With an aging population and Medicare rule changes, discharges from hospitals that follow a surgery or medical crisis have changed. It is likely you will need to choose for your spouse or your parent from a list of options. Titles such as Case Managers, Care Managers, Discharge Planners, Care Navigators or Social Workers are given to those healthcare professionals whose role is to get patients safely discharged from the hospital when the patient condition is considered stable. An understanding of what the options mean will be helpful.
All payer sources, most patients and their family members hope to return directly to home. Even when assistance is needed for them to safely go about their day, a discharge term is used called HOME WITH FAMILY. The assistance may come from friend or neighbors and can include support services stopping by the home to monitor the situation. The feasibility of discharging home-with-family is the assumption that there is a willing and capable caregiver at home to assist with anything the patient may need. This may require strong physical help.
Rarely is there a process that uncovers the capabilities or willingness of the future caregivers. Patients have the right and freedom to return home even if the risks of falls or other crisis situations is high. Imagine moving from an environment where a patient is monitored by trained healthcare providers who dispense medication properly to supervision by an untrained and often frail spouse or busy employed child with children of their own. For years hospitals have focused on reducing re-admissions to hospitals within the 30-day period after discharge.
There are other situations where patients have life-limiting illness or need palliative care that makes home with family discharges include visits from a local hospice organization feasible. Rather than curative treatment, the idea is for the caregiver to keep the patient comfortable as they do less and less for themselves (often while grieving themselves). An unknown time period for this type of care can stress out many busy families who have their own schedules to handle as well. The spiritual and psychological stress is not just for the patient but also the family caregiver.
Other discharge options such as a short visit to a rehabilitation nursing home have also been affected by Medicare rule changes. Universally, these visits now last fewer days than in the past. With a goal of the patient regaining strength and endurance by participating in various therapies the discharge to Home With Family soon follows. Seniors who live alone are often a concern for safe discharges, but Medicare payment rules do not take this into account. Children of single elderly adults should be aware going home will happen quickly.
An advantage of Assisted Living is the Medicare rules do not apply since the care being provided is privately paid. A temporary stay in an Assisted Living home-like community is called a respite stay. It allows the 24/7 custodial care burden to be paid for by the family but not provided by them. If the situation dictates a longer residence is needed or desired, a “permanent” stay just means a 30-day notice is needed to voluntarily leave. The loving family members with scheduling or health conditions of their own can visit anytime but be free when needed.
CarePatrol works with hospital discharges, rehabilitation nursing homes, family doctors and community resources to make a decision to choose the safest decision. Most often, they choose Assisted Living instead of Home With Family. Even after arriving home and discovering the situation is unsafe, we can help. Assisted Living and Memory Care communities provide a home-like environment with needed services to go along with the fluid and nutrition intake, activities, and housekeeping. Safer Senior Living. Your goal, OUR MISSION.