Our tips for hospital discharges can make the transition to home a bit easier. You might feel both happy and stressed when doctors decide you (or a loved one) can go home from the hospital. You may feel joy that you will soon be home in your own bed. But you might worry that you, or your loved one, are too sick to go home. Or you might worry that you cannot handle the required daily medical tasks. What seems like a positive step is often filled with fear and concern. The cause for concern is not unfounded.

The transition from hospital to home can be hazardous for patients and caregivers. Although this post focuses on potential issues surrounding discharges from hospital stays, patients going home from rehabilitation facilities face similar issues. My tips for hospital discharges, which generally apply to rehab discharges, can reduce the risk of complications.

Note – many patients go to long-term care facilities after a hospital stay. Although cared for by professionals at these facilities, this transition also carries risk of patient harm. However, this post focuses specifically on transitions to a home environment from either a hospital or rehabilitation facility.

For information on nursing homes and long-term care facilities, read my blog posts Nursing Home Safety Issues and How to Choose a Nursing Home.

Why are hospital discharges potentially dangerous?

Danger can occur when patients and/or family members do not understand how to care for themselves or their loved ones or are incapable of providing needed care. For instance, people can make medication errors, struggle with wound care, and miss important follow-up tests and appointments.

Shorter hospital stays can make care at home difficult.

Nowadays, hospitals discharge patients after shorter stays, which in general is a good thing since hospitals are full of dangerous germs that can make patients sicker. (To learn more, read How to Protect Yourself from Hospital Infections.)

But there’s a downside to shorter stays. Sending home sick patients with complicated medical needs that were historically handled by medical staff increases the risk of dangerous complications and infections – which can lead to serious health consequences and hospital readmissions.

What do patients and families want?

Researchers recently interviewed patients and family caregivers about their concerns around hospital discharges. The patients and family caregivers reported:

A desire to feel prepared and capable of caring for themselves or a loved one at home.
Wanting to know the healthcare system will meet their needs until they stabilize or recover
A desire to feel cared for and cared about by medical providers.

The researchers then compared the impact on care transition strategies on patient health. Unsurprisingly, they found for the hospitals that worked to improve trust in hospitals, used plain language, and coordinated care, their patients were more like to report improvements in:

Physical and mental health
Sleep quality
Ability to do daily activities
Pain levels

Moreover, researchers found these patients were less likely to return to the hospital or emergency room. However, these patients were more likely to spend at least one day at another healthcare site in the 30 days after leaving the hospital.

Patients and families need understandable discharge instructions.

Clearly, understanding discharge instructions helps you, or your loved one, recover and remain healthy. Therefore, hospital staff should make sure all parties understand exactly what care is required. Additionally, staff should make certain patients and/or family caregivers are willing to and capable of performing the required tasks. Finally, staff should ask patients about their living arrangements to make sure patients will be safe and will receive the proper care.

But hospitals often don’t do a good job preparing patients and families for discharge. In fact, federal data shows that less than 50% of patients feel confident in their understanding of how to care for themselves when they leave the hospital.

Furthermore, research shows that about 1 out of 6 Medicare patients are readmitted within 30 days of discharge. Researchers surmise that part of the reason for this high readmission rate is that hospital staff often rush patients and families through the discharge process.

Interestingly, one study found that systematically integrating informal caregivers, such as family members, into the discharge planning process for elderly patients reduced hospital readmissions by 25%.

For more information, read my blog posts:

Don’t think it’s the right time for discharge?

You may find yourself in situation where you think it’s too early for you or your loved one to go home. Perhaps you can’t arrange for timely delivery of necessary medical equipment, or perhaps you need additional time to hire home healthcare aides or to pick up prescription medications. Or you may fear that you or your loved one is too sick to be safe at home. Whatever the reasons for your concerns, it’s important to speak up as soon as possible.

Consider these options:

Talk to the doctor and discharge planner if you think it’s impossible to have a “safe discharge”. Provide details about your concerns, in writing if possible.
Ask your doctor to advocate on your behalf. Sometimes hospitals and health insurers pressure doctors to arrange quick discharges but having your doctor on your side may help.
Ask to speak with the hospital Risk Manager. Tell them why you are unhappy with the discharge plan.
For hospital patients – ask to speak to the hospital ombudsman or someone from the patient advocacy department. However, realize they are employees of the hospital and may be loyal to the hospital.
For patients in rehabilitation facilities – ask for the contact information for the ombudsman representative for the facility. Or find the ombudsman office for your state here.
You can hire a private health advocate. Although the services may be costly, their help can be invaluable. Learn more by reading How Can a Health Advocate Help You?
If the patient is covered by Medicare or by a Medicare managed care plan, you can file an appeal about a proposed discharge while you are still in the hospital. Ask the hospital for the form titled “An Important Message from Medicare” which explains how to appeal a hospital discharge decision. Appeals are free and generally resolved in 2 – 3 days. Importantly, the hospital cannot discharge the patient until the appeal is completed.
If the patient will receive hospice services at home upon discharge, ask the hospice provider to call the hospital on your behalf. The hospice may be willing to intercede on your behalf, particularly if they will not be able to provide the needed services and equipment at the proposed discharge date.
You can file a formal complaint with your state’s Department of Public Health (DPH). Find your DPH by searching online for {your state name} and Department of Public Health.