The primary goal of discharge planning is to ensure a patient’s smooth transition from the hospital to her home or another facility. Patients must be humanely and appropriately discharged when they are medically ready to leave the hospital. Senior patients who are unable to care for themselves cannot be sent home, if proper care is not in place; medically incompetent adults cannot be brought to homeless shelters; and patients in need of vital medications or medical equipment should have them. The discharge planner (DP) must work with all parties involved in their patient’s care to make sure that she is cared for while also facilitating as expedient a discharge as possible to prevent a potential increase in hospital costs.
The Importance of Discharge Planning
Medicare mandates that all inpatient facilities that bill the program provide discharge planning services. The way discharge planning is performed and whose job it is varies in every state and community. Hospitals that employ qualified and experienced discharge planners may see the numerous benefits of their service, including:
– Shorter length of patient stay
– Fewer readmissions to the hospital
– Improved patient outcomes
– Higher reimbursement rates
– Strong advocates who ensure that patients’ rights and choices are respected
– Patients who are better connected to any needed resources or assistance
– Improved connections between the hospital and relevant community services
– The education of fellow staff members
– Assistance with complicated and potentially problematic situation
It is a scary situation being sick and in the hospital. Most people do not know the steps or understand what your responsibility is, and what responsibility the hospital has regarding your discharge and follow up. Here is a discharge planning checklist for you to have in case you or a loved one ever find yourself/themselves in the hospital for an extended stay and will need some direction during discharge.
MEDICAL CASE MANAGEMENT DO’S AND DON’TS
– Be inclusive of all parties involved in the medical recovery process, especially when working with the elderly and their family.
– Include goals and timeframes when creating the care plan, and allow for updates as needed.
– Determine if treatment is appropriate.
– Determine if funding for case management services is secured before proceeding.
– Determine what is needed for successful return home, or if home is no longer an option, offering alternative solutions.
– Provide client advocacy and support at all times, and provide input and guidance on treatment services…
BE A LIAISON BETWEEN PARTIES.
– Use valid disability duration guidelines, and use them as GUIDELINES.
– Always obtain and maintain appropriate releases of information prior to beginning case management services.
– Understand that there are many players in the case management process, but that your main client should always be the patient you are helping.
– Always identify clearly your role as a case manager to the patient at the start of the relationship.
– Give legal advice at any time.
– Schedule IME appointments.
– Change employee’s doctor appointments just to fit YOUR schedule.
– Withhold information crucial to the success of the patients’ recovery.
– Perpetuate disability by failing to address doctor recommendations and health concerns.
– Become personally and/or emotionally attached to the client.
– Assume that you have an absolute right to attend all doctors’ appointments despite client wishes against it.
– Initiate cost services prior to obtaining carrier authorization.
– Provide legal direction to the claims adjuster, or engage in claims investigative or adversarial activities.
By having the patient aware of their rights and expectations, and giving them a better understanding of the role of the case managers and discharge managers, leaving the hospital does not need to be a daunting and confusing experience.
A SENIOR CONNECTION
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