My father was in the hospital; he was getting out but he was never going home. I had just been told in a meeting with his doctors that I needed to find a memory care facility for him and I had five days to do it. After that meeting I drove across town to a different hospital. I wanted to be there when another doctor told my mother she had ovarian cancer and three months to live. Her next stop would be a skilled nursing facility as she was weak and needed to rebuild her strength. That would give me a week, maybe two, to figure out where she was going to live for the remainder of her life. Her home was no longer an option if my father wasn’t going to be there. My home wasn’t an option; my marriage couldn’t sustain that kind of stress.
The next day I stopped in to visit my mother during my lunch hour. The doctor and a social worker were in her room when I got there. “We have good news,” the doctor said. “Your mother walked with a walker today and she is stronger than we thought. She can go home today.”
“Home where?” I asked. “She can’t go home and be alone.”
“Well then take her to your house,” the social worker said.
How’s that for hospital discharge planning?
Luckily, for many adult children a hospital discharge usually comes with a more positive prognosis. You’re happy that your mother or father is feeling better but your role as caregiver probably just got a lot more complicated. And notice? There’s a good chance that no matter what the situation is that you get as much notice as I did, aka none. Your parent may be out of the woods, but you feel like you are about to enter them.
Hospital discharge planning is key. Experienced caregivers know that the time to develop the discharge plan is the minute your parent is admitted but those new to the role can find themselves scrambling to make post-hospital arrangements. Whether this is your first discharge experience of third, here’s our guide of what to do when your elderly parent is discharged from the hospital.
Get a written discharge plan.
Make sure you get a discharge plan – in writing – from the hospital. A discharge plan should include information on:
- the appropriate post-hospital destination for a patient (i.e. home, skilled nursing facility, memory care unit, short-term rehab, etc.), as well as a list of facilities to consider
- what the patient will need for a safe transition from the hospital to the post-hospital destination (i.e. ambulance, ride from family or friend, oxygen en route, etc.)
- what services and treatment and care the patient will need post-discharge.
In other words, the plan should cover the medication list, what services, if any, your parent needs to line up (ex. physical therapy, occupational therapy), any diet restrictions, when to change bandages, when to follow up with the primary care physician and other specialists, etc.
Pro tip: I always ask the doctor or nurse what should prompt a call — which symptoms and side effects are normal and which ones should I be concerned about. I also like to know which doctor to call – the one from the hospital, the PCP, the specialist? Knowing the things that are out of the norm helps alleviate my concerns that I will miss something or that I will err on the side of not worrying enough or worrying too much.
Review the discharge plan with a doctor or nurse in person.
Review the written plan with the doctor or a nurse, in person, before you go. I always repeat the discharge instructions back to the doctor or nurse in my own words and ask them to confirm if what I heard is accurate. It’s not enough for them to repeat what they already told me. I need to internalize it and I don’t mind making them wait while I do that. This sometimes means really asserting myself so the doctor or nurse takes the time to stop and review the plan and then listen to me, not cut me off.
Check your feelings.
Your emotions may be on overdrive at the time of discharge. You’re nervous about what’s next and you may feel blindsided by the timing. Be aware of these emotions and don’t take them out on the hospital staff. Be respectful and listen to the care team; they are experts. But do know your top priorities are 1) to advocate for your parent – you know them best – and 2) to get all of the information you need. Once your parent leaves the hospital you are in charge. You need to know what you’re doing. Before they leave the hospital is the time to make sure you do.
Know your rights.
Upon admittance to a hospital, a patient should receive a patient bill of rights as well as information on the discharge process and how to appeal it. If you don’t see that information among your parents’ papers, ask for it. Discharges can be appealed. Per the Medicare website (www.medicare.gov), “If you believe you’re being discharged from a hospital too soon, you have the right to immediate review by the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) in your area.” The hospital can connect you or you can visit the Medicare website for contact information.
The hospital must keep your parent while the appeal is resolved and Medicare will cover the extra time spent in the facility, excluding any deductible or copays for which your parent is responsible.
Before you appeal: Make sure staying in the hospital is really the best option. Hospitals are full of sick people after all and they are a great place to catch an infection.
Know if your parent was actually admitted and for how long.
This may sound crazy since we are talking about discharge from a hospital stay, but was your parent actually admitted and if so for exactly how long? Sometimes hospitals keep patients for observation but don’t actually admit them. This makes a difference in what benefits Medicare will pay for post-hospitalization. Also, if your parent is discharged to a skilled nursing center or rehab, Medicare won’t pay for it unless your parent stayed in the hospital at least three days. Well, that sounds simple, you’re thinking. Really? What constitutes an overnight at the hospital? Does a patient need to be admitted by a certain time of day or stay past a certain time of day? Ask! Don’t assume.
Plan transportation for discharge and all follow on appointments.
You will need to review transportation options with the hospital discharge planner. Important: consider not only transportation from the hospital, but also to any follow up appointments. If you need to be at work, and your parent has multiple post-discharge appointments to schedule, you need to make arrangements for that too. You may be able to arrange for some services to be offered in your parent’s home, which will cut down on the need for arranging rides. My Dad requires weekly blood tests so I have a nurse go to the assisted living facility to draw the sample and insurance pays for it. I cannot miss work weekly to take him to the lab.
Ask the discharge coordinator what your options are for leaving the hospital. If your parent isn’t heading home after their hospital stay but instead is going to another facility, an ambulance may be covered by insurance.
Pro tip: Tell the care coordinator what kind of car you drive and ask whether it is suitable for transporting your parent. I once owned two cars: a big SUV and a tiny sports car. Neither worked for taking my mother home post surgery. She couldn’t climb up into the SUV and she couldn’t lift herself out of the low seat in the sports car. I had to borrow a car to take her home safely.
Pace yourself on discharge day.
On the day of discharge, you will receive a call that your parent is ready to be released. That may be true but most likely the hospital is not ready. Do not stress if you can’t get there right away. Your parent will not be thrown out. They will either stay in their room until you arrive or be placed in a discharge waiting lounge. Your parent may be cranky if you don’t show up right away – just shake it off. You are starting a new phase of caregiving and you need to pace yourself. If you need to finish up assignments at work, or run some errands, or get the kids off to school, do it now.
When you get to the hospital you will most likely wait – even if you kept the hospital waiting. You will wait for the care coordinator to meet with you and review the discharge plan. You may have to wait while your parent gets dressed. You can of course use this time to sit and talk with your parent but don’t be surprised if they doze off. Hospital stays are exhausting! Bring something with you like a laptop or pile of work papers or a good book so you don’t waste precious down time.
Rent-A-Sister lets you go to, and focus on, work while we handle the caregiving details that don’t require a family member. Learn more.
If your parent is going home:
No, not really. But you may want to make yourself a little less available. Often, hospital social workers base discharge plans – whether a patient can go home, how much help a patient needs, what services they will refer for a patient (and how they will present those services to the insurance company for payment), on whether or not there is family in the area. And by family in the area, I mean just that. Hospitals and insurance companies, in my experience, do not care if you work part or full time, if you are the breadwinner, whether or not you are raising children or have other commitments. If you live in the same or a neighboring area code, the hospital typically assumes you will be the primary caregiver. If you are not prepared, available, or willing to assume that role, make sure you let the hospital know, in no uncertain times that you cannot be available. Tell them if you have others to care for. Tell them if you will be at work from 8 am to 6 pm or traveling on business. Make sure they know that if you can not be the live-in caregiver – unless that’s what you plan to do. Most hospital discharge guidelines call for the social worker or care coordinator to factor in the availability, willingness, and ability of family members to provide care.
Work with the hospital to line up services.
You will want to work with the care coordinator to line up whatever services your parent will need post discharge. Medicare-participating hospitals are required to provide a list of Medicare-certified home health agencies that participate in the Medicare Program and request inclusion on the hospital’s list. Know that the care coordinator is prohibited from directing you or your parent toward any particular agency so you may need to rely on referrals from other people (This is where support groups can help – join ours!) or be prepared to make adjustments after the fact if you are not happy with the services.
Schedule a visit with your parent’s primary care doctor.
The hospital should provide your parent’s primary care provider with a summary of the hospital stay including the reason for hospitalization, treatments that were administered, the medication plan and the follow-on care plan. There is a very good chance this information will not make it to the primary doctor’s office before your follow up visit. Pro tip: Ask for a copy from the hospital and fax it or email it yourself in advance of your appointment.
If your parent is going to another facility:
Get referrals – the easy way.
If your parent is not going home post hospital stay – they may need to spend time in a skilled nursing facility or a rehab, perhaps they are going to a memory care unit or hospice home, or maybe it’s time to move them to assisted living – you want to make sure the facility meets your standards and is convenient to you. However, you may not have enough time (or notice) to visit local facilities. Know this:
The hospital should have a complete and reasonably up-to-date list of facilities. The social worker or care coordinator will call and check on bed availability but you need to be the advocate and push for the facility you want, not just the first available. The hospital should make every effort to find a facility that meets your parent’s and or your preference. If they cannot, you have a right to know the reason. I once had a social worker try to place my father in a facility 90 minutes from my home. She told me my convenience was not a factor in his placement and that I had to take the first available bed. I countered that as his healthcare proxy and daughter, my ability to visit the facility daily was a critical part of his care. She found him a bed closer to home.
You can hire someone to research and visit facilities for you. Many don’t charge you a fee. Download the checklist for choosing a senior living referral agency.
Medicare keeps a list and rating of facilities. It’s not a perfect way to choose a placement, but it can be a way to narrow down choices or make a decision when you have no time. Click here to access the database. You can search facilities by zip code.
Be present as much as possible the first few days.
When your parent is checked in to the new facility, be there as much as your life allows the first few days. Get to know the new care team. Your job is to let the staff know you are present in your parent’s life and available to them as part of the care team. Be friendly and respectful – but remember you are your parent’s advocate first.
Learn the schedule so you can advise visitors the best times to stop by and the times to avoid. Ask when the best times are for updates. If your parent moves in after 2 p.m. or on a weekend, do not expect any meaningful updates until the next business day.
How to manage your own life:
When your elderly parent is discharged from the hospital, a new phase of caregiving begins. You may think an ordeal is ending. That’s true. But it’s time to accept a new normal. Here are some tips to cut down the chaos in your life:
- Involve your spouse and kids in your decisions. Caring for an aging parent can strain even the strongest relationship. Do not cut your partner or children out. Let them know what you’re doing and why you are doing it. Ask for their support and thank them when they give it to you.
- Ask for and accept help. This is the time to ask for – and accept – help. Keep a list with you at all times of all the things you need to do. When someone asks, “How can I help,” consult the list and give them a task. Don’t just take help on behalf of your parents. Accept help running your own errands too. Let people pick up your kids from school or drop off your dry cleaning or make you a meal. By helping you, they are helping your parent too.
- Make a plan for how much you can manage at work. Do you need to take time off from work after your parent is released from the hospital? Only you can make that call. If your parent is not receiving services covered by insurance or you cannot afford to hire outside care, you may need to take some time off or cut back on assignments or hours. The Family Medical Leave Act allows for unpaid, job-protected leave for eligible workers. You could get 12 workweeks of leave in a 12-month period to care for a parent who has a serious health condition. The tricky part is eligibility. You must meet these requirements:
- work for a covered employer
- have worked 1,250 hours during the 12 months prior to the start of leave
- work at a location where the employer has 50 or more employees within 75 miles
- have worked for the employer for 12 months.
- Be forgiving. Forgiveness is key post-hospital discharge. Your parent may be demanding or frustrating. They may be scared. Medications might affect their mood. They could be mourning the loss of independence. Take deep breaths. Go for walks when and if you can. Be as patient as you can muster. And forgive yourself. You will mess up. You might be snappy and inpatient. There is no training for family caregivers. You are doing the best you can.
Let Rent-A-Sister handle all of the details during and after your parent’s hospital stay.
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