WEBVTT

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Welcome to the Light Keepers podcast. I'm Clayton

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Vandiver, your Light Keeper, with the show dedicated

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to everyone who wants to get the very most quality

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out of life that they can. My co -host, as always,

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Charlene, our very own licensed clinical social

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worker in the state of Florida, who is joining

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the conversation this week about what happens

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when you get discharged from the hospital. We

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talked last week about what happens in the hospital.

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And now we're going to talk about what happens

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next, right here on this episode of the Light

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Keepers Podcast. Before we start, please leave

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your questions or comments below. We love to

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hear from you. Questions this week will be answered

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on the show next week on the next episode of

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the Light Keepers podcast. Every Wednesday evening,

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7 p .m. Eastern. Charlene, good to have you again

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with us here. What happens when you get discharged

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from a hospital? Well, and a lot of people don't

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know what to expect with that because it can

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vary depending on why you were in the hospital.

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Most of the time when someone is discharged from

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the hospital, one of two things is going to happen.

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They're either going to go home with instructions

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to follow up with their primary care physician

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or their specialist, whatever is required. On

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the other hand, sometimes when someone is discharged

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from the hospital, they may not be ready to go

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home yet and they may need a little more. help

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to get themselves ready to go home at which point

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they would be discharged to a rehab facility

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which is pretty much kind of like a nursing home

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except they do physical therapy there and you're

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not there permanently okay well when you are

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in these sorts of facilities is your family a

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part of that visit are they able to be with you

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and As they would be in a hospital? So every

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facility has its own visiting hours. So I would

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encourage everyone to check in with that facility

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and find out what the visiting hours are before

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setting up any preconceived ideas about when

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they can visit and how much time they can spend

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with their loved one. Now, something that a lot

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of people don't realize, and this is very important

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to know, especially during the COVID pandemic,

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when people were being discharged to facilities,

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sometimes the facilities were not nearby. And

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that's something that the patient and the family

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has no control over. The hospital will try to

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work with the family to discharge their loved

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one to a facility that's of their choosing or

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is nearby. But if there is no availability, the

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hospital is not going to let that person sit

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there. They're not going to hold someone past

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the point that they're ready to discharge because

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they're not getting paid. Medicare, the insurance

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company, will not pay. once that person is no

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longer meeting set criteria to be hospitalized.

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And so what happens then is if a bed is not available

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at the facility that the family wants, the hospital

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caseworker will set up a discharge to the first

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facility that they can find to accept that patient.

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That's not always in the same town. It's not

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always in the same state. So who sets up all

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of those travel arrangements and getting there?

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The case worker at the hospital would be the

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one responsible for setting that up. Now the

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trick there is they don't always set up getting

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them home. That's usually left up to the family.

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I see. And during the COVID pandemic, I was working

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in the hospital at the time, and it was not uncommon

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for us to discharge patients because the facilities

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were taking fewer people. There were more people

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being discharged from the hospital, and we were

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discharging people as far out as three and four

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states over. Wow. Well, let me ask you, what

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other options are there when you're leaving the

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hospital? What other potential options? scenarios

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might we have? So the other possibility is returning

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home with physical therapy being set up at home

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because some people may have a better support

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network. They may be able to do that at home.

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Some people just have really strong aversions

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to going into a facility. Maybe they've had a

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bad experience. Maybe they've had a bad experience

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with a family member. The option there is that

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they can go home. and physical therapy can come

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to them and they can finish recovering at home.

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Okay, so physical therapy can follow you in a

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way. You don't have to go into like a rehabilitation

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center. Physical therapy, occupational therapy,

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most rehabilitative therapies can follow you

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home. Now, it can become complicated if you are

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needing very detailed equipment, like if you

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need a specific piece of equipment to be able

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to do that physical therapy, that may not be

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practical. But there again, if you can be transported,

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if you can move, if you're mobile, then you may

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be able to go to an outpatient rehab to do that

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physical therapy. Like for example, if you've

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got a broken leg or you've had a hip replacement.

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you're going to need to be doing exercises that

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you may not have the equipment at home to be

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able to do. And during those situations, if you

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can be transported to an outpatient rehab facility,

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then you can do that rehab there and go home

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afterwards. Well, you also have the benefit in

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those facilities of having a coach, if you will,

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someone to lead you through those to make sure

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you're doing them right and getting the most

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benefit out of doing them. Correct. They're very

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well -trained, well -skilled. We've got some

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great rehabilitation centers. uh here in uh in

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our town and it's just amazing to see them working

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with their patients absolutely yeah they're very

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very considerate are there any other scenarios

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and i know you were talking about a fellow i

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forgot his name now but you were talking about

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a fellow that um that had an interesting experience

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through the hospital stay and and in leaving

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and i think the name that we came up with was

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a very generic uh you know bob bob yes everybody

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Identities have been changed to protect the HIPAA

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privacy, of course. Actually, we were talking

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about creating a bob to go into the hospital

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and kind of a test patient to just provide a

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possible experience of what someone would encounter

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going through the hospital system, including

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going through discharge and rehabilitation. Again,

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it really does depend on why the person was in

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the hospital. And I'm going to give you a good

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example, like I was mentioning with the broken

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leg or the hip replacement. That's going to be

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a very different type of rehab than someone who

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is in the hospital for a heart attack. There

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are different types of rehab. There's cardiac

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rehab. There is even concussive rehab if you

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have a brain injury. Okay, like a traumatic brain

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injury, a TBI. And it seems like if you had movement,

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the inability with a broken leg, broken hip,

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knee replacement, if you're having mobility problems,

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the rehab is going to be very different than

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if you, after you've had heart issues, I suppose

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you don't want to get terribly excited, but you

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can still move around. Correct. In fact, they

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encourage movement, I think, to get you back

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on your feet as soon as possible, it seems. When

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you're coming out of a hospital these days, it

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seems like they want you back on your feet. If

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they could, I think they'd walk you from the

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operating room back to your room. No, I'm kidding.

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It's not that bad. Actually, no. Actually, they

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do want you up and walking as soon as possible,

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though, because that minimizes the risk for blood

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clots. Oh, that's right. So that is important.

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That is important. But the discharge process

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can be different for everyone, like I said, depending

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on why they're in the hospital. But the bottom

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line, what it is most likely going to include

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is a caseworker at the hospital who is going

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to work with you to set up your discharge plan.

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Now, that in and of itself can be complicated

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because depending on the quality of the hospital,

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there have been situations where discharge plans

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have been created without the patient's participation.

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And that can happen. How does that work? Basically,

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what happens... I take it that doesn't happen

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all the time, but... No comment. I'm just kidding.

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We hope not. We hope not. But it really does

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depend on the quality of the hospital. A good

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hospital will include not just the patient but

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the family in the discharge planning. But we

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all know that there are hospitals out there that

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may not be as good a quality as others, and therefore

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their standards and their procedures are not

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going to be as detailed and as thorough. And

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what can happen is if you have... a hospital

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that is slammed and they're out of beds and they're

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needing to empty those beds you're going to see

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patients who are being pushed to discharge sometimes

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maybe even before they're ready and that's something

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you don't really think about but the dynamic

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of what the hospital needs and what the community

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needs from that hospital can dictate what you

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get as a patient in some cases. Absolutely. There

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are limitations to everything. Absolutely. And

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what a lot of people don't know, especially our

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older citizens who are on Medicare, don't know

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that if they feel like they're being discharged

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prematurely, they can appeal that discharge.

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They can contact Medicare and they can appeal

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that discharge. Really? And they cannot be discharged

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until that appeal is completed. Now, every hospital

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is supposed to notify a patient of this prior

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to discharge. Okay. And a lot of hospitals will

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actually require you to sign a form acknowledging

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that you've been told you can appeal your discharge.

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Now, oftentimes after you've had medical procedures

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or you're not feeling well, Many of those forms

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that the hospitals have you sign, you're signing.

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You don't read them all. And you don't all the

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time, at least I know I haven't always been fully

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aware of exactly what it was. Oh, it's another

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piece of paper. Okay, and I'll sign this one

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too, and then that one too. Exactly, and they

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do that. And I'm not going to say they do it

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on purpose because I don't think they mean to.

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A lot of times it's just a matter of efficiency.

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But there are a lot of papers that need to be

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signed. You're consenting to treatment. You're

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consenting to rehab. You're releasing HIPAA information.

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You're acknowledging this. You're acknowledging

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that. And somewhere buried in that stack of papers

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is your acknowledgement that you've been told,

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whether you have been or not, you're acknowledging

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that you've been told you can appeal your discharge.

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You know, I've signed a lot of papers over many

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years. I never noticed that piece of paper before.

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A lot of people don't. And that's why it really,

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I think it's important that this is the sort

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of information that we love to share with our

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audience, both the listening audience, the viewing

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audience, because it's valuable information.

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It can change how you manage your own dish. It

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gives you power. Knowledge is power. And that

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empowers you to be able to perhaps change the

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course of your treatment and care. And just being

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aware of that going in can change greatly how

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you and your doctors coordinate and communicate

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with one another. Well, and there's a lot that

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goes into a hospital stay and a discharge that

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people don't realize. For example, tragic story

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that I encountered with a patient once. He lived

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alone, came into the hospital. And while he was

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hospitalized, no one knew he had a pet at home.

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Okay, well, guess what? Most hospital case managers

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are not going to ask you if you have a pet at

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home. And it wasn't until the gentleman was being

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evicted because he had not paid his rent because

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he was in the hospital that it was discovered

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that there had been a pet locked in the apartment

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all that time. See, when you're in the hospital,

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If you don't have family, if you don't have a

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friend, if you don't have someone that you can

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partner with, your bills aren't getting paid.

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Whatever is in the apartment is not being taken

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care of. Everything that you do in your day -to

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-day life comes to a screeching halt if there's

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not someone there that can pick that up for you.

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Right. I think of so many things around the household

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that you just do every day and don't even think

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about. It's just part of your routine. as part

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of your normal care of running a household, even

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if it's just a small apartment, if it's a large

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house. But if you're by yourself, you're depending

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on yourself. And if you have a pet, that pet's

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depending on you. And if you came in to the hospital

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after a tragic accident and you're not fully

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conscious, that pet may not be the first thing

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on your mind. You know, one of the things that

00:14:20.240 --> 00:14:25.580
I recommend always is having a card in your wallet

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that just, it can be handwritten or it can be

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handwritten, laminated, whatever. But something

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that says, hey, I have pets at home. These are

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their names. This is their vet. Because a lot

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of times, if you have a good, responsible caseworker,

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first of all, they're going to be going through

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that wallet. Sorry, it happens. That's how they

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find your insurance information. And a lot of

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times, a lot of times I've had Jane and John

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Does come into the trauma department. That was

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how I found out who they were. Yeah, if you're

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in a traffic accident and you come in unconscious,

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no one knows to call a next of kin. No one knows

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if you have a next of kin or a place to live.

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So you come in, somebody's going to have to find

00:15:09.779 --> 00:15:14.039
out who you are. And how many times did the local

00:15:14.039 --> 00:15:17.840
police department, stand there saying, we don't

00:15:17.840 --> 00:15:19.539
know who they are. We got no way to find out.

00:15:19.580 --> 00:15:21.899
And a few minutes later, the social worker walked

00:15:21.899 --> 00:15:23.559
around the corner and said, this is who they

00:15:23.559 --> 00:15:25.179
are. This is where they live. This is their next

00:15:25.179 --> 00:15:29.139
of kin. I've already called them. Sometimes police

00:15:29.139 --> 00:15:31.799
know. Sometimes the police is able to provide

00:15:31.799 --> 00:15:35.519
that information to the hospital worker. Sometimes

00:15:35.519 --> 00:15:38.299
it's the other way around, depending on how good

00:15:38.299 --> 00:15:40.000
of a Sherlock Holmes they have working in the

00:15:40.000 --> 00:15:43.590
trauma department. There you go. Well, it's important

00:15:43.590 --> 00:15:46.649
to have that personnel there advocating for the

00:15:46.649 --> 00:15:48.730
patient, and that's really what the social worker

00:15:48.730 --> 00:15:50.909
does. So when you see your social worker come

00:15:50.909 --> 00:15:54.529
around, realize that they're on your side. They

00:15:54.529 --> 00:15:57.889
can be trusted and they can be given that information

00:15:57.889 --> 00:16:00.350
because they're really there to help you. And

00:16:00.350 --> 00:16:02.629
they will work with you as much as possible,

00:16:02.690 --> 00:16:05.570
but even they have limitations based on the hospital

00:16:05.570 --> 00:16:09.159
setting. But again, it's important to include

00:16:09.159 --> 00:16:11.600
as much information as you can in your wallet

00:16:11.600 --> 00:16:14.919
or in your pocketbook, including next of kin.

00:16:15.039 --> 00:16:18.379
And by the way, a lot of people do this in case

00:16:18.379 --> 00:16:21.340
of emergency contact on their phones. Guess what?

00:16:21.440 --> 00:16:23.860
We can't access that if we can't unlock your

00:16:23.860 --> 00:16:30.629
phone. Now, isn't that a great thought? So a

00:16:30.629 --> 00:16:34.590
lot of times what I have done and what a lot

00:16:34.590 --> 00:16:37.230
of people that I've spoken with have done is

00:16:37.230 --> 00:16:41.090
they have included on their lock screen in case

00:16:41.090 --> 00:16:43.389
of emergency contact this person because then

00:16:43.389 --> 00:16:45.629
you don't have to unlock the phone to get that

00:16:45.629 --> 00:16:47.970
information. Well, another thought I just had

00:16:47.970 --> 00:16:52.009
for some folks who might have biometric. locks

00:16:52.009 --> 00:16:55.370
on their smartphones. The nurse in the emergency

00:16:55.370 --> 00:16:57.929
room could actually use a thumb or a forefinger

00:16:57.929 --> 00:17:00.929
on the screen to unlock it and that might be

00:17:00.929 --> 00:17:04.289
a good idea to use biometrics to give access

00:17:04.289 --> 00:17:07.329
to medical professionals who might need that.

00:17:07.809 --> 00:17:11.069
That thought does occur to a lot of social workers

00:17:11.069 --> 00:17:14.109
in the emergency department but usually only

00:17:14.109 --> 00:17:16.410
once the patient is deceased because if they're

00:17:16.410 --> 00:17:18.329
still alive there are more important things going

00:17:18.329 --> 00:17:22.289
on. Well, that's also a good thought. Well, not

00:17:22.289 --> 00:17:24.990
a good thought, but it's a, yeah. It's a pertinent

00:17:24.990 --> 00:17:28.049
thought. It's a pertinent thought. And on that

00:17:28.049 --> 00:17:30.450
pertinent thought, of course, this is all a highly

00:17:30.450 --> 00:17:33.089
personal choice and no conversation that we have

00:17:33.089 --> 00:17:35.809
on the Light Keepers podcast should ever take

00:17:35.809 --> 00:17:39.630
the place of your own medical care team or other

00:17:39.630 --> 00:17:42.430
professional advisor who should always be consulted

00:17:42.430 --> 00:17:46.170
by you on your specific situational needs. And

00:17:46.170 --> 00:17:48.009
it's always good to be willing to talk about

00:17:48.009 --> 00:17:50.930
quality of life because every single one of us

00:17:50.930 --> 00:17:53.750
may face some of these situations at some point

00:17:53.750 --> 00:17:57.829
and will either not be prepared at all, or very

00:17:57.829 --> 00:18:01.289
well prepared indeed, from watching The Light

00:18:01.289 --> 00:18:04.750
Keeper's Podcast. That's every Wednesday evening

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00:19:24.849 --> 00:19:27.890
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00:19:40.509 --> 00:19:43.789
podcast. I'm Clayton Vandiver, your Light Keeper.

00:19:44.049 --> 00:19:45.230
We'll see you here.
