In our line of work, we encounter many families who are not properly prepared for when their loved ones get discharged from the hospital. It makes sense – while in the hospital, it’s difficult to think about the future. You’re in a highly tense, emotional situation – and you’re trying to balance being there for your loved one with the rest of your life, outside of the hospital. Maybe your children need to be picked up from school between surgeries, or you’re trying to get work done from a laptop on the weak waiting room WIFI.   

For this very reason, we hope that the team of doctors, nurses, or even social workers will be there to talk us through the “after.” Many families expect that a doctor will prepare the family for all they need to know – from when they can expect a discharge to where medications will be sent for pick up to the type of care your loved one needs in the coming weeks – but the reality is, most hospital officials and even social workers will not provide this information unless you ask.

Remember, hospitals are busy places, and staff are balancing a number of different patients with different needs. So, they might not always be on top of speaking with families about what they should expect.

That’s why it’s so essential that you take the time to ask – and even arrange a meeting with your loved one’s medical and social work team. Too many times, we’ve witnessed families who are completely thrown off by a discharge and left to figure it out themselves unfortunately. We’ve had families who’s loved ones were discharged with no notice – and couldn’t find rides home from the hospital. We’ve known seniors who are discharged but still need overnight care and have no one to provide it because of lack of information and communication.

We’ve had seniors who are discharged and don’t know when or where to pick up their prescriptions. We’ve even had seniors who don’t take their prescriptions because they simply do not know about them, and the family was not properly informed.  And we’ve had seniors who are discharged to nursing homes – with little to no idea what that will entail.

Discharge affects seniors and family members. If a senior needs to be released into the care of someone else – the family needs to be prepared for what to expect – from whether they’ll need to take a day off work to pick their loved one up from the hospital to any changes or adaptations they need to make to their home to make it safer for their loved one.

When your loved one is discharged, you want to be able to focus entirely on them – making sure they are comfortable, content, and have everything they need. If you’re scrambling to find a ride to pick them up and a place for them to go, you don’t get a chance to focus on what really matters.

On today’s episode of All Home Care Matters, we’ll talk about exactly how you can prepare for your loved one’s discharge from the hospital – so you won’t be left confused and rushing about when it’s time for your loved one to come home. 

Too often, families are caught by surprise when a family member is officially discharged. A family caregiver might be at work and unable to pick their loved one up from the hospital or could even be out of town and unable to get to the hospital at all that day. You need time to prepare for your loved one’s discharge – so you can make sure you’re ready to pick them up (or have a ride arranged) well in advance.

The golden rule to hospital discharge is to ask a lot of questions – as many as you can think of. You can never have too much information when it comes to preparing for this tough transition, so start making a list of questions as soon as your loved one arrives in the hospital. We’ll go into more detail about specific questions to keep in mind during this episode.

According to a study published in the National Library of Medicine, adults over the age of 65 are “the largest consumer group of hospital care.” The study focused on whether or not seniors were prepared for their transfer from the hospital back to their home. Perhaps shockingly, 39% of those studied said they were given less than 24 hours’ notice before discharge. That lack of notice leaves many seniors lost when it comes to finding a ride home – or even knowing what to expect when they get there.

With that in mind, make sure to speak with your loved one’s doctor, social worker, and nurse about when they believe a discharge could take place. They may not be able to provide an exact estimate – but they should be able to give you a ballpark that will help you plan accordingly. For instance, if they say, “he should be ready to go next week,” then you know it’s time to make arrangements.

Again, we can’t expect doctors or nurses to offer this information on their own – we must ask. When we do, they’ll be glad to provide an estimate. Not to mention, asking about when a discharge might take place is a great way to start a longer conversation with your loved one’s team about what to expect post-hospital.

Remember – one of your biggest jobs as a family caregiver is to be your loved one’s advocate. Being an advocate means having these conversations in advance, so you AND your loved one aren’t left behind. After you receive an estimate about when your loved one might be released, it’s time to open a conversation about other important logistical details. Arrange a meeting with your loved one’s team, where you can have the opportunity to ask questions and get answers. The family should be invited and involved in a discharge meeting that includes the family, doctors, and healthcare team that has been part of your loved ones care while in the hospital, but sadly those do not always take place.

In preparation for the meeting, compile a list of important questions to discuss. These can include anything from which pharmacy the prescriptions will be sent to, to where your loved one should be getting care during recovery (are they able to stay at home and live independently, do they need a nursing home, or do they need full time home care?)

When it comes to prescriptions, make a list of your loved one’s medications and review them with the doctor or nurse – how should the drugs be administered and when? Make sure any newly prescribed medications will work with the medications your loved one is already taking – don’t assume that your doctor knows every medication they’re taking. Double check just in case they don’t. Ask about vitamins and supplements, too. Are there any that can help? Are there any that should be avoided?

Try to make sure the doctor sends the prescriptions to the same pharmacy for pick up – and, if possible, see if there’s a pharmacy at the hospital. That will be the easiest place to stop for any family – and picking up the prescriptions will feel less like a dreaded errand. 

In addition to medications, find out if your loved one should be using any Durable Medical Equipment, or DMEs, once they’re home. DMEs include bedside commodes, urinals, wheelchairs, hospital beds, walkers, etc. If so, find out where you can find such items (and if the hospital can provide them), and how they should be used. Are these things your loved one will need assistance with? Can the family provide such assistance, or will it be necessary to hire a registered nurse or a home care company to help? If your loved one needs a nurse, it might be necessary to consider alternative living options, like a nursing home.

In addition to DMEs, find out if your loved one should use bandages, gauze, creams or any other specialized medical supplies. Have a nurse walk you through exactly how to change bandages – and practice a few times under her supervision – so you know exactly what to expect.

Find out, also, whether or not your loved one needs to follow a specialized diet or if there are foods or beverages he should avoid. Often times, seniors will have dietary or fluid restrictions following surgeries or because of certain medications. If your loved one will require an extensive change to their diet, find out if there are a collection of recommended recipes that you can try.

After you find out what your loved one will need, you can follow up with the heavier questions. Find out what you should look for in the first days and weeks after discharge. Are there any abnormalities that may be red flags? This could be anything from bad headaches to a lack of bowel movements. If you do notice any of these abnormalities, how should you respond? Do you need to take your loved one to the ER, or will a call to the doctor suffice?

These abnormalities will vary depending on what your loved one was hospitalized for. Post-op patients will have a separate set of warning flags than those suffering from an infection – so make sure that you ask your doctor specific questions, and don’t rely on internet research or generalizations.

Next, make sure you know what to expect in regard to follow up appointments. Should you be scheduling a follow-up with the family doctor – if so, when? Will it be up to the family to schedule that appointment, or will the doctor give them a call to schedule it?

In some cases, a person will need to see a new doctor – usually a specialist in whatever they are experiencing or else a geriatric doctor. If this is the case, get a list of recommended doctors and find out who will be making the appointment.

Finally, you need to find out exactly what their care will look like from here on out. Depending on the situation, your loved one may need to start physical or occupational therapy. If so, ask your loved one’s doctor for a list of recommended therapists and try to get a feel for how long the therapy will last – so you can be prepared for how much of your week will be spent driving your loved one to their appointments.

Families should also ask about Home Health Care – which Medicare does pay for as long as there is a need for it. If the doctor feels that Home Health Care will improve the life of their patient, they will write a note making your loved one eligible for it. Home Health Care can be enormously helpful when it comes to seniors who need a little extra assistance but are still relatively independent. They do not assist with activities of daily living – like personal hygiene, feeding, dressing, or managing continence. However, you can hire home care helpers to assist with those needs at the same time.

Home Health Care comes about 1 to 3 times a week, and it only lasts as much as nine weeks. It can be shorter if your loved one’s needs don’t require as much care – but if your loved one requires more long-term care, you may need to consider other options.

Finally, if it is recommended that your loved one is transferred straight from the hospital to a nursing home, make sure that you have all the information you need in preparation. Speak to your loved one about what their own wishes are, too.

While a nursing home might be recommended, if your loved one would rather stay at home – especially during COVID when nursing homes might restrict visitation – see if there’s a way to make that work. This is especially important for dementia patients, who benefit enormously from being in familiar surroundings. If your loved one adamantly does not want to live in a nursing home – think about family caregiving or hiring professional home care services as an alternative. To learn more about those options, listen to our episodes on choosing the right care and our episode on what is home care?

In many cases, we have seen patients who are only allowed to be discharged to nursing homes – simply because the patient cannot be home alone and they did not have a family caregiver or knew that having a home care company was an option. This is another reason it’s so important to find out when discharge will be happening ahead of time – so your care plan can be in place.

Now, there can be circumstances in which a patient must be admitted into a nursing home. They might need more extensive medical care that simply cannot happen at home. Still, if this isn’t the case, we recommend looking into home care. If your loved one has dementia, especially, familiar surroundings are incredibly important, so all alternatives should be considered. We have met many families who simply did not know they had other options.

While we might assume that hospital discharge is the least of our worries (especially after a stressful hospital visit, where you just want your loved one to come home) many are shocked to see just how difficult the discharge process can be. The better prepared you are, the better. Remember – the golden rule to hospital discharge is to ask as many questions as you can think of – you can never be too prepared for what comes next.

We want to thank you for joining us here at All Home Care Matters, All Home Care Matters is here for you and to help families as they navigate long-term care issues. Please visit us at allhomecarematters.com there is a private secure fillable form there where you can give us feedback, show ideas, or if you have questions. Every form is read and responded to. If you know someone is who could benefit from this episode, please share it with them.

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Sources:

 

https://www.caringseniorservice.com/blog/preparing-for-a-hospital-discharge-plan-for-success

 

https://pubmed.ncbi.nlm.nih.gov/3389244/

 

https://seniorsathome.jfcs.org/hospital-discharge-checklist/