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Hospital Discharge Planning: A Guide for Families and Caregivers

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Summary: Good hospital discharge planning can help prevent readmission. Medicare Advantage plans offer extra benefits to help you after your hospital discharge.

Seniors, caregivers, and healthcare providers hope to limit time spent inside hospitals. At the same time, they also want to prevent as many hospital readmissions as possible. To achieve these goals, the National Institute of Health (NIH) says it’s essential to plan for discharge from hospitals carefully.

Learn more about the importance of hospital discharge planning and how to make sure it gets done right.

Why is a high-quality discharge from hospitals important?

It will help to look at some examples of problems with the quality of hospital discharge planning.  That way, you will know what you need to look for.

For instance, NIH reported on a study of 395 patients with an average age in their 70s. Almost all patients understood the general reasons they had gone to the hospital; however, in post-discharge interviews, less than 60 percent could describe their diagnosis.

Most patients got understandable discharge instructions for diet, symptoms to look for, and instructions for activities. At the same time, the researchers believed about one-quarter of these discharge instructions did not contain a good description of the reason for hospitalization in common language.

In other words, patients did not know or understand their medical diagnosis. They may have understood, for example, they went to the hospital because of pain, fatigue, or falling. At the same time, they did not understand the source of their symptoms.

Some other causes for concern included:

  • Only about one-third of patients left inpatient care with a follow-up appointment for either a primary care doctor or specialist.
  • About one-third of patients were not asked who would help with care when they returned home.
  • The same percentage of patients had less than a day’s notice before discharge.

The study revealed both good news and bad news. Most patients get a number of good instructions before their discharge from hospitals. On the other hand, all patients don’t get enough hospital discharge planning guidance. They also may not already have important follow-up appointments scheduled. Even worse, some elderly and sickly patients may not even know who they can rely upon to ensure continued care.

The NIH concluded that planning for the discharge charge from hospitals cannot be left to chance if patients, caregivers, and medical providers want to reduce hospital readmissions.

Ensuring good instructions for the discharge from hospitals

To ensure you or your elderly charge have adequate planning for discharge from hospitals, you might rely upon Medicare’s helpful hospital discharge planning guide. After your discharge from the hospital, you can use this document to ensure proper follow up. In addition, therapists, doctors, and other caregivers will find the information useful to ensure they give you the best care.

The Medicare checklist to plan a discharge from hospitals begins with:

  • Care after discharge from hospitals: This includes the name and contact information of caregivers, hospital staff who can answer questions, and information about your medical condition and post-hospital instructions. You should also have a list of all prescriptions, supplements, and OTC medication.
  • Recovery support: This part lists medical equipment, activities you may need help with, upcoming appointments or prescription refills, and so on. It can also include community support groups, dietary or physical activity instructions, and concerns over payment and insurance.
  • Caregiver support: Caregivers also have a section to document their responsibilities and concerns over care after discharge from hospitals.

More help from Medicare for hospital discharge planning

At the end of the Medicare document about planning for a hospital discharge, you will also find a list of helpful resources for government and community agencies that can provide you with additional help. If you have developed a new medical condition, you may also find that your old Medicare plan no longer suits you. Along with other hospital discharge planning, you might research Medicare Supplement Insurance Plans, Medicare Advantage plans, and Medicare prescription drug plans that meet your needs better.

Help after hospital discharge from Medicare Advantage plans

As of 2019, Medicare Advantage plans are allowed to offer expanded benefits that may help you after your hospital discharge. These extra benefits include:

  • Meal delivery in more circumstances
  • Transportation to get groceries
  • Heart-healthy food or produce if you have heart disease
  • A ride to your doctor office

Medicare Advantage plans have long offered other extra benefits not covered by Original Medicare, including prescription drugs, routine vision, and routine dental care.

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