From hospital to...?
An overview of discharge options
By Lisa M. Petsche
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There's a good chance that, sooner or later, your aging parent will require hospitalization for a medical crisis or surgical procedure, especially if he or she has chronic health conditions.
Once his condition is stable, hospital staff will work with him and your family to formulate a discharge plan.
When a patient makes a good recovery, planning may be simple and straightforward. In other situations, though, varying degrees of assessment and problem solving are required.
A good discharge plan involves communication and collaboration among the patient, family members and health care providers. It addresses issues around medical management, activities of daily living (self-care and home management skills), mobility, safety and finances, as well as psychosocial needs. The goal is to determine the most appropriate setting to meet the patient’s needs, and to ensure as smooth a transition as possible.
The hospital discharge planner, usually a social worker by profession, serves as the coordinator. An expert on community resources, he or she can assist with decision making and provide information and referral to community support services as needed. The discharge planner may also arrange a discharge conference that includes key members of the health care team who have been involved with the patient’s care.
Options for Discharge:
Following is an overview of typical settings to which a hospital patient may be discharged, depending on his or her condition when the acute phase of illness is over.
Many people are able to return directly to their home, especially if they have family or friends available to provide any needed assistance. Some may require special equipment and perhaps also support services, on either a transitional or long-term basis.
It’s important during the planning stage to be open and honest with your parent and the health care team about the type and amount of assistance you’re prepared to provide. If your parent is receptive to outside help, community or private pay agencies may be able to fill in any gaps.
If you have concerns about the feasibility of home discharge, now is the time to voice them so you can problem solve together. (Be aware that if your parent is deemed mentally capable, he has the right to choose to return home, even if this puts him at risk of a fall or other crisis.)
If your parent will be going home, clarify his medication needs and ensure necessary prescriptions are provided before discharge. Obtain details about any home health care services being arranged, including contact information for providers. Also inquire about follow-up medical appointments and tests, including who is responsible for arranging them.
Some patients need additional time to regain their strength before they can adequately manage at home, especially if family support is limited or unavailable. Selected retirement homes and nursing facilities have short-stay programs that, in addition to providing meals and housekeeping service, offer medical monitoring, treatment (such as wound care) and personal care as needed during this recuperation period.
If your parent has been hospitalized due to a stroke, hip fracture, prolonged acute illness or other type of major health crisis, an inpatient rehabilitation program may be recommended. Rehab may occur on-site or at an acute rehabilitation facility or skilled nursing home.
The goal is to help patients regain their strength and endurance, through participation in various kinds of therapy. Programs focus on reducing disability and, where permanent disability remains, teaching the patient to manage it in the best way.
Some patients do not make a good recovery and require a setting where 24-hour supervision or assistance is available. Even if they are able to perform basic self-care activities, including washing, dressing, grooming and toileting, they may have difficulty with one or more instrumental tasks that are necessary for independent living, such as medication management, meal preparation, laundering and housekeeping.
Physical accessibility can also be a factor in choosing long-term care. For example, a patient who suddenly must rely on a wheelchair for mobility may not be able to return home because needed renovations aren’t feasible.
Several levels of care are available, depending on the type and degree of services required.
For patients in the end stage of a life-limiting illness, inpatient hospice or palliative care may be recommended.
Rather than curative treatment, the focus is on maximizing comfort and quality of life. Patients receive medical care to alleviate pain and other distressing physical symptoms as well as interventions that address psychological and spiritual distress.
This type of program is not limited to patients with a cancer diagnosis. People with end-stage heart, lung or liver disease and neurological diseases such as Parkinson’s disease and Amyotrophic Lateral Sclerosis (ALS - also known as Lou Gehrig's disease) are among those who may benefit from specialized end-of-life care.
Lisa M. Petsche is a medical social worker and a freelance writer specializing in health and elder care issues.