After reading the true stories in last week’s blog (part one), you must be wondering how to prevent discharge horrors. You realize that the term “discharge planning” is, in many instances, an oxymoron.
The discharge part is true. The planning? A little less so. It’s typically brief and fraught with gaps in communication between hospital caregivers and family members who often take over that role. All you want to do is get your loved one home. But you also want to know what you need to know. And in clear, precise terms.
Ask for a preliminary discharge meeting before the day of discharge. This allows time for you to process information and identify issues or gaps in the planning. Will you need to rent a hospital bed, for instance? Do you need to arrange for outside care? These things take time. What services and equipment will be covered by insurance?
Get a list of medications your loved one is currently taking; compare it to the ones taken prior to admission. Make sure you understand what’s been added, changed or modified. To avoid confusion, or waiting around on discharge day, call your pharmacy in advance to see if they stock the new prescriptions.
Your Discharge Planning Meeting should be with health care professionals (usually a social worker or nurse, or both) in which they:
- Assess the patient’s needs: physical, social, and emotional.
- Clarify the discharge plan so that the patient and family members understand each element.
- Identify what resources (family, friends, community) are available to assist the patient in meeting identified needs. Are these resources sufficient?
- Educate family members and friends on their new responsibilities.
- Monitor and modify the plan, as appropriate, and in response to family/caregiver feedback before discharge.
Remember: You don’t have to accept a discharge plan. Express your concerns. Don’t leave without a full understanding and comfort level of your loved one’s condition and your role as caregiver. And if you feel anxious, or you’re worried about understanding everything, bring along an advocate as a “second pair of ears.”
Home Again. That’s all you and your family think when it’s finally time to leave the hospital. But once you’re home, reality sets in. You’re not really well, just well enough to be discharged. Just well enough to know there should have been better discharge planning.
True Stories:
(1) A surgical patient was sent home with a nasogastric feeding tube, a long narrow tube that goes through the nose and into the stomach, designed to carry liquids. Until he was better, this would be his source of nourishment. The patient’s wife was given written instructions on how to feed her husband through the tube; she practiced in the hospital, demonstrating her new skills to a satisfied nursing staff. Once home, she prepared the ultimate comfort food — chicken soup — and began feeding her husband. She never realized — and nobody ever told her — that the tube would handle only liquids. Hours after being discharged she had to call the nurses for help in dislodging the blocked tube. “Half information” filled with gaps and misunderstandings could have resulted in disastrous consequences. Upon discharge, she should have been told, not only what to do, but what NOT to do.
(2) As an elderly man was about to be sent home, the social worker quickly reviewed the discharge papers with him and his son. Health Champion was also there as an advocate. The son was thrilled to hear that his ordinarily agitated father — at risk for falling — was now “sleeping though the night,” and not attempting to get up. This felt wrong to us. At our insistence, the social worker checked deeper and discovered that the patient did, indeed, need to get up to use the bathroom at least twice nightly, and he required assistance. This is critical discharge information that requires home planning. We then discussed medication management, especially of the client’s psych meds. The social worker offered a plan that did not set right with us and we refused to accept the discharge plan until it was appropriately modified to cover issues of safety and physician oversight.
These real life stories show what can happen, even when you’re vigilant. Next week — in Part 2 — we’ll talk about how to ensure discharge planning that works in your best interests.