Five Common Pitfalls of the Hospital Discharge Process

By Christina Irving, MSW, Family Consultant at Family Caregiver Alliance

Last week, Carole’s 78-year-old mother was admitted to the hospital after a fall in her home led to a broken wrist. For days, Carole has been going back and forth to the hospital, ensuring that her mother was comfortable and recovering from her fracture and subsequent bump to the head. Now, word has come that the doctor is discharging Carole’s mom and it’s time to go home. While she’s relieved that her mother is well enough to go home, Carole also wonders what happens next.

Planning for Discharge
Each year, thousands of seniors are admitted to the hospital for various illnesses or medical emergencies, and later discharged to continue their recovery at home. However, a 2009 study in the New England Journal of Medicine found that approximately 20% of Medicare patients were re-admitted to the hospital within 30 days of discharge, often due to the rocky transition from hospital to home. Here are five pitfalls frequently encountered in the discharge process, and actions that  family caregivers can take to help avoid them.

1. Not Having a Plan in Place
As part of the discharge process, doctors, nurses, and social workers should work with the family caregiver and patient to create a plan of care for the return home. These discussions should include details about any medical and care needs, whether the patient will be going back  home or to a care facility, any special equipment required, changes in diet and medication, and the abilities and limitations of the caregiver to provide the level of care now needed. Starting out with an effective plan will help improve the chances for recovery rather than re-admittance.  See our fact sheet “Hospital Discharge Planning: A Guide for Families and Caregivers,” for important questions to discuss as part of a thorough discharge plan.

2. Lack of Medical Follow-Up:
Before a patient has been discharged from the hospital, it is important to schedule a follow-up appointment with a primary care provider as well as any other needed health care professionals within one week.  In these visits the doctor will be able to monitor the patient’s overall health and recovery, adjust medications if needed, respond to concerns about side effects, and answer any other questions you have about the patient’s care needs.  These visits should provide you with additional support in managing all of the patient’s medical conditions, not just the one they were hospitalized for.

3. Medication Mix-Ups:
Studies show that up to 40% of seniors have medication errors when discharged from the hospital. This typically happens when medications prescribed in the hospital aren’t “reconciled” or compared with pre-hospitalization medication. By comparing prescriptions, providers and caregivers can ensure that there aren’t duplicate medications prescribed by multiple providers, possibly causing harmful side effects. It is important that the hospital talk with you about any changes in doses or schedules of medications, new medications and their possible side effects, and if any medications have been stopped.  Having a clear, updated medication list will help ensure that prescriptions given at discharge are filled and taken as prescribed.

4. Being Afraid to Ask Questions:
When a patient is discharged from the hospital and back to their own home, they may require additional assistance, or different kinds of care than a family caregiver has provided in the past. As a caregiver, you should feel comfortable asking questions about the kind of care that a patient will need and make sure that you get any special training needed.

For instance, you may need to assist in transferring from the bed to a wheelchair,  change wound dressings, or provide tube feedings when you have never done so before. Asking for instruction from hospital staff and care providers will ensure that you have the knowledge needed to provide care after discharge.

It is important that you tell the hospital discharge planners about any concerns or limitations you have in providing the needed care at home.  This includes any physical or health problems you have, financial limitations, or home safety concerns that would affect the patient being safely cared for at home.  Also, if you or the patient prefer to have information communicated to you in a different language, let the hospital staff know.  If you don’t feel prepared to manage the patient’s care needs at home, speak up; you’re the expert on the home situation and the discharge planners need to hear from you.

5. Lack of Support in Overcoming Obstacles:
Hopefully you now have a clear and understandable discharge plan.  However, that doesn’t mean everything is smooth sailing from now on.  It may be difficult for Carole to convince her mother that she needs to go to her follow-up appointments, properly manage her pain with medication and get physical therapy scheduled.  These steps are meant to help with recovery and reduce the risk of hospital re-admission. Seek support from family, friends, and care providers, to find solutions to the challenges that you may face in following the discharge instructions.

Hospital discharges can be a frightening time for family caregivers and the patient. However, the need to be re-admitted can be an even bigger disappointment and lead to chronic health issues. By making sure that you have a clear discharge plan and the information and support you need, you may avoid these hospital discharge pitfalls and help keep your elderly loved ones at home and healthy.

2 comments to Five Common Pitfalls of the Hospital Discharge Process

  • charlotte rosenberg

    There are a number of concerns that a new caregiver should have in this instance such as, why did Carole’s mother fall in the first place? Was it due to a lack of balance on her part or was it due to unsafe conditions in the home such as a lumpy rug or an electrical chord that got in the way? How is her gait now when she walks? Is she dependent on using a walker or cane and if so is the break to a dominant arm? Will she be able to bathe and dress herself upon her release? These are just some of the issues that should be addressed in her discharge plan.

  • Great point Charlotte. The safety of the home and the patient’s level of functioning are important considerations in creating a safe discharge plan. FCA’s fact sheet on discharge planning covers some additional issues to be discussed, and Next Step in Care has some great guides for family caregivers to prepare for discharge from the hospital.
    Thank you,
    Christina Irving, MSW, Family Consultant

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