| Beginning on the day you are admitted to the | | | | The hospital staff is very skilled at watching the |
| hospital, the medical staff is assessing when you | | | | patient's recovery and estimating how much care |
| will be ready to leave, and where you will be | | | | the patient will need over the coming days and |
| released. Based on your condition and the length | | | | weeks. If the patient is too weak to go home |
| of your recovery, you may be transferred to a | | | | and needs more time in therapy to regain |
| rehabilitation hospital where intensive therapy is | | | | strength, then the recommendation is to be |
| available. If the level of care you need is less, you | | | | discharged to a rehabilitation hospital. When a |
| may be released to a skilled nursing facility. It | | | | patient needs a level of care beyond that which |
| may be that you will be well enough to return to | | | | can be provided in the home setting, the release |
| the home setting, either with or without extra | | | | from the hospital will most likely be to a skilled |
| help. Whatever decision is made for you will be | | | | nursing facility. If the patient is going to be able to |
| decided at the hospital "discharge planning | | | | be safe at home, and is strong enough to get into |
| meeting." | | | | and out of bed and on/off the toilet safely, then |
| 1. What is a "discharge planner"? | | | | the recommendation is for the patient to return |
| There are staff designated as discharge planners | | | | home. |
| at most hospitals. The job of the discharge | | | | 4. Does the patient or the family always know |
| planner is to plan what is best for you when you | | | | about the "discharge planning meeting"? |
| leave the hospital. This person coordinates | | | | No, not always. Sometimes plans are made for |
| ordering equipment, home health services, | | | | you and your family without your knowing or |
| outpatient therapy, and many other services. He | | | | being invited to the discharge planning meeting. Be |
| or she will make sure that the doctor has issued | | | | sure to attend this meeting, or have someone |
| prescription orders for all services you will receive | | | | attend as your representative, so that your |
| after you leave the hospital. Find out who the | | | | concerns can be considered. |
| discharge planner is so you can direct your | | | | 5. How would I get included in the "discharge |
| questions to the appropriate person. | | | | planning" meeting? Start by asking the nurse |
| 2. What is a "discharge planning meeting"? | | | | whether the hospital has a discharge planner, and |
| This is a meeting held at the hospital. The | | | | if so, that person's name and phone number. Call |
| attending doctor, a representative of the nursing | | | | that person (or have a family member call), |
| staff, any therapists involved in care of the | | | | introduce yourself, and ask if there has been a |
| patient, and, hopefully, the patient or a | | | | discharge meeting scheduled yet. Ask to be |
| representative will attend this meeting. At the | | | | included. If the hospital does not have a |
| discharge planning meeting, with input from the | | | | designated person to act as the discharge planner, |
| medical staff, it is decided if the most appropriate | | | | ask someone on the medical staff the name and |
| placement will be to a rehabilitation hospital, a | | | | contact information for the person who will be |
| skilled nursing facility, home with help from | | | | handling your discharge planning issues so that you |
| hospice, or home perhaps with help from a | | | | can attend that meeting. |
| caregiver, family member, or friend. This | | | | By being aware of the process and knowing a bit |
| determination is based on the patient's expected | | | | of hospital jargon (e.g., "discharge planning |
| rate of recovery, current strength level, and | | | | meeting"), you will be able to get more |
| estimate of future nursing needs. | | | | information and be able to more fully participate in |
| 3. How does it get decided where the patient will | | | | decisions about your continued care. |
| go after the hospital? | | | | |