Facing the Unknown After Discharge

 

Facing the Unknown After Discharge

Submitted by Kimberly Perkins-Akers, Amada Senior Care
Anne left their breakfast table to get George’s cane from the living room when she caught her foot on the rug and fell on the tile floor, breaking her hip. Luckily George was there to call for help. The next week was a whirlwind for George and Anne; ambulance ride, hip replacement surgery and begin the rehabilitation and recovery process.  
When Anne was well enough to go home, doctors instructed she would need physical therapy, medication, a wheelchair, check-ups and constant monitoring to continue her recovery.
Senior citizen families and patients like George and Anne persevere through illness or injury only to find themselves facing the unknown after discharge. It is enough of a struggle to make it through emergencies, hospital procedures and anxiety hanging on hopes for good recovery. But after leaving the hospital, senior patients are just beginning their journey towards restored health.
What should you do when facing the unknown after discharge?
Who is Involved in Hospital Discharge?
·         Patient – The patient succumbs to illness or injury and receives treatment from the hospital. He or she has the right to discharge into any post-treatment situation, so long as they are mentally capable. The patient can also discharge themselves against medical advice. Most patients want to come to the safest and healthiest solution possible.
·         Family Member / Caregiver – George is the family member involved in this story. His role is vital to Anne’s discharge planning because he knows Anne’s needs and preferences intimately. He is also the one who will most likely manage Anne’s care after leaving the hospital.
·         Doctor / Physician – Provides a significant amount of input into the patient’s discharge planning, making recommendations for continuing the patient’s physical and mental well-being. They have the authority to finalize discharge plans, prescribe medication and order further treatment, if necessary. The doctor or physician in the hospital is usually not the patient’s family physician; therefore, relaying accurate information between the two is critical.
·         Nurse – While a patient is in the hospital, multiple nurses take care at all times of the day. Observations are made of mental status, stamina, ability and willingness to follow directions. These observations are communicated to the discharge planner.
·         Discharge Planner – The hospital discharge planner is usually a nurse or social worker. It is their job to coordinate what happens during and after discharge. They also advocate for both the hospital and the patient. They juggle factors like cost-effective insurance coverage, doctors’ orders and patient preferences to plan the best follow-up care after hospital treatment.
Before Discharge
Spouses, siblings, children or caregivers have necessary input when it comes to the care of elderly loved ones. It is essential that all people involved are on the same page when planning what to do when a loved one is in the hospital. The patient, family members and caregivers should be informed enough to plan for the length and depth of hospital treatment and coverage of outpatient care. The patient’s needs and preferences, who they are comfortable receiving care from, where they are safe and how they will continue to function must be communicated.
Helping the Discharge Planner Help You
The discharge planner wears several hats, balancing what is cost-effective for the hospital with the patient’s wishes and wellbeing. They have established relationships with community agencies outside the hospital, such as rehabilitation centers, nursing facilities, hospices and home health companies.
One issue for discharge planners is the dilemma patients face if their insurance no longer covers hospital treatment, but they need more care. The discharge planner does their best to secure a fluid transition from hospital to home so that recovering patients do not have to be readmitted to the hospital. When discharge planners ask questions, be honest and request anything you need. The more a discharge planner knows about all aspects involved in your in-home recovery, the better. It is the discharge planner’s job to consider your needs and preferences to secure the services necessary for full recovery.
After Discharge
The discharge planner coordinates all the needed services, round-the-clock caregivers, physical therapists, nurses and specialist to visit the patient.
Being transparent about your needs and preferences, the discharge planner can work with you to find the best solution to grow stronger and recover from your illness or injury without being re-admitted to the hospital.
Amada Senior Care offers three types of services for seniors and their families including in-home private care, senior housing advisement, and financial care coordination with long-term care insurance or Veterans’ aid. Call Amada Senior Care at 480-999-5250 or visit www.AmadaMesa.com.
Contributing Author:  Michelle Mendoza

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