After all of the tests and waiting and treatments are completed, it is time to decide what the next steps are for your Mom or Dad. Here are some possible scenarios.

Scenario 1: The doctor wants your father to stay in the hospital

Ø      The first question is … Why?

• If it is for a blood test or x-ray that is needed tomorrow, can it be arranged and completed on an outpatient basis?
• If it is because he should not be alone for the first 24 hours, can your dad go home with you or can you stay with him?
• Does he live in an assisted living facility where you can arrange some nursing care and monitoring?
• Can he be sent home with in-home supports you can arrange, such as private home health aides?

Ø      The second question is … Will he be admitted or placed in an observation bed?

• Keeping your father in the hospital does not necessarily mean that he is going to be admitted!
• If the doctor is planning to place your father in an observation bed that means that:

–        MEDICARE WILL NOT PAY FOR ANY OF THE HOSPITAL BILLS INCURRED ONCE THE ER TREATMENT IS COMPLETED, AND

–        IF YOUR FATHER HAS TO BE TRANSFERRED TO A SKILLED NURSING FACILITY FROM THE HOSPITAL FOR REHABILITATION WITHOUT BEING ADMITTED, MEDICARE WILL NOT PAY FOR ANY OF THE BILLS FROM THE REHAB FACILITY.

• If the doctor is planning to admit your father to the hospital, that means that Medicare will most likely pay for his hospital bills, as long as it is a medically necessary admission.

Scenario 2: The doctor wants to discharge your mother

Ø      Where will your mother go?

• If she lives alone in an apartment or house

–        Does she need someone to be with her for a day, a week, or longer?

–        Does she have stairs to get to her bedroom or bathroom that are now an obstacle?

• If she lives in an assisted living facility, do you need to contact them for added services and supports to be in place before she returns home?

–        Can they have these supports available to her immediately upon her return, or does it take some time for them to arrange theses?

 Before your parent leaves the ER

Regardless of where your parent will be going, there are several issues you need to discuss with the doctor before your parent leaves the ER.

Need assistance? Wondering what the right thing to do is? Give us a call!

In good health,

The Health Champion Team

After reading the true stories in last week’s blog (part one), you must be wondering how to prevent discharge horrors. You realize that the term “discharge planning” is, in many instances, an oxymoron.

The discharge part is true. The planning?  A little less so. It’s typically brief and fraught with gaps in communication between hospital caregivers and family members who often take over that role. All you want to do is get your loved one home. But you also want to know what you need to know. And in clear, precise terms.

Ask for a preliminary discharge meeting before the day of discharge. This allows time for you to process information and identify issues or gaps in the planning. Will you need to rent a hospital bed, for instance? Do you need to arrange for outside care? These things take time. What services and equipment will be covered by insurance?

Get a list of  medications your loved one is currently taking; compare it to the ones taken prior to admission. Make sure you understand what’s been added, changed or modified. To avoid confusion, or waiting around on discharge day, call your pharmacy in advance to see if they stock the new prescriptions.

Your Discharge Planning Meeting should be with health care professionals (usually a social worker or nurse, or both) in which they:

1. Assess the patient’s needs: physical, social, and emotional.
2. Clarify the discharge plan so that the patient and family members understand each element.
3. Identify what resources (family, friends, community) are available to assist the patient in meeting identified needs. Are these resources sufficient?
4. Educate family members and friends on their new responsibilities.
5. Monitor and modify the plan, as appropriate, and in response to family/caregiver feedback before discharge.

Remember: You don’t have to accept a discharge plan. Express your concerns. Don’t leave without a full understanding and comfort level of your loved one’s condition and your role as caregiver. And if you feel anxious, or you’re worried about understanding everything, bring along an advocate as a “second pair of ears.”

Home Again. That’s all you and your family think when it’s finally time to leave the hospital. But once you’re home, reality sets in. You’re not really well, just well enough to be discharged. Just well enough to know there should have been better discharge planning.

True Stories:

(1) A surgical patient was sent home with a nasogastric feeding tube, a long narrow tube that goes through the nose and into the stomach, designed to carry liquids. Until he was better, this would be his source of nourishment. The patient’s wife was given written instructions on how to feed her husband through the tube; she practiced in the hospital, demonstrating her new skills to a satisfied nursing staff. Once home, she prepared the ultimate comfort food — chicken soup — and began feeding her husband. She never realized — and nobody ever told her — that the tube would handle only liquids. Hours after being discharged she had to call the nurses for help in dislodging the blocked tube. “Half information” filled with gaps and misunderstandings could have resulted in disastrous consequences. Upon discharge, she should have been told, not only what to do, but what NOT to do.

(2)  As an elderly man was about to be sent home, the social worker quickly reviewed the discharge papers with him and his son. Health Champion was also there as an advocate. The son was thrilled to hear that his ordinarily agitated father  — at risk for falling — was now “sleeping though the night,” and not attempting to get up. This felt wrong to us. At our insistence, the social worker checked deeper and discovered that the patient did, indeed, need to get up to use the bathroom at least twice nightly, and he required assistance. This is critical discharge information that requires home planning. We then discussed medication management, especially of the client’s psych meds. The social worker offered a plan that did not set right with us and we refused to accept the discharge plan until it was appropriately modified to cover issues of safety and physician oversight.

These real life stories show what can happen, even when you’re vigilant. Next week — in Part 2 — we’ll talk about how to ensure discharge planning that works in your best interests.