After an Emergency: Hospital Discharge Planning for Amateurs
Hospital discharge planning is not an amateur sport, but if there’s an emergency, you’re going to get taken off the bench pretty quickly. I know I was an amateur the first time my mother was hospitalized. The only previous emergency our family had experienced was over thirty years prior when a brother broke a leg. Over a dozen emergency hospitalizations later, I’ve learned the hard way that the information needed to understand your choices isn’t always provided, and you’re not always included in the planning by default (though in 36 states the law requires it.)
Here are some tips that might help you think proactively about what’s next after a hospitalization.
The minute you are hospitalized, the medical team is probably working on one of three things: getting you stabilized, getting you diagnosed, or getting you out. In some cases, a hospital may want to put you or your family member on observation status which can affect reimbursement. Make sure your first questions are aimed at understanding where you fall on this spectrum. Once you understand that, you can ask better questions and stay aligned with the medical team.
You also need to understand your condition and what recovery might look like. For most conditions, there’s a defined treatment protocol. Ask what it is, or research it on your own. This can give you valuable context in a confusing environment, and the requisite knowledge to participate in the decision-making process.
Choose Where You Are Going After Discharge
One discharge planning choice you have is where you go after the hospitalization, though it may not be presented that way. For example, the typical protocol after knee surgery calls for a patient to go home after a day in the hospital (if that!), followed by rehab at home. When my dad had knee surgery, he was the primary caregiver for my mom (who needed help) and there were stairs in the house that he couldn’t manage without help (which he didn’t have.) So we asked the doctor if he could go to in-patient rehab before going home. It was reasonable and necessary, but it wasn’t “standard”, and we would not have received the order without asking. You may need to actively insert yourself into the decision making process.
Ask for Training and Education for Any Special Tasks
When my mom was in rehab, the team there made a point of asking who would be helping my mom at home. Then they made sure we were all trained to safely transfer her to and from a wheelchair. Later, she was diagnosed with diabetes during a different hospital stay. That rehab team planned to send her home with no training to manage insulin injections and blood monitoring on her own (she has vision issues and no use of her dominant arm.) The point is, there’s no guarantee you’re going to get training if you don’t ask for it.
The person to ask about training and education is the social worker. Keep in mind that most social workers are highly focused on discharge, so it may help to associate your need for education with their ability to safely discharge you or your family member.
In the case of diabetes care for my mom, I did two things. First, I let the social worker know that we couldn’t guarantee my mom would be safe at home if they discharged her on short notice. (I needed time to find someone licensed to provide medical care to do the injections and blood monitoring.) Second, I asked for training on how to give the shots myself.
The moral of the story is: if you’re not comfortable with the tasks you’re being asked to do at home, find the social worker and ask for training.
Get Extra Help at Home
Like it or not, you might need some extra help at home for a few weeks. It’s amazing how weak you can get after just a few days in the hospital. Free sites like CaringBridge, Lotsa Helping Hands and Meal Train make it easier to coordinate friends, family, or volunteers. If you need more help than family and friends can provide, try community-based organizations, or large, national franchise home care agencies. (Tips on hiring help can be found in this free guide.)
Know What to Look Out for Once You’re Home
Most hospitals provide discharge papers with key information and follow up steps. Our experience with discharge varied. Sometimes a nurse went over the discharge papers in detail with us. Others times, discharge papers were shoved in a bag with other random things and we were sent on our way. The discharge papers will tell you two really important things: what symptoms you might experience in the coming days or weeks, and who to call if something goes “wrong.” Read the discharge papers!
Make Follow Up Appointments
Your discharge papers may also indicate when and with whom you should follow up. Sometimes follow up appointments will be made for you before you even leave the hospital. If it’s not clear what the follow-up plan is, ask before you leave, and make the appointments yourself if necessary.
I hope you get lucky and have an easy hospital stay with a seamless transition home. It can, and does, happen! But if you’re not comfortable or not getting the information you need to participate in the decision-making process, don’t feel shy about asking. That’s my best advice. That, and: start thinking about discharge planning the minute you get to the hospital (everybody else there has!)
About the Author
Karen Purze is the author of Life In Motion: A Guide for Gathering Life’s Vital Details, a workbook to help people get their affairs in order. She blogs about end-of-life and emergency planning at lifeinmotionguide.com.