Day 0: Still in the Bed
The Discharge Time Is Set, the Plan Is Not: How to Tell the Hospital Is Ahead of Your Family
When the discharge time is posted and you cannot yet say who is in the house tonight, the hospital is ahead of your family, and you can still close the gap before the car leaves.
The discharge time often arrives before the family is ready. A nurse says after lunch, or the case manager says later today, and the order goes in. Nothing about that order checks whether the people at home are ready. This piece is about that gap and the plain signs that tell you it is open.
Local option: New Plan Care gives families in the St. Louis area in-home help so a parent can stay home: companionship, help with bathing and dressing, meals, and overnight care. Call (314) 405-0887.
How to tell you have the gap
Try to answer these five questions out loud, while you are still in the room. If you cannot answer at least three of them, the hospital is ahead of your family.
Who is in the house the first night, and what time will they arrive?
Who is the ride home, and who is the backup if that person cancels?
Who collects the prescriptions, and which pharmacy has them ready before your parent gets home?
Who makes the first meal, and is there food in the house that your parent can actually eat?
Whose phone number is written down for the next morning if something looks wrong?
What Medicare expects the hospital to have done
Medicare's discharge planning rules (42 CFR 482.43) require the hospital to plan the discharge with the patient and with the people who will help after it. That planning is supposed to happen before the day of discharge, not on it. Ask the case manager to show you where the plan is written down. If it is not written down, say so, and ask when it will be.
If your parent has Medicare, ask whether the Important Message from Medicare about their rights has been given to them, and ask who explained it. Under Medicare's appeal rules, a patient who disagrees with the discharge can ask for a fast review by the Quality Improvement Organization. That request has a deadline, which is noon of the day before the discharge takes effect. Ask the nurse or case manager to tell you that deadline, and write it in your notebook with the time.
What to ask before the time is confirmed
Ask whether the discharge time is a firm order or a target. Ask whether it can be held for a few hours while the ride, the first night, and the prescription pickup are confirmed. Ask which items must be in the room before the car arrives, such as the medication list written in plain words, the follow-up phone numbers, and any equipment order. Keep your questions to what the hospital controls. Leave the house arrangements for your own list.
If the answers are thin
Do not simply refuse to leave on your own. Ask for the case manager, and if the case manager is not available, ask for the charge nurse. Say that the house is not ready for tonight, and ask what it would take to move the time. Write down the name of each person you spoke with and the time of the conversation.
While that conversation is going on, use your own list. The Day 0 to Day 14 After Discharge page walks through the same first-day questions in order. The Local Help After a Discharge page lists where to look for someone who can start in the next day or two. The rules quoted here are listed on the Sources page, so you can check them yourself.
A discharge time is a plan that someone can still change. Asking for the change is an ordinary part of leaving the hospital, and the people in that hallway hear the request every day.