Discharge planning woes.
So, my DH is in the hospital. Still in ICU. By law and CMS, discharge planning starts the minute you get admitted.
The case manager visited on Tuesday (he was admitted early Monday with a post surgical retroperitoneal bleed that required 7 units of blood to correct. He was still very, very ill on Tuesday, but I understood why she needed to come in and get demographics. We talked DH possibly needing rehab and where.
PT and OT assessed his functioning and the rehab place came to assess his eligibility. He will qualify for home care, not in patient rehab, because he's making fabulous progress.
The actual discharge planner called yesterday, Friday, and we discussed what agency to go with. I told her I would call her back later or Monday.
My husband called and said, "Good news. I'm coming home Sunday!"
Called the ICU unit he's on and the nurse said no one had told her that. She checked the notes and indeed, Discharge had put in discharge for Sunday.
I blew my stack on the phone. Called back the discharge planners number and told her no way, no how was this a safe discharge and why.
Called back the unit nurse and enumerated what needed to happen before discharge (like being stable medically).
The medical team came in this morning and I was grinding for battle. The urologist said "your husband isn't going ANYWHERE this weekend. We're in charge.
Which is my point. Remember that it's the doctors who sign off on discharge.
Whoever you argue with, you need to say that it's an "unsafe discharge" and list ways in which it is not safe
In our case, my husband's blood thinner has JUST been restarted. He can't come home until that's stable.
He is newly on insulin. His glucose is still high. No one has talked to him about how to inject, how to measure. Change is diet? Is this permanent?
Hemoglobin keeps bouncing up and down. How do we check that it's going in the right direction?
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I’m sorry you guys are going through this!
Thank you for sharing your story. I’m bookmarking this post, and keeping it for future reference.
Praying for you and your hubby.
I said it in a meeting with the Care Team at her NH. And suddenly, they found a way to fix everything.
We came out of the meeting and my brother said to me "what did you SAY?".
"Magic words", I replied.
Thanks for explaining about DRGs, Alva.
The discharge "planners" these days are the ones who come with a forklift, lift your hubby bodily out of the bed and dump him into the streets.
Think DRGs always.
When he enters a hospital dependent on his coding he gets so many days. If the diagnosis is blood loss he gets a day to pour in a unit, if it is confusion maybe another day. Pneumonia, maybe another one. So let us say three days total he is covered for his stay.
If they can get him out in two they are WINNERS big time with funds.
If they get him out in the two they were given on the DRG, then they do pretty well.
But every day after that the hospital is a "loser". Getting less of the money allocated for that diagnosis.
(By the way the DRG stands for Diagnosis related grouping).
So they don't care about age, prior health, prior surgery, ANYTHING but how many hours or days they GET for that coded diagnosis.
And this is where medicine began to go wrong.
Yes, you better be ready to scream loud and use the words "UNSAFE DISCHARGE and I will report it to JCAHO and there will be NO ONE to accompany him home and NO ONE to receive him at home".
All of that at the top of your voice.
I would also DEMAND rehab at this point or at least SNF as he still needs SKILLED NURSING ASSESSMENT.
Let the Discharge planners know that you will return him by ambulance to their ER AT ONCE at the DROP of the hat, and that he will be painted all over with UnSAFE discharge and reported to JCAHO (the joint commission on accreditation) which will ding their license good if too many folks return to hospital too soon.
Honestly it is disgusting that you have to fight so hard, given your already ramped up anxiety. You mentioned already the patient lying and the one standing, both being needed. What about when they BOTH GO DOWN???
I would not even SPEAK to discharge planners. They only want to assess how well YOU are and how well spoken so they can know to dump the patient in your lap all the more quickly.
Glad to hear dh is doing better and making good progress!