If ever there were a weak link in hospital care, it’s what happens when you or a loved one leaves the hospital. It’s becoming clear that the process known as discharge planning is deficient, can be harmful, and sometimes results in a patient’s decline.
One in five patients across the country needs further care after discharge from a hospital, according to a series of four reports published by the United Hospital Fund in New York City. That’s a lot of people, and many times their families don’t know where to turn for help. The Fund reported that hospitals themselves sometimes prove to be of little assistance.
Patients are being sent not only to nursing homes but also to long-term acute-care facilities, a relatively new type of facility that treats sicker patients for an average of at least 25 days for recovery; or to sub-acute facilities, home care agencies or rehabilitation centers with little input from their families and little explanation of what these facilities can do.
How many families have ever heard of an long-term acute-care facility, for instance? Mine never had, and neither had I when I found myself transferred to one early in 2018 after a long hospital stay necessitated by a series of ailments caused by what seemed to be a simple infection.
When my daughter called facilities in Manhattan — where we live — looking for care, most wouldn’t even take her calls. “I called around and realized you cannot find a place on your own,” she said. “That’s not how this works.”
Too often, families find that hospitals limit the options for them. The United Hospital Fund found that even though hospital staff stressed patient choice, patients and their families actually had little choice.
One woman sent me a tweet not long ago saying that a VA hospital gave her father and his family “zero” time to make a choice. Instead, they were given the names of three facilities, “all one star,” she said. Presumably she was referring to a ranking from the federal government’s Nursing Home Compare website that rates the country’s nursing homes. “We had to fight daily for basic human needs to be met,” she told me.
If hospitals are hitting the limits of what Medicare will pay for a patient’s care, they have a great incentive for moving people out. To them, it doesn’t matter if a patient is moved to another state, as I was, or to another town. Either one can make it difficult for family to visit and keep an eye on the care, which is all-important.
The Hospital Fund also noted that legal safeguards don’t go far enough to protect patients and help their families and caregivers choose high-quality options. That means hospitals are not giving enough good information to families, already stressed by the illness of a loved one.
Even if a hospital recommended the Nursing Home Compare website, families often found the site lacking information about services families needed. Hospital staff did not have or provide information about the quality of care or a facility’s relevance to the patient’s needs.
Because the system is such a mess, it’s hard to give good advice to families. But there are a couple things I can suggest.
Medicare requires a discharge notice, which sets out a patient’s appeal rights and procedures, to be given no later than two days after a person is admitted to a hospital. Some are given at admission, usually a time of confusion, and the explanation of rights is likely to be overlooked. Be aware of it, though, and read it carefully. You may need to rely on it if you think a relative needs to stay longer in the hospital.
And for all families who need more care after a hospital stay, the medicareadvocacy.org/medicare-info/discharge-planning/#hospital_discharge website of the Center for Medicare Advocacy has loads of information.
Trudy Lieberman, a journalist for 40 years, is a fellow at the Center for Advancing Health. She was recently director of the health and medical reporting program at the Graduate School of Journalism, City University of New York and had a long career at Consumer Reports specializing in insurance, health care and health care financing. Send comments to [email protected].
Trudy Lieberman, a journalist for more than 40 years, is a contributing editor to the Columbia Journalism Review, where she blogs about health care and retirement at cjr.org. Send comments to [email protected].
