If ever there were a weak link in hospital care, it’s what happens when you or a loved one leaves the hospital. It’s becoming clear that the process known as discharge planning is deficient, can be harmful, and sometimes results in a patient’s decline.
One in five patients across the country needs further care after discharge from a hospital, according to a series of four reports published by the United Hospital Fund in New York City. That’s a lot of people, and many times their families don’t know where to turn for help. The Fund reported that hospitals themselves sometimes prove to be of little assistance.
Patients are being sent not only to nursing homes but also to long-term acute care facilities (LTACs), a relatively new type of facility that treats sicker patients for an average of at least 25 days for recovery, or to sub-acute facilities, home care agencies or rehabilitation centers with little input from their families and little explanation of what these facilities can do.
How many families have ever heard of an LTAC, for instance? Mine never had, and neither had I when I found myself transferred to one early in 2018 after a long hospital stay necessitated by a series of ailments caused by what seemed to be a simple infection.
When my daughter called facilities in Manhattan — where we live — looking for care, most wouldn’t even take her calls. “I called around and realized you cannot find a place on your own,” she said. “That’s not how this works.”
Too often families find that hospitals limit the options for them. The United Hospital Fund found that even though hospital staff stressed patient choice, patients and their families actually had little choice.
One woman sent me a tweet not long ago saying that a VA hospital gave her father and his family “zero” time to make a choice. Instead they were given the names of three facilities, “all one star,” she said. Presumably she was referring to a ranking from the federal government’s Nursing Home Compare website that rates the country’s nursing homes. “We had to fight daily for basic human needs to be met,” she told me.
David Lipschutz, associate director of the Center for Medicare Advocacy, told me hospitals have electronic systems and share profiles of patients they are about to discharge with prospective recovery facilities: “They shop the patient around and say, ‘This is the facility to go to.'”
If hospitals are hitting the limits of what Medicare will pay for a patient’s care, they have a great incentive for moving people out. To them it doesn’t matter if a patient is moved to another state, as I was, or to another town. Either one can make it difficult for family to visit and keep an eye on the care, which is all important.
The Hospital Fund also noted that legal safeguards don’t go far enough to protect patients and help their families and caregivers choose high-quality options. That means hospitals are not giving enough good information to families, already stressed by the illness of a loved one.
Even if a hospital recommended the Nursing Home Compare website, families often found the site lacking information about services families needed. Hospital staff did not have or provide information about the quality of care or a facility’s relevance to the patient’s needs.
In the end, when families did have a choice, location and transportation were key to their decision, the Fund reported. In the absence of any other compelling information about a facility, who wouldn’t select a place where you could easily visit your relative?
But even if a family did make an informed choice, if their preferred facility did not have a bed available, they had to go elsewhere. The hospital made the decision.
Because the system is such a mess, it’s hard to give good advice to families. But there are a couple things I can suggest.
Medicare requires a discharge notice, which sets out a patient’s appeal rights and procedures, to be given no later than two days after a person is admitted to a hospital. Some are given at admission, usually a time of confusion, and the explanation of rights is likely to be overlooked. Be aware of it, though, and read it carefully. You may need to rely on it if you think a relative needs to stay longer in the hospital.
And for all families who need more care after a hospital stay, the website of the Center for Medicare Advocacy has loads of information.
What has been your experience with hospital discharge planning? Write to Trudy at firstname.lastname@example.org.
This piece was originally published as part of Rural Health News Service series, “Thinking About Health,” on 5/24/19.