How To Plan for Discharge After a Hospital Stay

discharge planning

By Angela Kauffman, Snyder Village

A trip to the hospital is sometimes an unexpected shock, but the next steps after being discharged don’t have to be a surprise. Having a hospital discharge plan can help make the transition smooth and ensure the well-being of your loved one.

Discharge Planning

Whether being discharged home, to a rehabilitation facility, or to a nursing facility, making a plan will improve the outcome of your loved one’s care. An effective discharge plan can decrease the chances of being readmitted to the hospital and can also help in recovery. According to the Family Caregiver Alliance, only a doctor can authorize a patient’s release from the hospital, but the process of discharge planning can be completed by a case manager, nurse, social worker, or other person such as a family member. Discharge planning is often a team effort.

The general basics of a discharge plan include evaluating the patient’s abilities, planning for the patient to return home or to be admitted to a facility, determining if the patient will require additional caregiver support, acquiring any necessary referrals, arranging any follow-up appointments, and doing a thorough review of all medications.

A family member can often be the best advocate for a patient being discharged from the hospital—especially if that family member has acted as a caregiver for their loved one. The hospital staff will not be as familiar with all aspects of the patient’s history and needs, and the caregiver may be able to fill in the gaps. If you act as the caregiver, it is important to assess if your loved one’s needs will require more than your time, abilities, or physical limitations will allow. If so, there are several ways to get the additional help that is needed.

Help at Home

If your loved one desires to return home after a hospital stay but his/her needs are greater than before, a home care service can provide the additional help needed. “Our services can vary from personal care like bathing or dressing, to household help like cooking, cleaning, laundry, and shopping,” explains Deb Albertson, director of Snyder Village Home Care. “Our schedule depends on the needs of the client. We may help them out for a few weeks or months until the client is fully recovered after an injury or hospital stay and able to return to normal activities. In other cases, we provide assistance long term.”

Rehabilitation or Nursing Care

If your loved one was not already living in a nursing facility but now requires it, having to suddenly choose a facility can be a source of stress. Doing research ahead of time can prepare you for this important decision. Visiting campuses, doing online searches, and talking to the staff at several facilities will give you confidence in choosing a facility that will provide the best care.

The Health Center at Snyder Village provides 24/7 skilled nursing care and other essentials that contribute to an enhanced quality of life such as activities, home-cooked meals, and opportunities for socialization. For those with rehabilitative needs or those who are learning to live with physical restrictions, the skilled therapy department at Snyder Village provides physical, occupational, and speech therapy as well.

As soon as you know your loved one will be discharged to a rehab or nursing care facility, it is best to contact the facility immediately to guarantee placement. “If you have a planned surgery or a loved one is unexpectedly in the hospital and the doctor recommends being discharged to skilled nursing care, give me a call and I can tell you all that Snyder Village has to offer,” says Kim Linehan, Admission Liaison at Snyder Village. “You can tell the hospital case manager that you want to come to Snyder Village, and I will work with them to make your transition here as smooth as possible.”

Memory Care

If your loved one shows signs of cognitive impairments such as Alzheimer’s disease or other forms of dementia, it may be too dangerous for them to return to their own home. Memory care programs, like the two unique programs offered at Snyder Village, provide safety, security, and specialized care. As with other skilled nursing or rehab services, it is important to contact a memory care facility as early as possible to begin the transition process.

The unique needs of each individual should be considered when planning for discharge after a hospital stay. Effective discharge planning can greatly impact the patient’s recovery and chance of rehospitalization. Along with support from hospital and facility staff, there are numerous online resources to help you plan for a hospital discharge. One such tool is the free “Discharge Planning Checklist” available at www.medicare.gov. By giving some thought to what happens after your loved one’s hospital stay, you’ll help ensure that the best possible care is what the doctor prescribes. 

Snyder Village in Metamora is a Life Plan Community that offers independent living in its retirement cottages and apartments. Beautiful assisted living accommodations, memory care programs, skilled nursing care, and physical therapy are also available on campus. Its home care services support individuals in Peoria, Tazewell, Woodford, and Marshall Counties. For more information, call (309) 367-4300 or visit www.snydervillage.com.

 

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