Commonly, the elderly come into the hospital with hip fractures, strokes, and infections. Chances are very good that after a hospital stay placement in a rehabilitation center (nursing home) will be necessary.
Discharge planning is a challenging task under the best of circumstances. For the older patient, however, the discharge from a hospital is a critical juncture because decisions are made (often too quickly) that influence the rest of that person’s life.
Changes in the health care environment have made it almost impossible to do such planning properly. Even under the best of circumstances, the discharge-planning process in hospitals is inherently complex. It requires gathering information from many sources –– including patient-specific information regarding functional status and patient and family preferences –– as well as information about available community resources.
The Elderly Lose When Hospitals Move Fast
The prime objective of the hospital’s discharge planners –– or as they are often called case managers –– is to move the elder out of the hospital into rehab as quickly as possible.
That urgency creates a number of potential hazards for the elderly and their families. You are wise to understand how discharge planners work and to become alert to the various strategies they employ.
- Early Discharge – Hospitals are looking to discharge elderly patients into nursing homes as quickly as possible. Physicians are pressured by hospital utilization review committee’s to release patients quickly. The attitude is that “the nursing home can take care of them.” The problem is that in many (if not most) cases the nursing home is not equipped to take care of someone who has been discharged too early. This often results in the patient being bounced from facility to facility.
- Poor Facility Choices – Usually the hospital hands the family a long list of nursing homes to choose from. These facilities might be close or far from the patient’s home. The hospital does not rate these facilities. They do not provide any insights into which facility is good or bad. While some discharge planners want to do the right thing and do not suggest poor facilities, others are looking to place patients quickly without regard to what happens to them.
- Pressure Tactics – Some discharge planners pressure families into accepting a local facility by threatening that their loved one would be moved far away.
- Lack of Proper Diagnosis – Hospitals often treat elderly patients as people in transition. The philosophy is “patch them up and send them to rehab.” An elder who comes in with a broken hip is rarely seen by a geriatric physician who would be able to determine if the elder has other challenges or issues. Unfortunately, many elders wind up in nursing homes for rehabilitation with diagnoses that the accepting facility is not equipped to deal with. This can be risky.
- Discharge Placement Brokers – Many hospitals are now using agencies to place residents in nursing homes or rehab facilities. Essentially, the hospital abrogates its moral and legal responsibility to discharge their elderly patients in a safe manner by referring them to the “body broker.” The broker has never met or seen the resident. Their only concern is placing someone into an empty bed and collecting a fee from the hospital or nursing home.
- No Family Input – In many discharges there’s no family input. Families often find themselves in situations where they receive a phone call from a nursing home informing them that their loved one is there. When the hospital is questioned, their response is, “didn’t so-and-so call you?”
As you can see, a hospital admission and consequent placement in a nursing home is a very trying time for the elder and their families. It’s a time of great confusion and emotional stress. There are so many balls up in the air that most families just don’t know what to do… and therefore many let the system do its thing.
The moment an elder family member is hospitalized, you need to secure an advocate to help you navigate these waters so that you can concentrate on your loved one’s health and emotional wellbeing.
Call My Elder Advocate The Moment Your Loved One Is Hospitalized
My Elder Advocate has dealt with hundreds of hospital discharge cases. We have an exceptional track record of success in preventing discharges in those cases where the elder is not ready for discharge.
With 36 years of experience dealing with hospital discharge planners, case managers, and social workers, MEA ensures that your loved one 1) is treated well, 2) is not discharged prematurely or 3) is not discharged to a poor or undesirable facility. Your call to My Elder Advocate at 212-945-7550 ensures that their rights are protected at all times.
The two major forces influencing the discharge-planning process are:
- Medicare –– Medicare is the major payer for the elderly in hospitals. They set the guidelines for lengths of stay and corresponding reimbursement rates. If an elder stays longer than his/her assigned length of stay, Medicare will not pay the hospital. Although there is an appeals process, decisions usually favor the hospital.
- HMOs –– The same principles as Medicare. Many elders belong to Medicare HMOs which is worse than having just Medicare. The HMO is profit driven and definitely not concerned about the patient’s wellbeing.