Leaving the Hospital | Discharge Information & More

Leaving the Hospital | Discharge Information & More
Leaving the Hospital
Patients & Visitors
Leaving the Hospital
Leave the hospital? Now what do we do?
By Dr. Karen Kowalenko, Correspondent
The patient's family didn't understand why the hospital was discharging
their elderly mother. The woman, who a week before was living independently,
had suffered a stroke and now had some disabilities. She was going to
need physical, occupational and speech therapies, along with other services.
A return to her two-story home was not likely, at least in the near term.
"Can't she stay here until she gets better?" one of her daughters pleaded.
It's a plea I hear often.
Most people see hospitals as places where sick people stay until they fully
recover, so this family concluded that someone who had suffered a disabling
stroke should remain in the hospital. I had to tell them that health care
doesn't work like that today.
Hospitals treat acute illnesses. Once the acute part of the illness is
over and the patient no longer needs hospital-level care, the patient
is discharged. That doesn't always mean the patient is fully recovered:
it just means that the patient's physician determined the condition is
stable and the patient no longer needs hospital-level care.
What do we do now?
A hospital discharge can be an overwhelming thing for spouses, families
and patients already reeling from a medical crisis. There's a lot to think
about and not a lot of time to make decisions. Spouses and families have
to decide the patient's abilities, home situation, care requirements and
whether there are people available for giving care. They may have to consider
placing a family member in facility they've never seen. Seemingly overnight
they have to become well-versed in various levels of care, quality, price,
and the limits of insurance.
This is where a hospital's case manager and social work staff can help.
Most hospitals have a case management staff - some call them discharge
planners - to help families figure out the next best place for a recovering
patient. Case management can help families arrange services in the community
and the home, as well as help with admission into nursing homes or other
facilities.
Discharge planning needs to begin the day of a hospital admission. While
this isn't always the case, family members need to be mindful that most
hospital patients aren't there for long periods of time. At most hospitals
there is a social worker and case manager available to help families sort
through patient wishes, community resources, family support, financial
issues and patient goals. Discharge from the hospital is made even smoother
when a patient designates one person — perhaps a spouse, family
member or friend — to serve as the patient's advocate. That person
can help provide information about insurance, health care proxy and advance
directive.
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New levels of care emerge
Because hospitals don't hold patients for long periods of time, alternative
levels of care have emerged. For medically complex patients or those who
require interventions such as ventilators, care of complex wounds, multiple
long-term antibiotics or other involved care, the next level of care might
be a long-term acute care hospital, such as Kindred Hospital New Jersey-Rahway,
located at Robert Wood Johnson University Hospital at Rahway. Patients
at these hospitals require complex, long-term acute care for more than 20 days.
Some hospitals have what are called subacute units, or skilled nursing
facilities (SNFs). These units are less medically intense settings that
provide the rehabilitation services patients need. At Robert Wood Johnson
University Hospital Rahway, the subacute unit is called Care Connection.
At Care Connection, a care plan that addresses the patient's medical and
rehabilitation needs is developed by a team of nurses, therapists and
other caregivers. The team then works to improve the patient's physical
function so the patient can either return home or transition to an appropriate
destination.
For hospitalized patients who are able to return home, there are visiting
nurse and home health care services. The specialized services of nursing
homes may also be an option.
Reasons for Leaving the Hospital
Being told a patient will be discharged days after a life-threatening illness
may sound cold, but there are good reasons for getting patients out of
the hospital. Patients who are hospitalized for long periods of time can
develop infections and life-threatening pneumonia. They risk blood clots
and hospital-related dementia. Still another factor is insurance reimbursement.
If a patient no longer meets the criteria for acute illness, Medicare
and other insurers won't reimburse a hospital for its services, leaving
the hospital or the patient to pay the bill.
A sudden accident or illness is devastating and being hospitalized is traumatic.
But working with a discharge planner or case manager from the first day
of hospitalization can help make the transition from hospital to home
more seamless and the care more effective.
Karen Kowalenko, DO, is a family practitioner. She is co-director of medical
management at Robert Wood Johnson University Hospital at Rahway. She is
currently president of the New Jersey Osteopathic Association.
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