Do you have a loved one, parent, child, friend or even yourself who is about to be discharged from a hospital stay?
Read before you proceed. Ten important questions to ask before you take your loved one home that could be a life saver.
1. What is the Prospective Discharge Date?
When a loved one is admitted to the hospital, the last thing on the mind of a caregiver or family member are concerns about them being discharged. Initially, all of the caregiver's or family's concerns are focused on the present. For example, concerns of what is wrong with the patient, what kinds of treatment the patient will undergo, and whether or not they will be fine are all commonplace during this time. The caregiver and family members of the patient realize that, unless the untimely happens, the patient will be discharged from the hospital at some point. The discharge most likely will happen sooner than expected. Based on today's statistics, the average hospital stay for a non-complicated patient is 1.5 days. Due to Medicare, Medicaid and private insurance regulations, hospitals and institutions are discharging their patients sooner than expected and utilizing other available resources such as rehabilitation centers, assisted living facilities, nursing homes, and course, the patient's family.
Technically, the discharge planning for the patient starts at the time of admission. As soon as a patient is registered into the hospital system, a team is ready to plan the discharge. The caregiver and family of the loved one are part of the discharge planning team that includes the physicians, nurses, social workers, case managers, and all other medical personnel involved in the patient's care. With this information on hand, the caregiver and or family of the patient must understand that they are an important part of the discharge planning team. Therefore, they must be informed, assertive, and proactive to obtain the best possible outcome for their loved one.
2. Who are Your Teammates?
It is imperative that the patient's caregiver or family meet with the discharge planning team, in order to understand their role and what to expect from them. Know them on a first name basis, meet with them, and collect their phone numbers.
a) The Patient
The patient is the most important member of the discharge planning team. It is easy for all those involved with the patient's care, as well as the patient's family, to assume that once a person is lying on a hospital bed all decisions are made by somebody else. However, it will ultimately be the patient, depending on their age and condition, who will make the decision of their care following discharge.
b) All Physicians and Specialists Involved
Keep in mind that the physician that provided care during the patient's hospital stay is not necessarily the one that will continue care after discharge. Today, more and more, hospitals have what is called a Hospitalist. A Hospitalist's involvement with the patient is limited to treatment and care required while in the hospital. Upon discharge, the patient must follow-up with their primary care physician. In other words, after discharge you may not be able to contact the discharging physician or Hospitalist for follow-up orders, refills or consultations. It will be very difficult and frustrating for you to try to contact him or her and ultimately they will refer you to the primary care physician. Obtain all prescriptions and services that the patient needs to continue after discharge. This includes equipment such as a hospital bed, wheelchair, oxygen, supplies, and home care services. Ask for these orders/prescriptions before the patient is discharged. If your loved one received care from any kind of Specialist, make sure that you have their names, specialty, addresses, phone numbers and their office manager's name. Ask if your patient must follow-up with them and make an appointment as soon as possible.
c) Clinical Personnel
This includes nurses, therapists, clinical managers and others involved in the patient's care. As well as the other team members, know them by name and obtain phone numbers where they could be contacted in case of questions or concerns. Learn what their responsibilities are when the patient is admitted and how you could get in contact with them if needed after discharge. Make sure that you get the name and phone number of the Nurse Manager of the unit where your patient was admitted.
d) Case Manager
Every patient admitted in a hospital or institution is assigned a case manager. This person plays a key role in the discharge planning process. Get to know her or him well. This individual is your line to sanity during the first few hours after discharge. The Case Manager is the one that coordinates the whole process. When a strong, positive relation is developed between the patient, caregiver, family, and case manager, the process is usually easier and less stressful for all those involved. The case manager will arrange for the equipment needed after discharge, home care services or hospice, referrals or placement to other health care facilities such as assisted living facilities, nursing homes or rehabilitation centers and transportation if needed.
e) Caregiver and Family Members of the Patient
Another extremely important team member in the discharge planning process, and most of the time the most difficult to coordinate, is the caregiver and family. It is important to identify, without a doubt, exactly who is in charge. Call for a family meeting and designate who will be taking the responsibility of coordinating the patient's care after discharge. Keep clear in mind that the caregiver position cannot be an assumed or imposed one. There are options available to be considered before making this decision. Caregiving - whether at home or outside the home - is one of the most stressful, life disturbing experiences anyone could ever live. I recommend that the person that is considering taking this responsibility take the Caregiver Assessment Test. This will provided some insight of the potential caregiver's strengths and weaknesses before undertaking the task.
3. What are the Patient's Diagnosis or Diagnoses, Prognosis and Life Expectancy?
Be very clear and specific about this. Ask for the specific name of the diagnosis or diagnoses. If unknown or difficult to understand, ask the person providing the information to explain it in simple words or to write it down for you. Research and educate yourself on the matter. The caregiver and/or family must be fully aware on what to expect after the patient is discharged. Ask about prognosis and life expectancy. This will be a difficult subject to deal with. Healthcare professionals sometimes have difficulty dealing with this topic themselves, and could be very evasive about it. The caregiver has the right to know, contingent with privacy regulations, the patient's condition to be able to make the best decision regarding the patient's after care.
4. What are the Best Options for After Discharge Care?
There are as many answers to this question as there are patients, diagnosis and conditions. It all depends on the patient's specific condition, prognosis, life expectancy, age, availability of caregiver and family support system. The options include but are not limited to; the patient's own home, family and friend's homes, nursing home facilities, rehabilitation centers and assisted living facilities. The caregiver or family must make a self-assessment to determine the best options for their loved, as well as themselves. If you, a family member or friend decides to undertake this task, I have created a simple tool that the caregiver could use to determine if care giving at home is an option. Take this simple test before you make any decision.
Talk with the patient's physician, case manager and other members of the discharge planning team, including other family members. Reach out! This will be your salvation once you start this journey of caring for someone at home.
5. What Treatments and Procedures will have to be Continued After Discharge?
Now more and more it happens that patients are being discharged from the hospital in need of continued care such as therapy, treatment or procedures. Even if the patient will receive home care services, usually these services are provided for a limited amount of time and the caregiver is expected to continue to perform them after the services are terminated. From insulin injections, tracheostomy care, colostomy care, wound care or dressing changes and everything in between. Many of these procedures do not require a professional to perform them but the caregiver must be instructed on how to perform them. Educate yourself, observe the healthcare provider performing these procedures while in the hospital, request a one on one, hands on instruction session. Plain and simple, get ready! It is up to the caregiver to get ready for the task. Clinical personnel will not volunteer to instruct the caregiver on certain procedures unless the caregiver demonstrates an interest in learning or it is specifically ordered by the physician.
6. Will My Patient Continue the Same Medications and Treatments Before They Were Admitted?
I wanted to list this question as a serious issue that needs to be addressed independently. In my experience as a nurse and caregiver, medication non-compliance is one of the most frequent reasons for the patient to be readmitted to the hospital. Most of the time, the patient and/or caregiver assume that a medication or medications are to be continued or discontinued without understanding the consequences. It is standard practice that when a patient is admitted into the hospital all of the medications that are taken at home are reconciled. The same procedure applies at discharge time. Make sure that a list of medications taken at home is brought in upon admission of the patient or shortly after. At the time of discharge, request to speak with the clinician in charge of your patient's care. Go over each one of the medications in the patient medication profile. Ask for indications, dosages, frequency and route as well as possible side effects and or allergic reactions. If a new medication has been indicated during the hospital stay, ask if it is to be continued after discharge. Be certain to request prescriptions for all those new medications. You do not want to find yourself in the situation of needing a medication, not having a prescription from discharge and it is a holiday. Good luck!
7. What are Possible Signs and Symptoms I should be Aware of?
It is here where the absolute understanding of the patient's diagnosis and prognosis comes into play. Signs, symptoms and actions to take depend on the patient's condition and vary with them. Request a conference with all those involved in the patient's care i.e. physicians, specialists, clinical personnel, and case manager or social worker. Ask all the questions that you think are pertinent to your patient's condition and prognosis. The ideal situation will be that the conference is held with all participants at once; however, most likely that will not be the situation. One thing is certain; you must have a face-to-face conversation with all the disciplines mentioned if you want to survive the first 24 hours after discharge. Get educated, be assertive and proactive, request, demand and expect. Most hospital personnel welcome the caregiver interested on a fast recovery or the best outcome possible of their loved one, but in today's fast environment the caregiver should assume a very assertive position.
8. Who is Responsible for the Patient's Financial Obligations?
This should be asked right up front. Do not assume that the caregiver is responsible for this obligation. Have an honest talk with the patient, if possible, on how he or she plans to meet their financial obligation with the hospital or institution. Request an appointment with the office of financial affairs at the hospital or institution to discuss the patient's bill status. Familiarize yourself with all medical insurance policies that the patient might have. Bring with you all of the identification cards, copies of insurance policies including any supplemental health insurance policies. Request an itemized bill. Obtain the name and phone number of the person you are dealing with. You will need to call back regarding this issue and you need a person that knows you. This will prevent the aggravation of having to tell your story to several people repeatedly.
9. What do I do During the Days Just Before Discharge?
The panic is overtaking you. Reality is sinking in. Your loved one is coming home tomorrow. You have accepted the responsibility of taking care of him or her at home. Welcome to the club. There are millions of members in this club. Hopefully, you took the Caregiver Assessment Tool Test before you assumed this responsibility.
Today you will collect the patient's belongings that will not be needed for the rest of the hospital stay. Make sure you go over every item that was brought with the patient at the time of admission. This includes eyeglasses, dentures, any equipment such as wheelchairs or walkers. If possible, ask the patient if there is anything else that was brought in that you are not aware of. If anything is missing, this is the time to speak with the personnel that took care of the patient and start a search. Do not wait until the day of discharge.
Make sure that before discharge, care is already coordinated and in place. This is equipment, supplies and services such as home care. Contact the home care agency that is supposed to service your loved one and inform them of the prospective discharge date. Get a contact person's name and phone number. Contact the case manager and inform him or her of any discrepancies in the coordination of services.
10. Today is the Day, What do I do?
Today is the day. Discharge day. Emotions are running high. Make sure that you are available at the time of discharge. It is imperative that you are there during this process. On this day, you will take last inventory of the patient's belongings. Get prescriptions from the hospitalist. Talk with the nurse that is in charge of the patient's care and request all medications that remained unused. Ensure these medications are on the list of medications that the patient is supposed to continue after discharge, as well as all supplies. These medications and supplies were already charged to the patient. Request a last-minute conference with the hospitalist to be clear on instructions that were already discussed. Clarify any doubts and ask questions. Avoid the feeling that you are taking their time or interfering with their schedule. They are there for you and your patient. Now, it is time to go home.
Welcome aboard.
The journey has begun.
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