Preparing for a hospital discharge

When a physician decides that a patient’s health is stable enough to no longer require acute hospital care, he or she will authorize a discharge. This doesn’t mean that the patient is completely recovered and can resume a normal life. He or she might need an assisted living facility or home nursing care before going directly from hospital to home to live independently. This guide will help you to understand the hospital discharge process to ensure you can help a parent transition smoothly from hospital to home.

The role of a discharge planner

Each hospital has discharge planners – nurses, social workers or other professionals who will be your primary contact in making plans for your parent’s transition from the hospital to his or her next level of care, which might include short-term care in a nursing home, rehab center, or assisted living facility, or home health care nurses at home.

The discharge planner’s job is to make sure that arrangements have been made – before the patient leaves the hospital – to ensure the discharge is “safe and adequate” as defined by Medicare. What’s meant by “safe and adequate” is up to you, the doctor and discharge planner to determine together. The discharge planner should ask about your parent’s living arrangements, with the objective of determining whether or not he or she can safely and realistically make a transition out of the hospital to another level of care outside of the hospital. So it’s important that you answer his or her questions thoughtfully and honestly.

Keep in mind that the discharge plan is immediate and short-term. Its purpose is to get your parent past the most immediate health issues and on the road to recovery, but it should lead to a sound, feasible long-term plan to keep your parent healthy. To best assess needs, ask the doctor to tell you exactly what your parent will be capable of doing once he or she leaves the hospital and what type of health care he will need. Answers to these questions will help you to decide between in home health care or a temporary stay in a facility. If your parent is recovering from a stroke for example, you’ll want to ask questions like:

• At what level are my parent’s thinking skills?
• Will my parent need assistance with bathing, eating, using the toilet, grooming, dressing or taking medications?
• Will he or she need physical and occupational therapy (how much and how often)?

If you disagree with the discharge decision

There are times when you might disagree with the physician’s decision to discharge your parent from the hospital, because you believe he or she is not well enough, or believe that a release without adequate care will jeopardize an already precarious condition. You can do something in these situations: Your parent’s rights are clearly articulated in the “An Important Message from Medicare” statement that the hospital must provide to you. It states that your parent has the right to receive all of the hospital care he or she needs, as well as necessary follow-up care after leaving the hospital. The hospital will also give you a written notice known as a “Hospital-Issued Notice of Non-coverage,” also referred to as a HINN. On that form, check out the phone number of the Quality Improvement Organization (QIO). Call them and tell them you want to file an appeal to delay your parent’s discharge. Until the QIO makes a decision, the hospital cannot force your parent to leave or force you to pay for continuing care in the hospital.

Preparation is the best defense

Ultimately, you never want to get caught scrambling to find alternative care when the hospital is asking your parent to leave. The best way is to plan in advance, and have a candid discussion with your parents about what might happen. Start by telling them you want to do what’s best for them in the event they can’t take care of themselves. Then present possible scenarios such as:

• If you had a stroke and needed to recuperate outside of the hospital but weren’t well enough to go home, where would you like to go?
• If you had a heart attack, what hospital would you like to go to?
• If you broke your hip and could go home only if you had in home health care, who would we hire?
• If you had cancer, would you want to try alternative treatments or opt for chemotherapy and radiation? Would you want us to call hospice?

It is unlikely most people will have ready answers to these questions, so ask your parents to start visiting and researching potential facilities so you’ll know where to turn if and when the time comes. The goal is to keep them in charge and to make smart, informed decisions when “heads are cooler” than in the heat of an emotional crisis.

The bottom line

• Just because your parent is discharged from the hospital, it doesn’t mean he or she is ready to resume a normal life at home. That’s why hospitals have discharge planners, whose job it is to work with you to ensure your parent can transition safely to the next level of care.
• The discharge planner will need to know about your parent’s living situation in order to determine the next step for your parent, which could include in-home care or a temporary stay at an assisted living facility.
• When working with the discharge planner, also consider what changes you can expect in your parent’s physical and emotional health as a result of the health condition that landed him or her in the hospital. This might include disorientation, physical weakness and more.
• If you don’t believe your parent is truly ready to be discharged from the hospital, contact the Quality Improvement Organization (QIO) to appeal the decision. Your parent can’t be forced to leave until the QIO had made a decision. (The number for the QIO can be found on the Hospital-Issued Notice of Non-coverage.)
• Ultimately, you never want to get caught scrambling to find alternative care when the hospital is asking your parent to leave. The best way is to plan in advance for the type of care your parent will want after a hospital stay.