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Toby Laping Associates www.WNYCareManager.com
Eldercare News |
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You Need To Know . . . Your Right to a Safe Discharge by Toby F. Laping, Ph.D., C.S.W. A couple of months ago, this column ran an article by Kristin Surdej, a care manager in my office. It addressed the issue of patients’ rights, noting how often patients and their families make decisions they feel forced into making. A week ago, I received a frantic call from the wife of an elderly client of my office. The gentleman was in the hospital and the discharge planner had just told his wife that he was no longer in need of acute care and so would be discharged that afternoon. The wife had no idea what to do. The discharge planner said her husband could go home and he’d get a little help from Medicare probably beginning in several days, but he needed a lot of care and the wife was ill herself. She was overwhelmed by the thought that she would be responsible for the life of the man she loves when she can barely manage her own needs. After telling the wife to take a deep breath, we reviewed what was going on and what we decided would constitute an appropriate plan for husband. First of all, I told the wife that although hospitals are bad places to be in unnecessarily, and older people in particular are often ill served by hospitalization, the reality was that we could delay discharge if that seemed to be the most appropriate thing to do. I asked the wife if she had received a letter saying that Medicare would no longer cover the hospital stay. She had not. I explained that most of the time, patients have several days of Medicare coverage even after that letter has been issued, so she need not yet worry about paying for the hospital bill. I also told the wife that she should tell the discharge planner about the fact that sending her husband home without sufficient help and adequate planning was not a safe discharge plan. Hospitals must provide safe discharges. Hospital discharge planners are typically caring, committed professionals. In most cases, tho, they are also overworked and they answer to their employers. Those employers are the hospital systems, and they benefit when patients leave hospitals quickly; they typically lose money when patients stay too long. This wife continued that the discharge planner had told her that her husband would “go ALC” the next day and that sounded pretty scary. I explained that “ALC” means alternate level of care, and that means that he no longer needs to be in a hospital bed. What else does it mean?, the wife persisted. I explained that it has significant implications for the hospital, but from her husband’s point of view, it really meant he could leave when a safe discharge was arranged. The discharge planner had also threatened to have the doctor write a discharge note. Again, I explained that we needed to focus on how her husband should be managed; how his care could best be provided. Ultimately, the wife accepted the fact that she could not be forced into a caregiving situation that was beyond her ability to provide. She recognized that she had options, and could discuss calmly what she and her husband both wanted to happen. He was discharged the following day to a facility which gave him 5 days of rehabilitation, after which he went home with a physical therapist coming twice weekly and with an aide 7 mornings a week for 2 hours each visit, beginning the day after he arrived home. That’s all that was needed, and soon both husband and wife were managing on their own. A happy ending. Too bad it was such trauma getting there. |