital requirement for coverage of skilled nursing facility services under Medicare."
At a July 30 hearing before the Senate Special Committee on Aging, U.S. Sen. Susan Collins, R-Maine, said in 2014 that Medicare beneficiaries had more than 600,000 observation stays that lasted three nights or more. Collins co-sponsored the Senate version of the bill, S. 569.
"Many of these patients find themselves in a kind of twilight zone," she said of those who are not officially admitted. "The financial consequences can be severe."
Toby Edelman, senior policy attorney for the Center for Medicare Advocacy, said her organization learned about the rampant use of observation status six years ago.
The situation was exacerbated by a misguided solution to fraud instituted last year by the U.S. Centers for Medicare & Medicaid Services, the "two-midnight rule."
Dr. Ann Sheehy, chief of the Hospital Medicine division at the University of Wisconsin-Madison, told senators about new research. Among the findings she cited: The observation rule is "in need of broad reform" and "is not a fix." On hospital rounds, she can't discern a person's status.
"Worse, many seniors have never heard of observation," she said. It only becomes clear when the bill is due.
Of course, government investigators and journalists should pursue Medicare abuse. But the 2013 rule that has hospitals running scared (because of potential government audits) has serious consequences for people who do not have time to wait.
Sylvia Engler, 83, of Framingham, Mass., testified that her husband Harold, 92, was in good health for most of their 60-year marriage. He returned to work at 87 after triple bypass surgery, but last year he needed another operation.
"Complications set in," she told the senators. He was in and out of a Boston teaching hospital, released eventually even though he was "unable to walk or stand alone."
After six weeks in rehab, that facility said his family could take him home, but not until they paid $7,859 "immediately," or the entire bill would be sent to a collection agency. All that hospital time was deemed "observation."
Connecticut Democratic U.S. Rep. Joe Courtney, the measure's chief sponsor in the House, said, "The external pressure to change this flaw in Medicare policy is building with each family that goes through this nightmare."
Courtney has more than 150 co-sponsors in the House, including Wisconsin's conservative Republican Jim Sensenbrenner, although most co-sponsors are Democrats.
Approving this bill would allow senators and representatives to show this could be a do-something Congress and help seniors. But it won't happen unless constituents let Congress know we want common-sense cooperation.
Nancy Day, a former Fulbright and Nieman fellow, is a veteran Associated Press, newspaper and magazine journalist based in Chicago. She has taught at Boston University and Columbia College Chicago.