Our team’s job is to provide exceptional home care families can count on, whether it is helping our clients through recovery from a serious illness or surgery, providing ongoing support to those with disabilities, or easing the end-of-life transition. We also feel a responsibility to educate and advocate for our clients and their families as they navigate healthcare so decisions can be confidently made.

The Realities of Hospital Discharge is a three-part series, covering three options after a hospitalization: home healthcare, rehabilitation centers and hospice.

Chances are you or someone you know or someone you love will eventually be hospitalized. While it might seem that being discharged from a hospitalization is the easy part, the fact is that after care is equally important to the outcome as the treatment is.

Like most everything else in life, it’s best to have a discharge plan for when it happens so you know what to expect and the focus remains on what matters most—recovery.

What to Expect During the Hospital Discharge Process

The discharge process can be complex and varies depending on the situation. Be that as it may, having a general understanding of what to expect can help you prepare better.

  1. Initial Assessment: Upon admission, the hospital staff will start planning for your discharge. This includes assessing your medical condition, recovery progress, and potential needs post-discharge.
  2. Discharge Planning Meeting: Typically, a discharge planner, often a nurse or social worker, will meet with you and your family to discuss the options. This might include home care, a rehabilitation center or hospice care.
  3. Review and Approval: Your healthcare team will review the plan, make necessary adjustments, and provide approval. This plan will outline the care you will need at home or in another facility—a skilled nursing or hospice center.
  4. Final Preparations: On the day of discharge, final preparations include medication instructions, scheduling follow-up appointments and arranging any necessary medical equipment or home modifications.

Terms You Might Hear About Discharge and What They Mean

Understanding the terminology used during discharge planning can help you navigate the process more effectively:

  • Discharge Planner/Nurse: A professional responsible for coordinating the discharge process and planning post-hospital care.
  • Skilled Nursing Facility (SNF): Also known as a rehabilitation center, it provides short-term care and rehabilitation.
  • Home Health Aide: A trained professional who provides personal care and assistance with daily activities at home.
  • Durable Medical Equipment (DME): Medical equipment prescribed for use at home, such as wheelchairs, hospital beds or oxygen equipment.

What to Expect on Discharge Day

Be prepared to spend the entire day at the hospital, even if told you will be discharged in the morning. There are several reasons for this, including:

  • Final Medical Checks: The doctor may need to perform final assessments to ensure the patient is ready to go home.
  • Paperwork: Completing and reviewing all necessary paperwork can be time-consuming.
  • Coordinating Services: Arranging home care services, medical equipment delivery and transportation takes time.

You Have Choices: Your Role in Hospital Discharge Planning

Patients and their families need not solely rely on the discharge planner. You have a choice and a say in the decisions. If home care is preferable and sufficient to cover needs, you can recover at home. You can determine which home healthcare company you use.

Be prepared for the necessity of a rehabilitation center. Visit a few when you’re not under pressure, stressed and in a rush. This proactive approach helps in making an informed decision when the time comes.

What the discharge planner suggests doesn’t always have to go. Discuss all possible options and choose what best fits your needs and preferences. If you have a home healthcare service or skilled nursing facility already selected, it’s one less thing to worry about when the time comes.

Home Care Services After a Hospitalization

Home care can be an excellent option for many, allowing for recovery in the comfort of your own home with family close by. One of the primary benefits of home care is that the services are tailored to individual needs, ensuring that each patient gets the specific help they require.

Being at home can provide emotional and psychological benefits that aid in recovery, as familiar surroundings and the presence of loved ones can significantly impact well-being. Moreover, depending on the level of care required, home care can be more cost-effective compared to staying in a skilled nursing facility.

We developed BEYOND THE ER™ (BETER) Care Package to assist with transitions from planned or unplanned hospitalizations, ER, or rehab facilities to home or hospice.

Our tapered 30-day plan, starting with 24/7 care for 1 week and gradually decreasing the hours per day each week for 4 weeks, increases the likelihood of success at home. This plan includes:

  • Nursing oversight and support on a weekly basis
  • Personal care services
  • Assistance with prescribed physical therapy treatments
  • Transportation to follow up appointments
  • Light housekeeping (laundry and other household chores)
  • Cleaning out and restocking the refrigerator if needed
  • Coordination of care with your choice of home health or hospice provider

Three Tips for a Smooth Transition Between the Hospital and Home

For a smooth discharge and recovery, it takes everyone being knowledgeable about the process and on the same page. Here are three tips:

  1. Communicate: Maintain open communication with the healthcare team, family and home care providers.
  2. Prepare Early: Ensure the home is ready with any necessary modifications and equipment before discharge.
  3. Follow-up Care: Stick to follow-up appointments and follow the care plan provided by your healthcare team.

By being informed and proactive, you can ensure that the transition from hospital to home is as smooth as possible, supporting a successful recovery.

For a free in-home evaluation or to discuss any of our in-home health services, call (816) 628-5303 or email us.

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