We’ve even reviewed the non-admission called “observation status” that warns us that we may not really be officially admitted to the hospital even when we think we are, and the toll that might take on our money and our health.
There’s at least one other aspect of being hospitalized that smart patients (and their caregivers and advocates) get ready for. That is, preparing to leave the hospital – your hospital discharge.
No matter how long you’ve been hospitalized, knowing it’s time to leave may elicit different reactions from you.
- You may be relieved, even excited, to leave and feel like the time is right.
- You may be fearful, as if you don’t feel you are ready or healthy enough to leave.
- You may want to leave – even if hospital personnel don’t think you are ready.
Here we’ll look at the first option – you feel as if the time is right and you want to prepare to leave.
How Do They Know When You Are Ready to Be Discharged?
Whether we think we are ready – vs – whether the hospital or our insurance thinks we are ready, may be two different times. To put this in perspective, let’s look at the aspects of our progress that help determine, from your doctor’s or the hospital’s point of view, whether you are ready.
If you are planning to go home, they need to know that you can handle the following, even if you need a caregiver to help, including a professional home health aide or nurse. These are the requirements for what the federal government (Medicare) calls “Safe Discharge:”
- That you can get a hold of (purchase and obtain), and take as prescribed, all your medications
- That you can take care of yourself (what are called Activities of Daily Living like eating well, sleeping well, getting around from room to room, using the bathroom, bathing, etc.)
- That you can eat well enough to stay healthy
- That you can follow up with your outpatient doctors as prescribed or necessary
The guidelines for Safe Discharge will apply whether or not you are a Medicare patient.
Safe Discharge requirements vary for patients who are being discharged somewhere besides home, like to a nursing home or rehab.
Where Will You Go When You Leave the Hospital?
Fortunately, most of us go home when we leave. At least that’s where we all want to go, eventually, even if there’s another stop along the way.
Of course, not all patients go home after leaving the hospital. About 25% are discharged to rehabilitation centers (rehab), like after a knee or hip replacement, or some other surgery or procedure which will require some sort of additional therapy.
Some, usually elderly patients, those who will not be able to care for themselves at home and don’t have some other caregiver to attend to them, and who aren’t able to be rehabilitated, will be discharged to a skilled nursing facility, or nursing home, or some sort of extended care facility which has skilled nurses available to help care for them.
If you won’t be going home, there will be a social worker or geriatric care manager in the hospital who will help you and your caregivers choose the right place for you to go. Or, if you’d like more control over the process of choosing, you may find a private patient advocate is a better choice.
How Will You Get There?
Transportation may be relatively simple (your spouse or parent or child picks you up and takes you home) or more complex (you ride in an ambulance to your destination) depending on what arrangements have been made for where you are going. Unless it’s an obvious choice, the hospital social worker will help to make the arrangements.
What Does the Discharge Process Look Like When You’re Going Home?
From your experience, the discharge process will seem quite simple. You will be told you’re going home (or leaving), and then eventually, perhaps after some coaching on what you need to do when you get to your destination, you will leave. From the time you’re informed, until you actually leave, may take hours and hours, even though when you’re told it’s time, it may seem like your discharge is imminent.
From the hospital’s perspective, your discharge is a highly complex process, most of which goes on behind the scenes and doesn’t involve you, even though it’s very much about you. Because of that, they employ a person called a “discharge planner” who will map out your individual discharge process.This is usually comprised of an extensive checklist of things that must be done, ranging from a reconciliation of your medications, to identifying where you’ll be going and making any arrangements that need to be made by them, to making sure all the signatures and components of your billing are in place, to providing you with appropriate instructions to take with you.
It’s important to know that as of late 2011, and reinforced in later years, hospitals are now faced with penalties if Medicare patients are readmitted to the hospital within 30 days. That means that they are more invested than they were prior to 2011 in making sure you are truly ready to leave, and that you have what you need for a successful discharge, including your instructions for prescriptions and follow up.