The Importance of Discharge Planning for Caregivers
Written by Angela D. Smith
It was a chilly day in January 2012 when I was sitting at my desk putting the final touches on a presentation, and my cell phone chimed that I had a text message. I saw it was my father, who I communicated with regularly, but this time was different. The text stated, “Please send help.” I immediately called him but there was no answer. A few minutes later I received a second text saying, “I can’t talk.”
After a flurry of calls, tears, and panic, I pieced together that the night before my father had suffered a stroke in his hotel room, had fallen in between the two beds in the room, and crawled through the night to the door. Somehow he managed to send a text message. Somehow, he managed to survive.
When I arrived at his side, I learned that in addition to losing function on most of his right side (his strong side), his speech was slurred and he had been diagnosed with hypertension and type 2 diabetes. Suddenly, my father’s whole life had changed, along with my role in it.
Over the next few days we experienced a flurry of tests, information, and paperwork. I muddled through contacting my father’s employer to get him set up with short term disability and talk through his insurance coverage. I contacted family and friends. I researched hypertension, diabetes, and the various medications that were prescribed to him. I stayed with him in the hospital for ten days.
There are many lessons learned from my father’s health crisis, and I am thankful to report he regained some mobility and function on his right side. Thankfully, his speech also returned after a few weeks with therapy. However, there is a facet of our story and experience that to this day bothers me: the paperwork and process of getting my father discharged from the hospital.
What is discharge planning?
According to the Agency for Healthcare Research and Quality (AHRQ), discharge planning “is the process of identifying and preparing for a patient's anticipated healthcare needs after they leave the hospital.”
Ayla Roberts, MSN, RN, a registered nurse and freelance writer learned early on in her training the power of proper discharge planning for patients and their loved ones.
“As nurses, we were taught that discharge planning should start at admission! The medical team should constantly be thinking about discharge and what the patient's needs will be,” Nurse Roberts shared.“ The smoothest discharges are the ones where the medical team is communicating effectively and the patient and any loved ones who are present are engaged and ready to learn the discharge information.”
Unfortunately, the discharge planning process for my father and I amounted to a quick sit down conversation with a caseworker and a pile of paperwork I was left to complete. So, there I was, 29 years old, sitting in a hospital room, trying to decipher and understand my father’s options now that his condition was stable.
Some of the questions going through my mind were:
What type of in-home care would he need?
Would he be more comfortable with a male therapist than a female?
What needed to be changed in his apartment to make it more accessible?
What food did I need to stock his fridge and freezer with?
What would I do with his vehicle?
I was overwhelmed and frightened my ignorance would result in further harm to my father.
Thankfully, there is now a wealth of information and resources available for patients and caregivers planning for discharge.
Angela Smith
Overcoming Barriers to Effective Discharge Planning
The Family Caregiver Alliance offers a comprehensive guide specifically for families and caregivers, providing what caregivers, as advocates, should be prepared to do for their loved one along with lists of questions to ask before getting discharged from the hospital, depending on the circumstances. Medicare also offers a six-page checklist and resources to use to help individualize a discharge plan before leaving a hospital, nursing home, or other care setting.
On the other side of discharge planning are the hospital systems and teams that determine whether a patient is ready to leave the hospital.
According to Nurse Roberts, “Ideally, patients would interact with several different members of the medical staff.” She shares that staff would include medical doctors, physician assistants and potentially nurse practitioners, case workers, nurses, who “are most likely going to be the ones that provide you with your discharge instructions and teaching.”
For my father and I, nurses were vital to his wellbeing and recovery, providing constant information and care, sometimes as simple as holding off on checking vitals in the middle of the night when he was stable, so he could get some much needed rest. And, Nurse Roberts continues, “depending on the situation, physical therapists and occupational therapists who determine how well you are doing in therapy and if they feel you are doing well enough to continue your care at home and/or start outpatient therapy.” All of these roles are important to the discharge planning process.
AHRQ has created a handbook for hospital systems to reference when preparing a patient for the transition from hospital to home. It covers a variety of areas in an effort to reduce adverse events and readmissions.
Nurse Roberts advises patients and their caregivers to make sure to have a copy of all discharge instructions in writing and in your preferred language, including your activity orders, diet orders, and medication instructions. You will also want the information for your follow-up appointments, including the date, time, address, and phone number.
“If you are going home with new medications, you should have the paper prescription to take to the pharmacy, unless the provider already called it into your pharmacy for you. But don’t assume they called it in; always ask prior to discharge,” Nurse Roberts said.
Ayla Roberts, RN
Discharge Planning Checklist
For all the caregivers out there who have been charged with helping their loved ones after leaving the hospital, Nurse Roberts advises:
Understand it is okay to feel a little overwhelmed, especially if this is something you’ve never done before!
Be present at the hospital as much as possible, especially during the discharge teaching process!
Write your questions down as you think of them and keep them with you. Don’t trust your memory because it’s easy to forget what you were going to ask when the provider or nurse arrives!
Do not be afraid to ask for clarification or even the ability to practice certain care tasks while supervised by the nurse prior to discharge!
“All of this can really help boost your confidence about your ability to care for your loved one at home,” she said.
Conclusion
Discharge planning done effectively is beneficial to all involved.
However, despite its importance, the challenge with discharge planning is there is currently no universally utilized system in hospitals in the U.S.
In our case, proper discharge planning would have provided peace of mind and confidence in knowing my father was safe and receiving the care and follow up needed to improve his health and aid his recovery.
When you find yourself in the caregiver role as a young person, remember you are not alone. Armed with Ayla's checklist and advice, and the resources we have highlighted, you will be well equipped to provide the best care for your loved one you possibly can. You've got this!
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