Welcome to the Light Keepers podcast. I'm Clayton
Vandiver, your Light Keeper, with the show dedicated
to everyone who wants to get the very most quality
out of life that they can. My co -host, as always,
Charlene, our very own licensed clinical social
worker in the state of Florida, who is joining
the conversation this week about what happens
when you get discharged from the hospital. We
talked last week about what happens in the hospital.
And now we're going to talk about what happens
next, right here on this episode of the Light
Keepers Podcast. Before we start, please leave
your questions or comments below. We love to
hear from you. Questions this week will be answered
on the show next week on the next episode of
the Light Keepers podcast. Every Wednesday evening,
7 p .m. Eastern. Charlene, good to have you again
with us here. What happens when you get discharged
from a hospital? Well, and a lot of people don't
know what to expect with that because it can
vary depending on why you were in the hospital.
Most of the time when someone is discharged from
the hospital, one of two things is going to happen.
They're either going to go home with instructions
to follow up with their primary care physician
or their specialist, whatever is required. On
the other hand, sometimes when someone is discharged
from the hospital, they may not be ready to go
home yet and they may need a little more. help
to get themselves ready to go home at which point
they would be discharged to a rehab facility
which is pretty much kind of like a nursing home
except they do physical therapy there and you're
not there permanently okay well when you are
in these sorts of facilities is your family a
part of that visit are they able to be with you
and As they would be in a hospital? So every
facility has its own visiting hours. So I would
encourage everyone to check in with that facility
and find out what the visiting hours are before
setting up any preconceived ideas about when
they can visit and how much time they can spend
with their loved one. Now, something that a lot
of people don't realize, and this is very important
to know, especially during the COVID pandemic,
when people were being discharged to facilities,
sometimes the facilities were not nearby. And
that's something that the patient and the family
has no control over. The hospital will try to
work with the family to discharge their loved
one to a facility that's of their choosing or
is nearby. But if there is no availability, the
hospital is not going to let that person sit
there. They're not going to hold someone past
the point that they're ready to discharge because
they're not getting paid. Medicare, the insurance
company, will not pay. once that person is no
longer meeting set criteria to be hospitalized.
And so what happens then is if a bed is not available
at the facility that the family wants, the hospital
caseworker will set up a discharge to the first
facility that they can find to accept that patient.
That's not always in the same town. It's not
always in the same state. So who sets up all
of those travel arrangements and getting there?
The case worker at the hospital would be the
one responsible for setting that up. Now the
trick there is they don't always set up getting
them home. That's usually left up to the family.
I see. And during the COVID pandemic, I was working
in the hospital at the time, and it was not uncommon
for us to discharge patients because the facilities
were taking fewer people. There were more people
being discharged from the hospital, and we were
discharging people as far out as three and four
states over. Wow. Well, let me ask you, what
other options are there when you're leaving the
hospital? What other potential options? scenarios
might we have? So the other possibility is returning
home with physical therapy being set up at home
because some people may have a better support
network. They may be able to do that at home.
Some people just have really strong aversions
to going into a facility. Maybe they've had a
bad experience. Maybe they've had a bad experience
with a family member. The option there is that
they can go home. and physical therapy can come
to them and they can finish recovering at home.
Okay, so physical therapy can follow you in a
way. You don't have to go into like a rehabilitation
center. Physical therapy, occupational therapy,
most rehabilitative therapies can follow you
home. Now, it can become complicated if you are
needing very detailed equipment, like if you
need a specific piece of equipment to be able
to do that physical therapy, that may not be
practical. But there again, if you can be transported,
if you can move, if you're mobile, then you may
be able to go to an outpatient rehab to do that
physical therapy. Like for example, if you've
got a broken leg or you've had a hip replacement.
you're going to need to be doing exercises that
you may not have the equipment at home to be
able to do. And during those situations, if you
can be transported to an outpatient rehab facility,
then you can do that rehab there and go home
afterwards. Well, you also have the benefit in
those facilities of having a coach, if you will,
someone to lead you through those to make sure
you're doing them right and getting the most
benefit out of doing them. Correct. They're very
well -trained, well -skilled. We've got some
great rehabilitation centers. uh here in uh in
our town and it's just amazing to see them working
with their patients absolutely yeah they're very
very considerate are there any other scenarios
and i know you were talking about a fellow i
forgot his name now but you were talking about
a fellow that um that had an interesting experience
through the hospital stay and and in leaving
and i think the name that we came up with was
a very generic uh you know bob bob yes everybody
Identities have been changed to protect the HIPAA
privacy, of course. Actually, we were talking
about creating a bob to go into the hospital
and kind of a test patient to just provide a
possible experience of what someone would encounter
going through the hospital system, including
going through discharge and rehabilitation. Again,
it really does depend on why the person was in
the hospital. And I'm going to give you a good
example, like I was mentioning with the broken
leg or the hip replacement. That's going to be
a very different type of rehab than someone who
is in the hospital for a heart attack. There
are different types of rehab. There's cardiac
rehab. There is even concussive rehab if you
have a brain injury. Okay, like a traumatic brain
injury, a TBI. And it seems like if you had movement,
the inability with a broken leg, broken hip,
knee replacement, if you're having mobility problems,
the rehab is going to be very different than
if you, after you've had heart issues, I suppose
you don't want to get terribly excited, but you
can still move around. Correct. In fact, they
encourage movement, I think, to get you back
on your feet as soon as possible, it seems. When
you're coming out of a hospital these days, it
seems like they want you back on your feet. If
they could, I think they'd walk you from the
operating room back to your room. No, I'm kidding.
It's not that bad. Actually, no. Actually, they
do want you up and walking as soon as possible,
though, because that minimizes the risk for blood
clots. Oh, that's right. So that is important.
That is important. But the discharge process
can be different for everyone, like I said, depending
on why they're in the hospital. But the bottom
line, what it is most likely going to include
is a caseworker at the hospital who is going
to work with you to set up your discharge plan.
Now, that in and of itself can be complicated
because depending on the quality of the hospital,
there have been situations where discharge plans
have been created without the patient's participation.
And that can happen. How does that work? Basically,
what happens... I take it that doesn't happen
all the time, but... No comment. I'm just kidding.
We hope not. We hope not. But it really does
depend on the quality of the hospital. A good
hospital will include not just the patient but
the family in the discharge planning. But we
all know that there are hospitals out there that
may not be as good a quality as others, and therefore
their standards and their procedures are not
going to be as detailed and as thorough. And
what can happen is if you have... a hospital
that is slammed and they're out of beds and they're
needing to empty those beds you're going to see
patients who are being pushed to discharge sometimes
maybe even before they're ready and that's something
you don't really think about but the dynamic
of what the hospital needs and what the community
needs from that hospital can dictate what you
get as a patient in some cases. Absolutely. There
are limitations to everything. Absolutely. And
what a lot of people don't know, especially our
older citizens who are on Medicare, don't know
that if they feel like they're being discharged
prematurely, they can appeal that discharge.
They can contact Medicare and they can appeal
that discharge. Really? And they cannot be discharged
until that appeal is completed. Now, every hospital
is supposed to notify a patient of this prior
to discharge. Okay. And a lot of hospitals will
actually require you to sign a form acknowledging
that you've been told you can appeal your discharge.
Now, oftentimes after you've had medical procedures
or you're not feeling well, Many of those forms
that the hospitals have you sign, you're signing.
You don't read them all. And you don't all the
time, at least I know I haven't always been fully
aware of exactly what it was. Oh, it's another
piece of paper. Okay, and I'll sign this one
too, and then that one too. Exactly, and they
do that. And I'm not going to say they do it
on purpose because I don't think they mean to.
A lot of times it's just a matter of efficiency.
But there are a lot of papers that need to be
signed. You're consenting to treatment. You're
consenting to rehab. You're releasing HIPAA information.
You're acknowledging this. You're acknowledging
that. And somewhere buried in that stack of papers
is your acknowledgement that you've been told,
whether you have been or not, you're acknowledging
that you've been told you can appeal your discharge.
You know, I've signed a lot of papers over many
years. I never noticed that piece of paper before.
A lot of people don't. And that's why it really,
I think it's important that this is the sort
of information that we love to share with our
audience, both the listening audience, the viewing
audience, because it's valuable information.
It can change how you manage your own dish. It
gives you power. Knowledge is power. And that
empowers you to be able to perhaps change the
course of your treatment and care. And just being
aware of that going in can change greatly how
you and your doctors coordinate and communicate
with one another. Well, and there's a lot that
goes into a hospital stay and a discharge that
people don't realize. For example, tragic story
that I encountered with a patient once. He lived
alone, came into the hospital. And while he was
hospitalized, no one knew he had a pet at home.
Okay, well, guess what? Most hospital case managers
are not going to ask you if you have a pet at
home. And it wasn't until the gentleman was being
evicted because he had not paid his rent because
he was in the hospital that it was discovered
that there had been a pet locked in the apartment
all that time. See, when you're in the hospital,
If you don't have family, if you don't have a
friend, if you don't have someone that you can
partner with, your bills aren't getting paid.
Whatever is in the apartment is not being taken
care of. Everything that you do in your day -to
-day life comes to a screeching halt if there's
not someone there that can pick that up for you.
Right. I think of so many things around the household
that you just do every day and don't even think
about. It's just part of your routine. as part
of your normal care of running a household, even
if it's just a small apartment, if it's a large
house. But if you're by yourself, you're depending
on yourself. And if you have a pet, that pet's
depending on you. And if you came in to the hospital
after a tragic accident and you're not fully
conscious, that pet may not be the first thing
on your mind. You know, one of the things that
I recommend always is having a card in your wallet
that just, it can be handwritten or it can be
handwritten, laminated, whatever. But something
that says, hey, I have pets at home. These are
their names. This is their vet. Because a lot
of times, if you have a good, responsible caseworker,
first of all, they're going to be going through
that wallet. Sorry, it happens. That's how they
find your insurance information. And a lot of
times, a lot of times I've had Jane and John
Does come into the trauma department. That was
how I found out who they were. Yeah, if you're
in a traffic accident and you come in unconscious,
no one knows to call a next of kin. No one knows
if you have a next of kin or a place to live.
So you come in, somebody's going to have to find
out who you are. And how many times did the local
police department, stand there saying, we don't
know who they are. We got no way to find out.
And a few minutes later, the social worker walked
around the corner and said, this is who they
are. This is where they live. This is their next
of kin. I've already called them. Sometimes police
know. Sometimes the police is able to provide
that information to the hospital worker. Sometimes
it's the other way around, depending on how good
of a Sherlock Holmes they have working in the
trauma department. There you go. Well, it's important
to have that personnel there advocating for the
patient, and that's really what the social worker
does. So when you see your social worker come
around, realize that they're on your side. They
can be trusted and they can be given that information
because they're really there to help you. And
they will work with you as much as possible,
but even they have limitations based on the hospital
setting. But again, it's important to include
as much information as you can in your wallet
or in your pocketbook, including next of kin.
And by the way, a lot of people do this in case
of emergency contact on their phones. Guess what?
We can't access that if we can't unlock your
phone. Now, isn't that a great thought? So a
lot of times what I have done and what a lot
of people that I've spoken with have done is
they have included on their lock screen in case
of emergency contact this person because then
you don't have to unlock the phone to get that
information. Well, another thought I just had
for some folks who might have biometric. locks
on their smartphones. The nurse in the emergency
room could actually use a thumb or a forefinger
on the screen to unlock it and that might be
a good idea to use biometrics to give access
to medical professionals who might need that.
That thought does occur to a lot of social workers
in the emergency department but usually only
once the patient is deceased because if they're
still alive there are more important things going
on. Well, that's also a good thought. Well, not
a good thought, but it's a, yeah. It's a pertinent
thought. It's a pertinent thought. And on that
pertinent thought, of course, this is all a highly
personal choice and no conversation that we have
on the Light Keepers podcast should ever take
the place of your own medical care team or other
professional advisor who should always be consulted
by you on your specific situational needs. And
it's always good to be willing to talk about
quality of life because every single one of us
may face some of these situations at some point
and will either not be prepared at all, or very
well prepared indeed, from watching The Light
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