A trip to the hospital is something none of us look forward to. During the hospital stay both the caregiver and the hospital’s main focus is to look out for the well-being of your loved one. However, what we seldom think about is what we need to do when our loved one is being discharged from the hospital. If you are like most people this thought will cross your mind only at the time of discharge – by then we are physically and emotionally exhausted with the stay at the hospital. So it’s a little too late for detailed conversations with hospital discharge planners or anyone else for that matter. This is why it’s important to know your rights and what to know before your loved one is discharged from the hospital. Doing this will empower you and provide your loved one with the proper post hospitalization resources they need to recover comfortably at home or another facility if needed.
What is Discharge Planning?
There is no standard practice across the United States that all hospitals follow for discharging planning. However, the general definition of Discharge Planning is – It is the process of determining what a patient needs for a smooth move from one level of care to another.
Ideally this is a team approach taken up by the hospital that covers all aspects of Evaluation of the patient, Discussion with patient and family members, Planning for homecoming or other care facility, Determining additional training or support needed, Referrals to home health care or other community based facilities, Arranging for follow up appointments or check ups.
What Are Your Rights?
This is an important discussion that must be had with the hospital’s qualified staff so you are fully equipped with caring for your loved one as you leave the hospital. Most hospitals provide proper detail upon discharge but if yours doesn’t then remember that it is your right to have detail information from your hospital that covers the following:
- General Discussion point you may have
- Post Hospital Planning
- Determining additional resources needed
- Referrals needed for additional care
- Follow ups needed
So ask for this information! If you are still not satisfied with the hospital’s response or lack thereof then you even have the right to ask the hospital to provide you the state department’s hotline number for you to file a formal complaint. This will immediately get your hospital doing circles around you as the hospital very well knows your complaint to the state department will lead to an on-sight survey. Trust me, hospitals look forward to an on-sight state survey as much as you and I look forward to an IRS audit!
If you feel your loved one is being discharged prematurely then you once again have the right to appeal the decision. Your first step should be to talk with the physician and discharge planner and express your reservations. If that doesn’t work, you will need to contact Medicare, Medicaid or your insurance company. Remember, formal appeals are handled through designated Quality Improvement Organizations or QIO (see Useful Links below for more details). You should know that if the QIO rules against you, you will be required to pay for the additional hospital care. Once again the hospital must let you know the steps to take to get the case reviewed.
You also have the right to choose which home health care agency, nursing home or any community based facility you would like to choose upon discharge if needed. Do not let the hospital tell you which one you should choose. Some Hospitals have a habit of steering people towards their own home health agency or a nursing home that’s easy for them to work with – it’s simply a business decision and not always the best for your loved ones. Choose the facility that is best for your loved one not the hospital. The hospital must provide you all the facilities that are available in your community. If they don’t provide you a list then simply ask for it. It’s your right to know.
As we have continuously noticed this gap in care upon discharge from the hospital to homes we at Precision Health Care now provide complimentary service to our community in this regard. Call us before discharge and we will visit you at the hospital and equip you with all that you need to know prior to discharge so your loved one can continue to recover at home avoiding unnecessary re-hospitalization. I said ‘home’ purposefully – some times hospitals are too quick to send your loved ones to institutional facilities when they can recover better at home with personalized care from clinical professionals. This is where we come in. If it is in the best interest of your loved one to be in the nursing facility then we will let you know – this gives you a professional second opinion on this very important decision that most of us know little about.
The visit to the hospital may been unplanned but the discharge from the hospital should be planned.
CMS Quality Improvement Organizations
www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityImprovementOrgs/ (link is external)
Next Step in Care
United Hospital Fund
Comprehensive information and advice to help family caregivers and healthcare providers plan transitions for patients. Spanish translations available.
www.nextstepincare.org (link is external)
Medicare’s Nursing Home Compare
www.medicare.gov/nursinghomecompare (link is external)
Medicare Rights Center
www.medicarerights.org (link is external)
Center for Medicare Advocacy “Hospital Discharge Planning”
www.medicareadvocacy.org (link is external)
Aging Life Care Association
www.aginglifecare.org (link is external)