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What Does a Good Hospital Discharge Plan Look Like for My Dad?

March 17, 2022
David Parker, Esq.
Long-Term Care Insurance?
David Parker, White Plains and New City NY Estate Planning Attorney
David Parker, Esq.
David Parker is an attorney who specializes in Estate Planning and Elder Law and has been practicing law for 30 years. Be it Wills, Trusts, Powers of Attorney, Health Care Proxies, or Medicaid Planning, David provides comprehensive and caring counsel for seniors and their families. A large portion of David’s practice is asset protection strategies so that families do not lose their hard earned savings to nursing home care costs. He also handles probate administration for the settlement of estates.
Standing up to a health care professional can be daunting, especially if you're worried about a premature discharge from a hospital.

Hospital Discharge - Kistein Monkhouse, CEO & founder of Patient Orator, a digital startup helping underserved patients close the communication gap with their health care team, says that communications issues between patients and caregiving teams happen often. As a result, it is critical for people to know and understand their rights. "It's a highly emotional time and especially if it's an emergency, the urgency is around seeking care, not focusing on your rights as a patient. Then something happens and you are left wondering what to do," Monkhouse said.

Next Avenue’s recent article entitled “Discharge Planning: Know Your Rights” says that hospitalization can be especially challenging for people impacted by health disparities, whether it's people of color, or LGBTQ+, women, or older adults, according to Monkhouse. Insurance is a huge driver of early hospital discharge, and in fairness, she said, hospitals do not want patients to get any infections while there. Therefore, sending them home is frequently the safer option.

However, if a senior in the hospital cannot perform "activities of daily living," such as getting to the bathroom on their own, getting dressed, eating independently, or taking care of personal hygiene, it is probably too soon. Monkhouse said it is important the person be able to stand up on their own without being afraid of falling.

It is usually the family caregiver who must step in during the discharge planning process, especially if the patient cannot advocate strongly on their own behalf. Good hosptial discharge planning for patients, their families and their care providers means more successful transitions from one care setting to another. Medicare-participating hospitals must deliver valid, written notice that states a patient's rights as a hospital patient, including discharge appeal rights.

This notice should be provided at the time of admission, or within two days of entering a facility. About 40 states have or will soon implement the Caregiver Advise, Record, Enable (CARE) Act. That is a model state law developed by AARP to help family caregivers, as their loved ones transition from hospital to home. The CARE Act requires hospitals to:

  • Record the name of the family caregiver on the medical record of the loved one;
  • Tell family caregivers when their loved one is to be discharged; and
  • Provide the family caregiver with education and instruction of the medical tasks he or she will need to perform for the patient at home.

A discharge plan should be provided in writing and should include the following:

  • Where and how a patient will get care after discharge;
  • What the patient and his or her support groups can do to help with recovery;
  • Any health care issues that might occur in the new care setting;
  • Clear explanations about medications going into the new care setting;
  • Arranging for necessary equipment or supplies for activities of daily living;
  • Resources available to help cope with and manage the illness or condition; and
  • Available resources to help with care-related costs.

Note that hospitals must display a Patient Bill of Rights.

Reference: Next Avenue (Feb. 4, 2022) “Discharge Planning: Know Your Rights”


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