When you or a loved one leaves an acute care hospital, nursing and rehabilitation center or a long-term acute care (LTAC) hospital, recovery does not end. In many ways, it begins — whether you are going to another care setting or home. Learn more about how to transition home after leaving a medical facility.
Many studies have shown that the period after hospital discharge, or the transition between acute care and a less intense level of care, represents one of the times when the patient is most vulnerable.1
“Family conferences with our interdisciplinary team of care providers help our patients and families become oriented to the continuum of care needs that they have, and their progress along that continuum,” says Sandra Morgan, Chief Clinical Officer at Kindred Hospital Bay Area in Tampa Bay, Florida. “It is very important to them to have our experts give them advice on next steps and planning.”
There are several important ways that you can take an active role in making sure you or a loved one’s discharge is not an end. Here are three steps you can take toward further recovery and meeting your personal objectives at the next level of care:
Like Kindred Hospital Bay Area in Tampa Bay, many facilities offer discharge planning resources or a dedicated staff member to aid patients with plans. Take advantage of these resources, ask the right questions and voice your concerns.
It’s common for patients or their family members to expect a full return to their pre-hospital selves after a health event. However, this is sometimes not possible, and not maintaining realistic expectations about recovery can lead to disappointment and depression.
At minimum, many patients will need to make lifestyle changes to prevent the kind of event that precipitated the hospitalization from happening again. These changes may include dietary or exercise modifications. At the other end of the spectrum, many patients require extensive additional treatment, monitoring or rehabilitation. Before leaving the hospital, make sure you understand the extent of improvement that is expected to take place, and what further therapy or treatment is needed to ensure the best outcome.
Here are some of the largest challenges patients experience after leaving a medical facility:
Patients and their loved ones can be important participants in this team process with the goal of excellent outcomes.
“Connecting the dots throughout a patient’s episode of care leads the way to safe, efficient treatment from their admission at a long-term acute care hospital through their discharge home,” said Derek Murzyn, Chief Executive Officer of Kindred Hospital Greensboro in Greensboro, North Carolina. “Treating appropriate patients at the appropriate level of care at the appropriate time is the best way for us to leverage clinical resources and physician expertise to offer patient-centered, comprehensive care.”
Using the tips in this article can help you prepare for leaving a medical facility, maintain realistic expectations for your transition and know potential challenges you may face so you can create a plan to prevent them.
1Okoniewska BM, Santana MJ, Holroyd-Leduc J, Flemons W, O’Beirne M, White D, Clement F, Forster A, Ghali WA. “The Seamless Transfer-of-Care Protocol: a randomized controlled trial assessing the efficacy of an electronic transfer-of-care communication tool.” BMC Health Serv Res. 2012 Nov 21;12:414.
Do you have experience transitioning a senior loved one home after a hospital stay? Share your stories with us in the comments below.