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Ten vital questions to ask before bringing a loved one home that could save their life.
1. What is the anticipated discharge date?
When admitted to the hospital, concerns about a loved one’s discharge are the last thing on a caregiver’s or family member’s mind. Initially, the caregiver’s or family’s concerns are about the present. Concerns about what is wrong with the patient, what treatment the patient will receive, and whether or not they will recover are all common during this time. The patient’s caregiver and family members understand that, unless something unexpected occurs, the patient will be discharged from the hospital at some point.
The discharge will most likely occur sooner than expected. According to current data, the average hospital stay for a non-complicated patient is 1.5 days. In addition, because of Medicare, Medicaid, and private insurance regulations, hospitals and institutions release patients earlier than expected and utilize other available resources such as rehabilitation centers, assisted living facilities, nursing homes, and, of course, the patient’s family.
Technically, the patient’s discharge planning begins at the time of admission. However, a team is ready to plan a patient’s discharge as soon as they are registered in the hospital system. The caregiver and loved one are the discharge planning team members, including physicians, nurses, social workers, case managers, and all other medical personnel involved in the patient’s care. With this information, the patient’s caregiver and family must recognize that they are essential to the discharge planning team. As a result, they must be well-informed, assertive, and proactive to achieve the best possible outcome for their loved one.
2. What are your teammates’ names?
The patient’s caregiver or family must meet with the discharge planning team to understand their role and what to expect from them. Know them by their first names, meet with them, and get their phone numbers.
a) The Individual
The most important member of the discharge planning team is the patient. It is common for all those involved in the patient’s care and the patient’s family to believe that once a person is lying in a hospital bed, all decisions are made for them. However, depending on their age and condition, the patient will ultimately decide on their care after discharge.
b) Involved Physicians and Specialists
Remember that the physician who provided care during the patient’s hospital stay may or may not continue to provide care after discharge. Hospitals are increasingly employing what is known as a Hospitalist. The involvement of a hospitalist with the patient is limited to the treatment and care required while the patient is in the hospital. Following discharge, the patient must make an appointment with their primary care physician.
In other words, you may be unable to contact the discharging physician or Hospitalist for follow-up orders, refills, or consultations after discharge. It will be challenging and frustrating for you to get them, and they will eventually refer you to the primary care physician. Obtain all prescriptions and services that the patient will require following discharge. This includes hospital beds, wheelchairs, oxygen, supplies, and home care services. Before the patient is discharged, request these orders/prescriptions. If your loved one received care from a Specialist, ensure you have their names, specialty, addresses, phone numbers, and the name of their office manager. Inquire if your patient needs to follow up with them and schedule an appointment as soon as possible.
c) Clinical Staff
Nurses, therapists, clinical managers, and others involved in the patient’s care are included. Know the other team members’ names and phone numbers so they can be contacted if you have any questions or concerns. Learn their responsibilities when the patient is admitted and how you can get them after discharge if necessary. Note the Nurse Manager’s name and phone number for the unit where your patient was admitted.
d) Case Supervisor
A case manager is assigned to each patient admitted to a hospital or institution. This person is crucial in the discharge planning process. Learn everything you can about them. During the first few hours after discharge, this person is your only link to sanity. After that, the Case Manager is in charge of coordinating the entire process. The process is usually more manageable and less stressful for everyone involved when there is a strong, positive relationship between the patient, caregiver, family, and case manager. In addition, the case manager will arrange for post-discharge equipment, home care services or hospice, referrals or placement in other health care facilities such as assisted living facilities, nursing homes, or rehabilitation centers, and necessary transportation.
e) Patient’s Caregiver and Family Members
The caregiver and family are other crucial team members in the discharge planning process, and they are often the most difficult to coordinate. It is critical to establish, without a doubt, who is in charge. Call a family meeting and decide who will coordinate the patient’s care after discharge. Remember that Remember caregivers are released. There are alternatives to consider before making this decision. Caregiving, whether at home or away from home, is one of the most stressful and life-altering experiences anyone can have. I recommend that anyone considering this role take the Caregiver Assessment Test. Before beginning the task, this will provide insight into the potential caregiver’s strengths and weaknesses.
3. What is the patient’s diagnosis, prognosis, and expected life span?
Make it very clear and specific. Inquire about the exact name of the diagnosis or diagnosis. If something is unfamiliar or difficult to understand, ask the person providing the information to explain it or write it down. Investigate and educate yourself on the subject. After the patient’s discharge, the caregiver and family must be fully informed of what to expect. Inquire about the prognosis and life expectancy. This will be a complex topic to address. Healthcare professionals may have difficulty dealing with this topic, which may sometimes be mysterious. The caregiver has the right to know the patient’s condition, subject to privacy regulations, to make the best decision regarding the patient’s aftercare.
4. What Are the Best Options for Post-Acute Care?
This question has as many answers as there are patients, diagnoses, and conditions. Everything depends on the patient’s situation, prognosis, life expectancy, age, caregiver availability, and family support system. Options include but are not limited to, the patient’s own home, the homes of family and friends, nursing homes, rehabilitation centers, and assisted living facilities. The caregiver or family must conduct a self-assessment to determine the best options for their loved one and themselves. If you, a family member, or a friend decide to take on this task, I have created a simple tool that the caregiver can use to determine whether home care is an option. Before making any decisions, take this simple test.
Consult with the patient’s doctor, case manager, and other members of the discharge planning team, including family members. Make contact! Once you begin caring for someone at home, this will be your salvation.
5. What treatments and procedures must be continued following discharge?
Patients are increasingly being discharged from hospitals needing ongoing care, such as therapy, treatment, or procedures. Even if the patient receives home care, these services are typically provided for a limited time, and the caregiver is expected to continue performing them after the services are terminated. Everything from insulin injections to tracheostomy care, colostomy care, wound care, or dressing changes is available.
Many of these procedures do not necessitate the use of a professional, but the caregiver must be instructed on how to carry them out. Educate yourself, watch the healthcare provider perform these procedures while you’re in the hospital, and request a one-on-one, hands-on training session. Simply put, prepare yourself! It is the caregiver’s responsibility to prepare for the task. Clinical personnel will not volunteer to instruct the caregiver on specific procedures unless they are interested in learning or the physician specifically orders it.
6. Will my patient’s medications and treatments remain the same as before they were admitted?
I wanted to highlight this question as a serious issue that must be addressed separately. Medication noncompliance is one of the most common reasons for a patient’s readmission to the hospital in my experience as a nurse and caregiver. The patient and caregiver frequently assume that a medication or medications will be continued or discontinued without fully understanding the implications. When patients are admitted to the hospital, all medicines they take at home are reconciled. The same procedure is followed when it comes time to discharge.
Ensure that a list of medications taken at home is brought in with the patient upon admission or shortly after. Request to speak with the clinician in charge of your patient’s care at discharge. Examine each of the medications listed in the patient’s medication profile. Inquire about indications, dosages, frequency, route, and any potential side effects or allergic reactions. If a new medication is prescribed during your hospital stay, determine if it will continue after you leave. Make sure to get prescriptions for all of your unused drugs. You don’t want to be in a situation where you need medication but don’t have a prescription from your discharge, and it’s a holiday.
Best wishes!
7. What are some of the potential signs and symptoms I should be aware of?
At this point, a complete understanding of the patient’s diagnosis and prognosis is required. The signs, symptoms, and actions to be taken vary depending on the patient’s condition. Request a meeting with everyone involved in the patient’s care, including doctors, specialists, clinical personnel, and a case manager or social worker. Ask any questions relevant to your patient’s condition and prognosis.
The ideal situation would be for the conference with all participants simultaneously; however, this is unlikely. One thing is sure: if you want to survive the first 24 hours after discharge, you must have a face-to-face conversation with all the disciplines mentioned. Get educated, be assertive and proactive, and make requests, demands, and expectations. Most hospital personnel welcome caregivers who want their loved one to recover quickly or have the best outcome possible, but in today’s fast-paced environment, the caregiver must be assertive.
8. Who is in charge of the patient’s financial obligations?
This should be asked right away. Do not assume that the caregiver is in charge of this responsibility. If possible, discuss with the patient how they intend to meet their financial obligations to the hospital or institution. Request an appointment with the hospital or institution’s economic affairs office to discuss the patient’s bill status. Familiarize yourself with all of the patient’s medical insurance policies.
Bring all of your identification cards and copies of your insurance policies, including any supplemental health insurance policies. Request a detailed bill. Obtain the name and phone number of the person you are dealing with. You will need to call back about this issue, and you will need to speak with someone who knows who you are. This will save you the trouble of telling your story to multiple people.
9. What should I do in the days leading up to discharge?
Panic has taken hold of you. Reality is beginning to set in. Your loved one will return home tomorrow. You have taken on the responsibility of caring for them at home. Hello and welcome to the club. This organization has millions of members. Hopefully, you took the Caregiver Assessment Tool Test before taking on this role.
You will collect the patient’s belongings that will not be required for the remainder of the hospital stay today. Check every item that the patient brought with them at the time of admission. This includes spectacles, dentures, and any equipment like wheelchairs or walkers. If possible, inquire with the patient if there was anything else brought in that you are not aware of. If anything is missing, now is the time to contact the person who cared for the patient and begin a search. Don’t put it off until the day of discharge.
Ascertain that care is already coordinated and in place before discharge. This category includes equipment, supplies, and services such as home care. Inform the home care agency to care for your loved one of the impending discharge date. Obtain the name and phone number of a contact person. Contact the case manager and notify them of any inconsistencies in service coordination.
10. What should I do now that it’s the big day?
This is the day. Today is discharge day. Emotions are at an all-time high. Ascertain that you will be available at the time of discharge. You must be present during this process. You will take a final inventory of the patient’s belongings on this day. Ask the Hospitalist for prescriptions. Speak with the nurse in charge of the patient’s care and request all unused medications.
Ensure that these medications and all supplies are on the list of drugs the patient is supposed to continue after discharge. The patient had already been charged for these medications and supplies. Request a last-minute conference with the Hospitalist to clarify previously discussed instructions. Clarify any uncertainties and ask questions. Avoid the impression that you are wasting their time or interfering with their plans. They are available to you and your patient. It is now time to return home.
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