Hospital Discharge Planning

What is hospital discharge planning?

Discharge planning helps to make sure that you leave the hospital safely and smoothly and get the right care after that.

You, the person who is caring for you, and your discharge planner work together to address your concerns in a discharge plan. Whether you go home, to a relative's home, to a rehabilitation facility, or to another health care setting, your plan outlines the care you need.

In the days before you expect to leave the hospital, you will meet with your discharge planner.

Your discharge planner can tell you why you are going home or to another health care setting and why your care is changing. You will work together on:

• What care and services you may need after you leave. This can include nursing, physical therapy, occupational therapy, or speech therapy. A health care agency may set up a program to regularly visit you to check your blood pressure, pulse, oxygen saturation, or weight.
• What equipment you may need, such as a walker or oxygen.
• Whether or not you can get care at your home. You may need to go to another health care setting, such as a skilled nursing facility, a rehabilitation hospital, or an assisted living facility. Or family or friends may stay with you at your home, or you may stay with them.
• How to best move you from the hospital to your home or to another health care setting.

Write down any questions you have about what will happen when you get home, what your family can do to help, or who's going to pay for your care.

What happens when you leave the hospital?

When it's time to leave the hospital, you'll have a discharge plan. Discharge planning helps to make sure that you leave the hospital safely and smoothly and get the right care after that.

You, the person who is caring for you, and your discharge planner work together to address your concerns in a discharge plan. Whether you go home, to a relative's home, to a rehabilitation facility, or to another health care setting, your plan outlines the care you need.

Going home

Before you leave the hospital, talk to your care team and discharge planner about things you'll have to do at home. Get information in writing about:

• Your medicines. Get a list of medicines and how you take them. Have your doctor highlight any new medicines or medicines that need to be stopped or changed since before your hospital stay.
• When you need to see the doctor again and any follow-up tests you need.
• How and when to change bandages.
• How active you can be. This may include physical therapy and taking steps to prevent falls.
• What you can and can't eat.
• Whether you need any special equipment or supplies, such as a walker or oxygen.
• What to do if you have questions or if there is an emergency.

It's easy to think you can do everything, but it can be hard. If you feel you or your caregiver won't or can't do certain tasks, say so. The discharge planner can help you make other arrangements.

Going to another health care setting

If you have been living at home but will need to go to another setting when you leave the hospital, the discharge planner can give you a list of options. You, a family member, or a friend will have to call around to see which one you prefer. Things to think about when choosing another setting include:

• How you'll get your prescriptions, such as on-site or by mail order or delivery.
• If there are any problems with using any medical equipment.
• How easy it is for your family or caregiver to get to it and visit you.

If you have been living in another health care setting—for example, a nursing home or a rehabilitation hospital—you'll have to talk with someone at the facility about leaving for your hospital stay and then coming back afterward. They and the discharge planner can help you with a plan.

If you don't feel ready

Talk to your doctor about your concerns. Even though you may not feel strong enough to go home, your doctor can explain why you are ready to go home or go to another health care setting.

If you still have concerns about going home, ask for help from the hospital's patient advocate.

How do you stay healthy after you leave the hospital?

After you leave the hospital, be sure to follow your doctor's instructions, which may include things like taking medicines as prescribed, getting needed exercise, knowing what you can and can't eat, or knowing how to take care of an incision from surgery.

It's also important that you know:

• When you need to see the doctor again and any follow-up tests you need.
• Whether you need any special equipment or supplies, such as a walker or oxygen.
• What to do if you have questions or if there is an emergency.

Taking good care of yourself after you get back home is the best way to recover and avoid problems.