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Taking Control of the Hospital Discharge Process

June 2, 2010

It’s stressful enough to have a family member hospitalized, but hospitals seem to move patients out so quickly that the stress is intensified.

A hospital discharge does not mean that the patient has recovered fully.  Rather, it means that a physician has decided that the patient has reached a stable condition and doesn’t need to be hospitalized any longer.  Discharge planning is defined by Medicare as a “process used to decide what a patient needs for a smooth move from one level of care to another.”  Medicare requires that the discharge plan be “safe and adequate,” and if you don’t agree with the plan, you can appeal it.  Until the appeal is decided, your family member can remain in the hospital.

Make sure there aren’t any inaccurate assumptions in the discharge plan, especially about what family caregivers are expected to do.  If the discharge is to home, make sure the home care services have actually been set up before the discharge (not just a phone call made by the discharge planner), as any gaps in coverage will immediately fall on family caregivers once your family member has left the hospital.  In a difficult situation involving a senior citizen, getting a geriatric care manager involved can often remove a great deal of stress from you.  (If you’re in need of one, a Certified Elder law Attorney (www.nelf.org) can provide you with a referral.)

If the discharge is to a nursing home, make sure that you feel that the nursing home is located in an appropriate place for visits from family and friends, as a lack of visits may result in corners getting cut and less than adequate care.  While the hospital discharge planner may be able to locate a nursing home that has an available bed, there may be a good reason that beds are available at that nursing home, so you should make your own decision about whether the nursing home is appropriate.  You should personally visit the nursing home.  Print out the Nursing Home Facility Checklist at  http://nursinghomeadmission.com/findahome.php, and through the same page on that website you can check out the Massachusetts and federal ratings of any nursing homes that you are considering.  Don’t feel pressured to make a too-quick decision; again, getting a geriatric care manager involved can reduce your stress level.

Above all else, trust your common sense and don’t let the hospital discharge planner steamroll over you.  If you feel your family member is being pushed out of the hospital too soon, you may be right:  based on the way health insurance works, hospitals make money by refilling beds, not by having existing patients linger in the hospital.

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