You’re Being Discharged from the Hospital… Now What?

You’re Being Discharged from the Hospital…What’s Next?

Most people don’t have the good fortune to plan a hospital stay; they may have had an accident, a stroke or a traumatic injury from a fall.  There are some hospital stays which are planned: hip replacement surgery or cancer care.  Regardless of whether or not you have planned for a hospitalization, your discharge from the hospital can be a whirlwind of difficult decisions and confusion about housing, rehabilitation and care.

Those who had the ability to plan for a hospitalization and recovery typically have a much less stressful situation.  When the outcome of your hospital stay is not what you expected or if your hospital stay was completely unexpected, there are some challenges to deal with.  Will you be able to go home?  Will you need outside care at home?  Will you have the needed support of family and friends? What if you have to go to a rehabilitation center for continuing therapy?

Hospitals are discharging patients quicker these days.  Due to complex Medicare funding rules, much of the care that used to be receive in the hospital is now given in skilled nursing facilities, senior living communities or senior care homes.

While planning for a discharge, many different health professionals are likely to play a role in your future.  The physician who cares for you in the hospital will make recommendations for the level of care you require after discharge.  The discharge planner, usually a social worker employed by the hospital, will help you through the process of moving on to the next step in your care.  You may work with an Elder Care Advisor to help define housing and care options or with a private case or care manager who will define a plan of care for you.

According to Medicare, the discharge planner’s job is to find you a “safe and adequate” place to go after you leave the hospital.  For some, that may be home.  But for many that choice will be limited to places that can provide the follow-up care you need in order to recover completely.  Some patients, depending on circumstances may never get back to the level of health, mobility or activity they were at prior to their hospital stay.  Your needs at discharge may change in the months or years following.

You may not be able to predict the long-term future, but you will have a definite idea at the time of discharge about your immediate care requirements.  If you need intensive occupational therapy or physical therapy, wound care, or continue to be bedridden, you will most likely be discharged to a skilled nursing facility.  These facilities vary greatly and a personal visit by a friend or family member is highly recommended.  The location of the nursing home will be important to your family members who will want to stay close to you during recovery.  Available space within the care community is always a factor, as is the question of whether or not the facility has a contract with your insurance carrier.  The place that is closest to home may not have an available bed, or the nursing home of preference may not have a contract with your insurance provider.

While Medicare will pay for skilled nursing after a three day stay in the hospital, they will only pay for your convalescence while you continue to improve or up to 100 days, whichever is less.  Medicare does not automatically pay for 100 days of skilled care.  Once your condition plateaus, you may be decertified; that is, your benefits from Medicare will cease.  You will then be faced with still another decision: can I go home, or will I need to move to some type of assisted living?  Again, a discharge planner will be there to advise you.  A care conference involving your family advocates and your care team will determine your discharge date and make recommendations for your care.

If you are considering returning to your home, the big question is who will care for you there?  An elderly spouse may not be a satisfactory option.  Working adult children may not be available.  You may want to bring in a home care provider who can help with tasks like lifting, bathing and toileting.

Assisted Living may be a very good option at this point.  You may choose a large community with many amenities or a small, intimate adult care home, providing services to two to six individuals.  These environments offer a great variety of “hands on” care, medication services and meals.  Some homes even offer on site physical therapy.  There is often a nurse on staff to keep an eye on the progress of your recovery. Many assisted living communities are now offering respite, or “short-term stays” that will allow you to ease back into normal day-to-day living after a hospital stay.  If you like the lifestyle there, you can opt to become a permanent resident.  Most assisted living facilities rent on a month-to-month basis so you might even decide to return home later.

Though we can’t know when a crisis will find a family member in the hospital, we can be prepared by learning as much as possible about the hospital systems, Medicare coverage and what care options are available.  We can also explore community resources, social services and local housing options before we need them.

If you are in need of help and guidance in knowing what care and housing options exist for an older adult, please call CHOICE Advisory at 800-361-0138.  Our agency assists privately-paying or insurance-covered older adults age 55+.  There is no fee for our help.