Beth’s dad was in the hospital for two days and he was discharged from the hospital suddenly this morning. Yesterday, there was a referral for inpatient rehabilitation but that all changed this morning because he greatly improved overnight. Beth has had conversations with his hospital case manager concerning home health. Even though Beth is an RN, the case manager offered the services of just two specific home health agencies as possibilities since he is ready to go home today. Do Beth and her dad have a choice?
Like many people, I have been an advocate for family members who have been ill. Several years ago I found myself in a similar situation. My dad was in the hospital after fracturing his hip. He wasn’t able to get out of bed or walk without help because of pain, weakness, and confusion. In my dad’s situation, the case manager told me Dad was accepted at a rehab, however she didn’t prep me or even ask me which rehab we would choose. Instead, she told me where she was sending him.
Wait…what? Where was Beth’s choice? Did I have a choice? Yes, we ALL have the right to choose, but we need to be assertive and use it. The health care system is moving very fast, and insurance companies and healthcare facility staff must look for ways to decrease health care costs. Like it or not, people are forced to move to lower cost settings in one or two days. It’s rapid fire and you’re left with confusion and potentially, limited choices.
Choice is derived from the Patient Bill of Rights. Every patient is given this notice when receiving services in an inpatient setting. It is often housed in a folder or pamphlet provided by the hospital or other healthcare organization. The Patient Bill of Rights was adopted by the U.S. Advisory Commission on Consumer Protection and Quality in the Health Care Industry in 1998. Virtually any organization that provides services and bills Medicare and Medical Assistance are required to inform patients of these rights when they start providing services to the individual.
To be in the hospital or have a family member in the hospital is intimidating. As a caregiver, you may not have given much thought ahead of time to the process of planning your loved one’s next steps in care.
If someone has been in the hospital for more than a day or two, most of that time has most likely been spent in bed. Spending most of the time in bed sounds like a good thing to do, especially if the person is medically fragile. The body adjusts very quickly to this “downtime”. If the person was frail before going into the hospital (and really any healthy person who is in bed for more than several days) will have risks of a return trip to the hospital if a good plan is not in place.
Here are some suggestions when you find yourself in an advocacy role with a loved one in the hospital:
- Realize and recognize that there is a responsibility to advocate for your loved one. Be present, check in with daily phone calls and ask questions.
- Consider asking questions as soon as your loved one is admitted to the hospital. Call the hospital or during a visit, ask to speak to the case manager. Find out what their initial impression is for how long the hospital stay will be.
- Ask for a physical therapy evaluation. The physical therapy evaluation will help you determine if it’s safe for him or her to return right home or if rehabilitation will be needed.
- If a rehabilitation stay is needed, ask for a printed list of all the options in the area. You don’t have to go with the hospital’s first recommendation.
- If a rehab hospital or nursing facility stay isn’t needed, consider home health, especially if your loved one has risk factors for a return trip to the hospital. If a hospitalized family member has frailty, there is a risk. Risks for re-hospitalization include:
- unintended weight loss of 10 or more pounds over the last 90 days
- fatigue or exhaustion
- slow walking speed
- weakness that requires help with walking or personal care
- multiple health problems or chronic illnesses such as heart failure, emphysema, diabetes, high blood pressure
- history of falls
- taking 7 or more medications per day
6. You can select home health from a list, from your own personal experience, or based on the positive experiences of family or friends. The hospital case manager will set up the services for you and assure that the agency has the doctors orders and all of the paperwork needed.
Being proactive and assertive is smart and will assure that the transition to the next level of care or home is as seamless as possible, with as few surprises as possible. The end goal is always to return home without recurrence of problems and avoiding a trip back to the hospital.