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HOSPITAL DISCHARGE PLANNING

Hospital discharge planning is a service to assist patients in arranging the care needed following a hospital stay. Discharge planners help arrange services including home care, nursing home care, rehabilitative care, out-patient medical treatment and other help. Hospital discharge planning is usually handled by the hospital’s Social Services Department.

If you need help arranging nursing home care, ask your doctor to contact the hospital Social Work Department on your behalf. You can do this when you are admitted to the hospital or even shortly before admission. If a hospital discharge planner does not contact you within a short time, contact the Social Work Department directly for assistance.

Discharge planning services in Medicare certified hospitals must meet the following standards:

• Hospitals must identify and evaluate persons who may need discharge planning assistance.

• The evaluation must be done on a timely basis and must determine the need for services after the hospital stay and the availability of these services.

• The results of the evaluation must be discussed with the patient or patient’s representative.

• If requested by the patient’s physician, the hospital must help develop and implement a

• Discharge planning must be provided or supervised by a social worker, registered nurse or

If you need nursing home care, the hospital’s discharge planner should give you a list of and information about local nursing homes, and should help identify homes that have vacancies. You will be expected to contact these homes and identify a small number of homes that you prefer. The discharge planner should then follow-up with these homes to provide needed medical information and discharge status.

Problems may develop if the homes you prefer have no vacancies or are unwilling to admit your relative for other reasons. In this case, the hospital discharge planner may pressure you to consider alternative facilities.

Unfortunately, the facilities with the most vacancies may not be the most desirable homes. The hospital should not force you to accept placement in a facility that is not certified my Medicare and Medicaid or in a home with a recent record of poor care. Nor should you be required to use a nursing home that is too far away that would prevent visits from family or friends.

You will need to balance your right to refuse placement in an inappropriate facility with the reality that your relative cannot stay in the hospital indefinitely. Consider asking the hospital to use its influence to help you gain admission t o one of the nursing homes on your preferred list. Keep in mind that many hospitals own and run their own nursing homes and certainly have the ability to secure admission to these facilities. For your part, you may need to expand the list of nursing homes you are willing to consider.

The hospital cannot force a patient to go to any particular nursing home or discharge a patient to a nursing home without the patient’s legal representative’s consent. If the hospital believes that a patient no longer needs hospital care and is refusing appropriate discharge, it must issue notice to the patient of its determination. This notice can cause the patient to become responsible for payment of continuing hospitalization, subject to the patient’s right to appeal. The notice and appeals rights are discussed below.

Although Medicare covers up to 90 days of hospital care each benefit period, it will only pay for your care if it determines hospitalization is medically necessary. You are entitled to stay in the hospital and receive needed care as long as the hospital is the appropriate place for you to be. If your care can be provided safely elsewhere, Medicare will not approve payment for your hospital stay.

Medicare pays hospitals based on a system known as "Diagnosis Related Groups," or DRGs. Medicare pays hospitals a ser amount based on the average cost for all patients with a particular diagnosis (DRG). For example, the hospital may get the dame amount for every Medicare patient who is admitted with a broken hip.

If the hospital spends more than that set amount to care for you, it will lose money because it cannot bill your for the extra costs. But, if actual costs for your care are less than the ser amount paid by Medicare, the hospital gets to keep the difference and can make money.

The system is meant to reward hospitals that operate cost effectively. Hospitals can make money on lower cost cases and those of shorter than average duration. As a result, hospitals have been discharging patients earlier than in the past, and not admitting some patients for care. This saves the hospital money, but some patients may leave the hospital before they receive all of the care they need or before good plans have been made for their care after hospitalization.