Angela Cole Westhoff is president and CEO of the Maine Health Care Association.

When Medicare was created in 1965, it wisely recognized that older adults often need skilled nursing care after hospitalization. That’s why Medicare requires the patient to spend at least three days in a hospital before covering the subsequent care in a skilled nursing facility. It’s a straightforward policy designed to ensure patients get the care they need during their recovery and it has worked well for nearly six decades.

But today, that system is being undermined by a loophole that results in patients and families having to choose between paying out of pocket for needed medical care or going without care.

The problem is “observation status.” Increasingly, hospitals are classifying patients as “observation status” rather than “inpatient,” even when patients deemed on “observation” spend three or more days in the hospital receiving the same level of care as inpatients.

Under current Medicare rules, a patient who is labeled as observation status will not have their days in hospital count toward the three-day requirement. As a result, a patient can spend four, five or even six days in a hospital under observation, receive intensive medical care and still find themselves unable to access Medicare-covered care in a nursing facility after they are released from the hospital.

The consequence? It forces older adults to decide between medical debt or skilled nursing care as part of a medically indicated recovery plan. 

This problem is happening to older adults in Maine right now. A patient who spends five days in a hospital receiving IV therapy, wound care and cardiac monitoring under observation status doesn’t qualify for Medicare coverage at a skilled nursing facility, even though they need that level of care. They either stay in an expensive hospital bed longer than necessary, potentially in a bed that could be used for another individual in need, or they attempt to go home without the professional, skilled support their condition requires.

Recent research from Brown University found that Medicare’s three-day requirement, combined with the observation status loophole, has become “suboptimal” for patients needing skilled nursing after a hospital stay. The findings reveal serious concerns: this policy isn’t improving outcomes. It’s not making care safer or more efficient. Instead, it results in longer hospital stays, increased costs and no improvement in patient health. In fact, the data suggests it may be counterproductive.

That’s why I’m grateful for Sen. Susan Collins’ recent introduction of the Improving Access to Medicare Coverage Act. This bipartisan legislation would allow days spent under observation status to count toward Medicare’s three-day minimum. It fixes a loophole without changing how hospitals operate or adding bureaucratic complexity. It simply recognizes that when a patient spends three days in a hospital receiving acute care, regardless of the billing classification, they should have access to the skilled nursing care that logically follows.

Skilled nursing facilities across Maine are staffed by dedicated professionals who are passionate about caring for older and disabled adults. Our registered nurses, licensed practical nurses, physical therapists and other clinical staff provide medical care and compassionate support that helps patients heal faster and regain their independence.

These are the caregivers who know their patients by name, celebrate their progress and are committed to helping them return to the people and activities they love. That personalized, compassionate approach to care accelerates recovery in significant and impactful ways. When patients transition from the acute care setting to our communities, they benefit from continuity, stability and the kind of individualized attention that transforms outcomes.

It’s time to recommit to what Medicare was designed to do: ensure our older adults get the right care, at the right time, in the right setting. The Maine Health Care Association calls on all members of Congress to support this legislation. It protects our seniors, honors the intent of Medicare and allows our nursing homes and assisted living communities to do what we do best: help Maine’s older adults heal and thrive.