Mastering the Hospital Discharge Process: Expert Tips
An unplanned hospitalization of a loved one is a stressful and unexpected event that often happens at the most inconvenient times, impacting the entire family. Here are some tips to help you navigate the hospitalization, a potential rehab stay, and the transition back home or to a long-term care setting.
About the ER Visit
Most often the beginning of the hospital course starts in the ER with an urgent situation requiring immediate medical intervention. Upon arriving at the ER make sure you take notes! You will encounter many people coming and going, but insist on knowing the name of the doctor, PA or ARNP who is assigned to your loved one in the ER.. Take their name and the phone number of the emergency department.
The ER visit can be a quick in and out or can take you down a path of an “observational hospital stay” or an admission to the hospital. A word of caution here is to push for your loved one to be “admitted” to the hospital and not just kept on “observation”. The key here is your loved one has to be medically unstable enough to require admission.
Lets use this example: Your loved one fell and now has extreme back pain.The ER took X-rays and found there are compression fractures in the spine, and your loved one is in too much pain to walk. They may be medically stable enough to go home, but mobility is impaired. In this case, the hospital may not want to admit this person to the hospital, stating you will need to take them to rehab if they can’t go home.However, without a hospital admission and 3-night stay in the hospital, medicare will not cover the cost of a rehab, so the key here is to push push push for admission to the hospital. Medicare rules are very strict, but if you point out any and all medical issues that are now exacerbated by the pain, the immobility, the stress level that may bring on additional health impacts, you may find a doctor who will rationalize admitting your loved one to the hospital.
Advocating for your loved one doesn’t end at admission; it continues through discharge. To ensure they’re supported and safe, consider these critical aspects of the hospital discharge process, and our related advice.
Medication issues
Paperwork review
Your discharge planner
Transportation needs
Staying organized
Home health support
1. Medication Issues
Having a current medication list for your loved one is going to be an important step in understanding any medication changes that are made during a hospitalization (or rehab) stay. Compare the med list prior to hospitalization to what is being given now. If you find additions or omissions, make sure to note the changes and discuss with the doctor. Ask questions regarding why a particular medication is no longer being given, or why a new medication is being added.
Learn the purpose of each medication and familiarize yourself with the key side effects to monitor.
2. Paperwork review
Often, at time of discharge, you will be handed a large manilla envelope full of paperwork and you will be asked to sign the discharge form, WITHOUT giving you adequate time to understand all of it. This is the moment you must STOP and insist that you would like the discharge planner, nurse or doctor to go through the packet and answer questions. Believe me, you will not always get cooperation; staff are busy and often people are in a rush. Ask for at least 10 minutes of staff time to go through these documents to ensure you understand everything.
Compare your baseline medication list to any new medications/changes or omissions in what was being taken before. If you find important medications have been omitted, ask that the doctor puts the order back in place BEFORE you leave the hospital.
When going through the paperwork, also check to see if Home Health - services like physical therapy (PT) and occupational therapy (OT) - is ordered and what company will be contacting you to set it up; you need to know this information.
Also find out if any medical equipment has been ordered such as a walker, wheelchair, wheelchair cushion, alternating air pressure mattress to promote skin healing, oxygen, etc. If any DME (durable medical equipment) is ordered, find out what company will be providing it and how to reach this company if the equipment is not delivered.
Follow-up care instructions are very important to understand. These instructions cover how soon your loved one should see their primary care provider (PCP), or if they are going to rehab, how to get their PCP involved.
Often, it is hard to know what is missing when you don’t really understand the whole packet of info, so here is a short list of what to ensure is included:
A clear medication list with medication names, doses and frequency signed by the MD
Your Durable Medical Equipment (DME) orders
Home Health orders, if the client is coming home
A hospital discharge summary that describes the hospital stay and the medical problems associated with the hospital stay.
Follow-up instructions that should cover how soon your loved one should be seen by their PCP, and how to ensure follow up with their PCP if going to Rehab.
Transportation plans
Another important thing to confirm is that all of your packet info pertains to YOUR loved one and not someone else! It is quite frequent that paperwork gets mixed up. Double-check that your loved one’s name is on all of the paperwork and NOT someone else’s.
3. Your Discharge Planner
The discharge planner may seem like someone you would meet near the time of discharge; however, my advice is to establish this relationship as soon as possible upon hospital stay. Your discharge planner should get to know you and your loved one, his or her strengths and weaknesses, and the situation of your home: are there stairs, is there a bathroom/bedroom on the main level; and how will your loved one navigate the home? The discharge planner uses this info in determining if your loved one can go home after a hospital stay or go to a rehab center for strengthening, balance and recovery.
If you establish a good relationship with your discharge planner, then, if after discharge you have questions, that person is your go-to and will likely be able to answer your questions. Don’t wait to establish a relationship with the discharge planner. Do it right from the start. As soon as there is a hospitalization, start planning the discharge.
4. Transportation Needs Upon Discharge
Generally the discharge planner is responsible for setting up transportation either to home or to the rehab center. If your loved one can comfortably and safely be seated in a wheelchair, a cabulance is a good choice for transport; it is less expensive than an ambulance transport in which the client would be laying down on a gurney. If your loved one seems to be strong enough to sit in a regular car, you may transport your loved one home, but keep in mind, if you have stairs or difficult areas to navigate, this will all fall on you and be your responsibility to safely get your loved one into the home. A cabulance would be a safer option as you know he or she can be transported safely inside of the home.
Just recently a client of mine was discharged with the family who took her home, but she weighed 240 pounds and could not navigate the 2 steps into the home. The family was not able to assist her and had to call 911 to return her back to the hospital.
5. Staying Organized
To stay organized post-discharge, I recommend keeping a notebook (or use an I-pad or laptop if you prefer) to keep track of your visits, who you talked to on your visits, how PT/OT is going and what the PT/OT folks names are, your nurses’ names, discharge planner name and doctors’ names. Touch base with your discharge planner regularly to understand if anything has changed in the discharge plans.
6. Home Health Support
You will want to identify the orders for home health and know what company has been set up to come for services. Your discharge planner should go over this information with you. It often takes a few days before a Home Health agency can get out to admit a new client; however it should not take more than 5-7 days. If it does, you need to be calling the Home Health agency and find out why there is a delay. Typical Home Health services can include PT and OT. PT includes assistance with transfers, ambulation, stamina, balance, gait and learning to walk within the frame of the walker and navigating the home. OT is more focused on dressing safely, personal hygiene, safely showering or bathing in the home, buttoning buttons and putting on shoes and socks. All of these tasks sound so simple when one is healthy, but after a stroke or a painful fall, these tasks can be monumental. Skilled nursing care may be required for tasks like wound or catheter care. Speech therapy is often needed for individuals recovering their ability to speak after a stroke, addressing swallowing difficulties, or improving cognitive abilities.
Home health is provided for a limited time only, based on medicare guidelines and the progress the client is making. If a client refuses to work with Home Health, they will be discharged, and this is a great loss. Insist, and be persistent that your loved one works with Home Health to the fullest extent they are eligible for.
Mastering the discharge process can make all the difference in your loved one’s recovery. With the right preparation and support, you can help ensure a smooth transition and set them up for the best possible care going forward.
If your loved one needs 24/7 care in the East King County area upon hospital discharge, we can provide assistance in finding ideal placement options for you.
