Questions To Ask When Being Discharged From Rehab?

Here are some of the questions family caregivers should ask a hospital or rehab discharge planner.

  • What Is the Prognosis?
  • What Free or Low-Cost Services Are Available?
  • What Is Being Gained from the Home Care Agency Referral?
  • What Should We Expect?


How do you transition from rehab to home?

5 Tips for Transition: A Smooth Move from Rehab to Home

  1. Expect things to be different. Unrealistic expectations about being able to return to life as normal can lead to disappointment and frustration.
  2. Start planning early.
  3. Stay focused on goals.
  4. Take advantage of resources.
  5. Recognize that it’s OK to have help.

What should I ask my doctor before discharge?

The 10 Questions You Must Ask Before You Leave the Hospital

  • Has my diagnosis changed?
  • What was the ultimate treatment?
  • What should I expect during my recovery?
  • What sort of equipment will I need?
  • What activities should I avoid, and what do I need to do?
  • Are there dietary restrictions I need to follow?

What questions should I ask at a hospital discharge?

8 questions to ask during your hospital discharge

  • What’s the status of my medical condition?
  • When do I need to see a doctor again?
  • How do I get to my appointment?
  • What should I know about taking medication when I get home?
  • How do I use this equipment?
  • What are the warning signs that something’s wrong?

How do you fight a rehabilitation discharge?

Consider appealing the discharge Make sure the rehab program provides you with contact information for the local Quality Improvement Organization (QIO) that reviews such appeals. You can also find this information online. Appeals often take only a day or two.

What does it mean to be discharged to rehab?

When patients leave rehab they might be discharged to:  Home, with no needed services.  Home, with help needed from a family caregiver.  Home, with help needed from a home care agency.  A long-term care setting (such as in a nursing home or.

Can a physical rehab kick you out?

Reasons You Can Get Kicked Out of Rehab Failing to follow a rehab’s rules can result in expulsion; if someone relapses, they usually won’t be kicked out right away, but they will most likely lose privileges and be given a strict warning.

Can I ask to be discharged?

You have the legal right to leave. There is no law that requires you to sign discharge documents. Still, you should prepare a letter that explains why you decided to leave. Keep a copy of the letter and give a copy to the hospital administrator.

Can I ask to leave the hospital?

Generally, yes. You can leave even if your healthcare provider thinks you should stay. But it will be documented in your record as discharged against medical advice (AMA). What happens if I leave the hospital before being discharged?

What are 2 questions you could ask the family to help determine their needs for a supported discharge?

10 Questions to Ask Before Your Hospital Discharge

  • Is there someone who will advocate for my care as I transition home?
  • Do I need any kind of care after my hospital stay?
  • What medications should I take, and what medication schedule should I follow at home?

What is hospital discharge planning?

Discharge planning is the process of identifying and preparing for a patient’s anticipated health care needs after they leave the hospital. 9 Hospital staff cannot plan discharge in isolation from the patient and family.

What is a hospital discharge?

When you leave a hospital after treatment, you go through a process called hospital discharge. A hospital will discharge you when you no longer need to receive inpatient care and can go home. Many hospitals have a discharge planner. This person helps coordinate the information and care you’ll need after you leave.

What is safe discharge from hospital?

“Safe discharge” laws preclude hospitals from discharging patients who don’t have a safe plan for continued care after they leave a hospital.

Can a patient discharge themselves from a nursing home?

Though nursing homes are forbidden by law from refusing patient discharge under normal circumstances, there is a single exception. Nursing homes and other long-term care facilities cannot force residents to stay, but any resident leaving the facility must be able to make his or her own medical decisions.

How many days of rehab will Medicare cover?

Medicare will pay for inpatient rehab for up to 100 days in each benefit period, as long as you have been in a hospital for at least three days prior. A benefit period starts when you go into the hospital and ends when you have not received any hospital care or skilled nursing care for 60 days.

Can a nursing home just throw you out?

Overview. Nursing homes are generally prohibited from moving residents. They can transfer or discharge residents from the home only for certain reasons and, even then, only when they follow specified procedures. There are several reasons why a nursing home may try to evict a resident.

Questions to Ask Your Discharge Planner or Social Worker

Getting your loved one ready for discharge is an important part of the road to better health and recovery. There are things you can do to make the process go more smoothly and ensure that your loved one receives the care he or she requires after leaving the hospital, rehab facility, or transitional care unit. One of the most straightforward methods to ensure that you have all of the necessary information is to ask questions of the discharge planner or social worker. Here are some things you should discuss with your doctor throughout the discharge planning process, as well as some questions you should consider asking.

Discharge Planner FAQ: Knowing What Topics to Cover

You can help ease the transition and ensure that your loved one receives the care he or she requires after leaving the hospital, rehab center, or transitional care unit by following these steps. The discharge planning process is a vital part of the route to health and recovery. Asking questions of the discharge planner or social worker is one of the most straightforward methods to ensure you have all of the necessary information. Here are some things you should discuss with your doctor throughout the discharge planning process, as well as some questions you might want to ask him or her:

Care Questions

Your loved one may require further care after being released from the hospital or rehabilitation facility. It is critical that you understand the magnitude of the care and all that your loved one will require during this time. Some of the questions to ask are as follows:

  • If someone you care about requires assistance with the activities of daily living, call us. What kind of specific therapy, exercise, or treatment do you think your loved one might benefit from
  • How long is likely to be required for recuperation
  • What kinds of warning indicators should you be on the lookout for
  • Whether or if your loved one will want assistance with housework and other everyday activities

Dietary Needs

Depending on the doctor’s recommendation, a senior may require a particular diet that is tailored to his or her changing needs. You should find out whether there are any special foods that your loved one should be consuming or avoiding. The following are examples of questions you might ask:

  • The doctor may propose an unique diet that’s tailored to the changing needs of a senior, and you’ll want to know whether there are any particular items that your loved one should consume or stay away from. You can ask the following questions:


Following an illness or injury, it’s conceivable that your loved one will require specific drugs to recover. You must be aware of the drugs in question, when they must be taken, and how they should be administered and controlled. You can inquire about items such as:

  • What are the names and dosages of all of the drugs that will be required
  • And When should the drugs be delivered, and for how long should they be administered
  • What are the probable negative effects of the medication
  • Is there any specific guidance, such as whether to take it with meals or on an empty stomach

Equipment and Supplies

It is essential that you and your loved one are both familiar with and understand how to utilize any particular equipment that they may require. This might include a cane, a hospital bed, a wheelchair, oxygen, grab bars for the shower, or other types of assistive technology. The following are examples of questions to ask:

  • What kind of equipment or materials will be required
  • You should know how, when, and where you may learn how to properly utilize them. Where can I get the equipment or supplies I need to complete my project? What will be covered by insurance
  • Is it necessary for your loved one to have supplies such as incontinence products, specific creams, or wound care supplies?

When your loved one is discharged from a hospital or rehabilitation program, being prepared for what will happen next is crucial to ensure that he or she receives the care and therapy necessary to continue healing and rehabilitation. For families whose loved ones are enrolled in Walker Methodist’s transitional care or rehabilitation programs, our discharge planners will be pleased to assist you in obtaining all of the information you want. Get in touch with us now if you would like more information about the discharge planning process at a Walker Methodist TCU or rehabilitation program.

Discharge Planning Checklist: Short Term Rehab

Your mother or father is going to be freed from the hospital or short-term rehabilitation, but you aren’t sure if they are ready to return home and manage their affairs on their own yet.

It is at this point that a discharge planning checklist becomes important. Using the checklist, you may ensure that your mother or father receives the most appropriate answers from the medical staff, resulting in the best possible after-care outcome for them.

Discharge Planning Checklist

The first item on your to-do list should be to have the discharge form in your possession, which you should have received from the registered nurse. This document should include information on the cause for your parent’s admittance, the procedures performed, and the result. The nurse will instruct you on how to care for your parent (this is referred to as “patient teaching”). Make certain that it covers the following health concerns:

  1. The warning signs and symptoms to look out for, as well as what to do if they arise
  2. Identifying who to contact if an issue arises shortly after returning home
  3. The drug list as well as the regimen
  4. Appointments for follow-up

Inquire about the continuation of therapy that is required for a full recovery:

  1. Will treatment sessions be carried out at home, or will they be carried out at an inpatient or outpatient clinic? Approximately how long do you expect these sessions to last? What are the patient’s expectations or desired outcomes from therapy
  2. Will these treatments be covered by insurance?

Inquire about the patient’s functional level in regard to his or her day-to-day requirements. This will assist you in preparing for the problems of after-care.

  1. In what way is my parent’s physical restriction defined precisely? What is the likelihood that my parent would have adequate strength to perform basic chores or activities of daily living (ADLs) such as bathing, toileting, dressing, and eating
  2. Is my parent going to require assistance with errands, laundry, and food preparation? Whether or not medication management will be required, and whether or not I should monitor for compliance

By answering the following questions, you may determine whether medical equipment for therapy will be required in the house and, if so, whether it will be possible to adapt it in the home environment:

  1. Is it possible that my parent may require specific medical equipment? The equipment’s functioning will require the expertise of a nurse, would that be required? Will the equipment be delivered, and if yes, when will it be delivered? Whether or if the home setting has any unique safety-handling needs
  2. Is it necessary for me to install a Personal Emergency Response System in the event that my parent falls or needs to contact for assistance

Note: Before getting started, find out what services and equipment may be covered by Medicare or commercial insurance plans. A geriatric care manager is frequently on hand at health clinics to provide further advise on discharge planning and to provide an additional layer of support for caregivers. Keep in mind that this is your loved one, and you will want to err on the side of caution while developing a safe discharge plan for him or her. It is preferable to have more services in place and gradually reduce their need on them as they regain strength rather than to think they can manage on their own and risk re-admission to the hospital or rehab.

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They may believe they can cope just as well as they did before to their hospitalization.

Short-term or respite care at an assisted living facility may be the best option for your family member.

Key Takeaways:

  • A discharge planning checklist serves as a guide to obtaining answers to your questions from the medical team on the best strategy to assist your mother or father in their recovery at home. It is essential that you have the discharge form, which contains a summary of the patient’s hospitalization
  • In addition, you should obtain “patient education” material from a member of the medical team. For your parent’s ongoing treatments, inquire about whether they will be provided in the parent’s home or as outpatient care. Observe and ask questions regarding your parent’s functional state, particularly as it relates to addressing day-to-day demands and activities of daily living
  • Determine whether medical equipment is required for operation in the house and whether the skills of a nurse are required. You could want to consider a short-term or respite stay while your parent regains their strength and functional abilities.

About Elizabeth Bemis

My career journey began in 1998 when I passed through a building site for an assisted living facility. After learning that it was being built by United Methodist Homes, I understood that the next stop on my path would be to work for a mission-driven organization. As Executive Director of our Middlewoods of Farmington community, I quickly rose through the ranks and eventually served as Regional Manager for the Middlewoods properties before assuming my present position as Vice President of Marketing, Promotions, and Assisted Living Operations.

I also enjoy spending time with my grandchildren.

12 Questions to Ask Before Discharge

If you ask now, you might be less likely to come back later. The medical team has just returned from their rounds, and the good news is that you are ready to return home. Or are you a liar? At some point during your hospital stay – preferably before you are carried out the door – you should ask the following questions of hospital staff members. Also, be certain that you understand the replies. 1. Let’s start with the basics. The transitional care manager at the University of California, San Francisco Medical Center, Eileen Brinker, encourages patients to advocate for themselves and to ask clinicians simple, straightforward questions.

What is the prognosis for me?

When patients undergo exploratory surgery, they “need to know what their diagnosis was, whether it has changed since they’ve been in the hospital, and any determinations about their health status,” according to Torrey, author of “You Bet Your Life: The 10 Mistakes Every Patient Makes,” a book about medical errors.

How can I obtain assistance with.

Patients should express their need for support at home, according to Brinker, whether it’s access to groceries and hot meals, aid with pharmaceutical expenditures, or translation services, among other things.


Instead of worrying about your copay, insurance coverage, and insurance red tape at home, Brinker recommends that you tap into the experience of competent personnel in the hospital’s financial services or social work departments during any lengthy hospitalization, especially for a new ailment.

  • 5.
  • Torrey explains that some patients are just not ready to be discharged when the hospital wants to send them home.
  • Alternatively, a patient might be experiencing a fever spike.
  • “The doctor has the power to file an appeal with the insurance company and have them allowed to remain,” Torrey explains further.
  • Did anything go wrong throughout the process?
  • Were there any difficulties or negative side effects during the procedure(s)?
  • “ It’s quite OK to just inquire, “Did anything go wrong while I was here?” Torrey expresses himself.

It’s possible, but not guaranteed.


Because discharge may be a difficult moment, Eric Coleman, director of the Care Transitions Program at the University of Colorado, advises patients and their loved ones on the particular actions they should follow after being released from the hospital.

What you should do when these red flags occur, who you should contact, and what kind of after-care is available are all good things to ask as follow-up.

As with every new prescription, you should inquire about the proper way to take the meds that have been prescribed (with meals?

before bedtime?

Inquire about drug interactions as well, such as how they will combine with other medications or particular foods.


Your hip replacement procedure went smoothly, but now you need to know what to expect next, including whether you’ll be sent to a rehabilitation center or your own home afterward.

“However, if they are unable to leave the house, how can they have their prescriptions filled?” 10.

Patients should be aware of the activity expectations before release, according to Torrey: “Are they being sent home to take 10 days off work to recover?

You may need to inquire as to when it is safe to engage in sexual activity again.

When it comes to cardiac patients, are there any restrictions on their activities or do their physicians encourage that they become less sedentary and engage in greater physical activity?

You have the right to request a copy of your medical record from the hospital.

Request the initial history and physical examination, as well as consultation reports from specialists and operation reports.


When it comes to asking patients “What are your major goals when you return home?” asks Kristen Rising, head of acute care transitions in the department of emergency medicine at Thomas Jefferson University Hospital.

“‘Can you tell me about your main priorities for the upcoming week? What are the most important items you need to accomplish those objectives, and how can we assist you with them?” If your doctor does not inquire as to what is most important to you, you should tell them nevertheless.

It’s Discharge Time at the Rehab Facility – Now What?

If you ask now, you might be less likely to return later on. It has just been confirmed by the medical staff that you are healthy and ready to return home. You’re either lying or you’re lying down. Here are some questions you should ask hospital staff members at some point during your stay — ideally before you are carried out the door. Be certain that you understand the questions. 1. Let’s start with the fundamentals of communication. In her role as transitional care manager at UCSF Medical Center, Eileen Brinker encourages patients to advocate for themselves and ask clinicians simple, clear questions.

  • Patients should be informed, argues patient advocate Trisha Torrey, who may make you gag before asking.
  • 3.
  • scheduling appointments, arranging transportation, and paying for treatment?
  • Aside from that, hospital social workers or case managers may be able to hook you up with services such as Meals on Wheels or home health care (which may be cancelled if you decide you no longer require them).

Instead of worrying about your copay, insurance coverage, and insurance red tape at home, Brinker recommends that you seek the advice of knowledgeable people in the hospital’s financial services or social work departments if you are admitted for an extended period of time or have a new medical condition.

  • How do I proceed if I’m not physically or mentally prepared to leave?
  • It could be too soon for an older surgical patient, or for a newborn, or for someone who has heart issues or diabetes, which could make their healing and recovery more difficult to manage.
  • It is important for the patient or their family to stand up to the doctor if they believe discharge is too unsafe, according to the expert.
  • Torrey emphasizes that you must be aware of any difficulties that arise while you are in the hospital.
  • Has your medicine been provided to you in error, resulting in a chain reaction?
  • To paraphrase Torrey, ‘Do I believe they’ll give you a straight answer?’ I wonder.
  • Almost by definition, if it’s in the books, they have to do it.” 7.

Patients and loved ones should be aware of particular actions they should follow after release because it is such a difficult moment, says Eric Coleman, director of the Care Transitions Program at the University of Colorado.

What you should do when these red flags occur, who you should contact, and what kind of after-care is available are all good things to ask.

In the same way you would with any new prescription, you should inquire as to how the drug should be used (with meals?

before bedtime?

Make sure you understand how the medication will mix with other medications and meals as well.

Is there a certain type of therapy I’ll require?

“If patients are going to require some type of therapy, they need to know whether that therapy has already been scheduled or if they will be required to make the arrangements themselves, as well as what their treatment alternatives are,” Torrey explains.

How active need I be in order to achieve my objectives?

“Or do they have to go home and hop on their bikes and go around the neighborhood?” they wonder.

Also, be aware of what may be expected in terms of activity over a lengthy period.

Where can I obtain a copy of my medical records?

Children’s Hospitals and Clinics of Minnesota’s Anne Tegen, head of the Health Information Management Department, explains that some information is essential in the treatment of children.

Also request a current medication list, significant test results (such as echocardiograms or MRIs), and your discharge summary, as well as any other documentation you feel is necessary.

What questions do you think your physicians should ask you about your condition?

” ‘Can you tell me what your main priorities are for the upcoming week?” In order to achieve your objectives, what are the most important things you require, and how can we assist you with these needs?” You should still tell your doctor what is most important to you even if they don’t ask about it.

10 Questions to Ask Before Your Hospital Discharge

When you are about to be discharged from the hospital following a hospitalization, the prospect of recovering at home may seem daunting. If you ask yourself the following ten questions, you will acquire the knowledge you need to make your recuperation at home as effective as possible. You will almost certainly have other questions concerning your rehabilitation, so be sure to ask all of your questions when you talk with your medical team about your condition.

1. Is there someone who will advocate for my care as I transition home?

If you do not have a steady team of family caregivers and friends to support you at home, consider professional in-home care and assistance, such asRightTransitions ® from Right at Home, which provides professional in-home care and assistance. It is also possible that the hospital will appoint a social worker or case manager to advocate on your behalf and help you learn about insurance and community resources that are available following your hospitalization. Before the actual discharge, it is possible that someone will need to come to the house to ensure that the atmosphere is safe for returning.

Is the heating or air conditioning functioning properly?

The coordination of a home safety assessment and continuous care services may be critical in ensuring that your return home is as seamless and safe as possible.

2. Do I need any kind of care after my hospital stay?

If you have not walked following your hospitalization or if you are still feeling weak and think, “Am I strong enough to go home?” this is a warning indicator that you may require home health care after your hospitalization. Despite the fact that you may look awake and robust in the hospital, your medical team must determine if you require transition care and at-home care services after discharge. The importance of communication and collaboration between the hospital and the family or the next facility cannot be overstated.

  • Will you require home healthcare to assist you with a medical condition or doctor-directed therapy at any point?
  • Your medical team will review the activities you can participate in while in the hospital to guarantee that you will be able to participate in similar activities at home.
  • Is it possible for you to go into and out of the bathroom and shower?
  • If you have chronic obstructive pulmonary disease (COPD), your doctor may recommend that you be placed on oxygen therapy.

Your level of activity may decrease, and you may become fatigued when performing specific tasks. The medical personnel will take note of how you move around in the hospital and determine whether or not you require home health care services.

3. What medications should I take, and what medication schedule should I follow at home?

Many questions arise when it comes to medications, and they should. One of the most critical phases in the rehabilitation process is to properly manage your medicines. Before you leave the hospital, your medical staff should present you with a documented list of all of the drugs you are taking. Please make certain that you have supplied a complete list of all drugs, including prescription and over the counter medications, that you have been taking up to the time of your hospitalization. In the event that any of your existing drugs need be discontinued or modified, your doctors will notify you.

  • What is the schedule for my medication?
  • Was it determined whether the prescriptions had been called into the pharmacy?
  • When is my next dosage scheduled?
  • The fact that pharmaceuticals might look the same or have names that sound the same means that it is easy to accidentally take the wrong prescription once the medications have been removed from their bottles.
  • Regarding new medicine prescriptions, discuss with your doctors whether you should stop taking them after they run out or if you should continue taking them continuously.

4. What activities am I allowed to do or what activities should I avoid?

Nurses and discharge planners may examine your capacity to walk and any progress you have made with physical or occupational therapy a few days before you are scheduled to be discharged from the hospital. For example, can you safely mount the steps to your home or the stairs inside your home? Is it possible for you to get into and out of the bathtub at home? What measures may be taken to reduce the risk of falling? Are you able to prepare your own meals? Is it possible for you to reach to wash and dry your back?

Do you require support with any other aspects of your everyday life as well?

5.Do I have any dietary restrictions or nutritional requirements?

Because of your hospitalization, you may not have been consuming solid food for a few days. If this is the case, you should consult your doctor. Before leaving the hospital, you should discuss with your medical staff the type of diet that will be most beneficial to your recovery or the diagnosis of a disease. In the event that you have any new or changing dietary requirements, what are they, and how can you ensure that your home-cooked meals meet these requirements? Some patients suffer from congestive heart failure, and they must limit their salt consumption.

Others are on dialysis and require a renal diet to maintain their health. Other than knowing what foods and fluids to take, it is critical to appropriately assess your abilities to purchase and prepare meals and snacks on your own in order to evaluate whether or not you will want assistance.

6. What medical equipment will I need at home?

A person’s strength diminishes by one day for every day that they are admitted to the hospital, according to legend. If you have been bedridden for several weeks, it may take some time for you to rebuild your strength at home. Do you think you’ll need a cane, a walker, or a wheelchair? Have you put these assistive technologies through their paces in a medical setting? Do you understand how to use a nebulizer or infusion tube if you are sent home with one? Do you know how to keep the equipment clean to avoid infection?

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7.Do I have follow-up medical appointments, and when are those?

It’s critical to know what follow-up appointments will be required before you leave the hospital and before you return home. It is possible that you may need to see your primary care physician, a new or current specialist, or a physical therapist. Recognize whether or not appointments have already been booked, and whether or not you will be required to organize the appointments. Make a note of the name and phone number of any doctors who will be responsible for your follow-up treatment.

8. What resources are available to me to help with my care at home?

Consult with the hospital’s discharge planner or social worker to learn about any supports that may be available to assist you in your recovery at home. Area Agencies on Aging, Meals on Wheels, Right at Home, and the Supplemental Nutrition Assistance Program are just a few of the programs available (SNAP, formerly known as food stamps). Medicare.govis a useful resource for comparing services provided by different local care providers.

9. Will I be hearing from anybody else from the hospital, and when would I expect to hear from them?

Many hospitals provide patients with a patient navigator to assist them with the move back to their homes. In addition, hospitals call patients after they have been discharged to see how they are doing. If you do not generally answer the phone when a caller ID is unknown, it is beneficial to inquire with the hospital about when they may be calling. In the course of your rehabilitation and general health, it is critical that you communicate with your medical team during the care transition process.

10. What red flags or changes in my condition should I watch for?

Inquire with your medical team about what you may expect throughout your recuperation period. While every patient is unique, your physicians should be able to give you a sense of how long your recovery will take and whether or not there will be any significant milestones along the way. It’s critical to understand what you should be searching for when you return home before you go. What are some signals that your recuperation is progressing smoothly? Are there any indications or symptoms that may suggest that you require extra medical care?

Beth Lueders is an award-winning journalist who has covered stories in almost 20 countries. She is also an author, writer, and speaker who regularly reports on a wide range of themes, including aging and health challenges, for both domestic and international businesses.

How My Dad’s Early Discharge From Rehab Taught Me a Lesson

Inform yourself on what to expect from your medical team during your recuperation. Your doctors should be able to provide you with an estimate of the length of your recovery as well as any milestones along the route, even if every patient is different. Understanding what you should be searching for when you return home is critical before you leave for the airport. Is there any evidence that your healing is progressing smoothly? Are there any indications or symptoms that may suggest that you require extra medical treatment right now?

Beth Lueders is an award-winning journalist who has covered stories in almost 20 countries.

  1. Inquire with your medical team about what to expect during your recovery. While every patient is unique, your doctors should be able to provide you with an estimate of how long your recovery will take and any milestones you may expect along the way. It’s critical to understand what you should be searching for before returning home. What are some of the signals that your recuperation is doing well? Exist any indications or symptoms that suggest you require more medical attention? What symptoms should prompt a trip to the emergency department, and which symptoms may be handled with a doctor over the phone? Beth Lueders is an award-winning journalist who has chronicled tales in almost 20 nations. She is also an author, writer, and speaker who regularly reports on a wide range of themes, including aging and health challenges, for both domestic and international businesses.

The nursing home administrator swiftly changed her mind about discharging my father after I pointed out that he had not received a Medicare discontinuance letter and that he had long-term care insurance, as happened in my father’s situation. I was relieved by this conclusion since neither my sisters nor I were certain that Dad was ready to return to the family. This is where I discovered my lesson. Imagine my astonishment when I discovered that my father had a different point of view. He needed to return home as soon as possible, and he was entirely on board with the discharge plan that the nursing home had originally given to him.

  1. When my sisters and I discovered what our father intended, we backed up and adjusted our path to arrange for home care for our father instead.
  2. Yet, it is restricted in scope and frequently requires private payment for a home care help from an agency; however, it is still worthwhile to pursue.
  3. It may be difficult to respect the autonomy of an elderly parent, especially when you believe you know what is best for them.
  4. Put your own preconceptions and anxieties aside, and genuinely listen to what they are trying to tell you about what they want in order to be successful in this endeavor.

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What questions should Medicare patients ask before they’re discharged from the hospital?

Readmission to the hospital within 30 – 90 days of being discharged is a problem that Medicare and hospitals have been attempting to resolve for some years. There are initiatives in place by the federal government that aim to minimize the occurrence of readmissions for patients with a variety of serious medical diseases, and the results show that these programs are having a positive impact. Readmissions can be caused by a lack of coordination and communication, thus it is critical that patients and their family supporters take the initiative and ask the proper questions.

  • Is it possible for me to qualify for inpatient nursing and rehabilitation services? While most individuals are ready to return home, elderly patients, in particular, may benefit from the supportive atmosphere provided by round-the-clock nursing care and daily rehabilitation until they are able to return to their homes more completely after their hospitalization. In addition, inquire about hospital-based rehabilitation programs if applicable. Days spent in such programs are typically counted as “hospital days” rather than “skilled nursing days” under Medicare, which may allow for more lengthy rehabilitation and recovery, which may be particularly beneficial for specific diseases in particular. You may be eligible for Medicare coverage for rehab at a skilled nursing facility after being discharged from the hospital, assuming you’ve had at least a three-day inpatient stay. If your doctor determines that you require this level of care (as opposed to returning home and completing follow-up physical and occupational therapy on an outpatient basis), you may be eligible for Medicare coverage for rehab at a skilled nursing facility.
  • Inpatient nursing and rehabilitation treatments are available to me if I meet the eligibility requirements. While most individuals are eager to return home, elderly patients, in particular, may benefit from the supportive atmosphere provided by round-the-clock nursing care and daily treatment until they are able to return to their homes more completely after their surgeries. Investigate, as well, the availability of rehabilitation programs in hospitals. Days spent in such programs are typically counted as “hospital days” rather than “skilled nursing days” under Medicare, which may allow for more lengthy rehabilitation and recovery, which may be particularly beneficial for certain ailments in specific situations. In the event that you are discharged from the hospital after having spent at least three days in an inpatient setting, and if your doctor determines that you require a higher level of care (as opposed to returning home and completing follow-up physical/occupational therapy on an outpatient basis), you may be eligible for Medicare coverage for rehabilitation at a skilled nursing facility.
  • When it comes to day-to-day tasks, what is my present functional level and in what areas would I want more in-home support during my initial stay at home
  • When and how will I be given discharge instructions is still up in the air. Insist on brief but complete discharge instructions written in layman’s terms, as well as an opportunity for a spoken explanation. Preferably, make arrangements for a professional patient advocate or a family caregiver to be there while these instructions are being given to you. Make certain that the information gleaned from your hospitalization is shared with your primary care physician and other healthcare professionals. If you have any follow-up visits, bring your updated medication list with you.
  • What are the “red flags” that I should be looking out for, as well as the symptoms that I should be keeping an eye out for? What should I do and who should I call if I become aware of a problem or a change

Please read the following articles for further information: Checklist for a Safe Discharge from the Hospital, Tips for a Better Hospital Stay, and Tips for a Safe Return from the Hospital. If you fear you are being discharged too soon and do not have the necessary assistance to care for yourself, speak with your doctor or discharge planner about your choices before leaving the hospital. You have the right to file an appeal against the decision to dismiss you from your duties. Aaging Wisely, LLC is a complete care management firm, and EasyLiving, Inc.

Shannon Martin is the Director of Communications for Aaging Wisely, LLC and EasyLiving, Inc.

7 Questions to Ask at Discharge: Leaving the Hospital After Stroke or Brain Injury

Treatment that is constant | September 28, 2015 |Traumatic brain injury,Stroke The process of getting out of the hospital may be just as frightening as the process of getting into the hospital. Listed here are the questions you should ask yourself or a loved one as you or they prepare to return home following a neurologic incident such as a brain damage or stroke. Entering the hospital, whether by ambulance or as a result of a routine planned hospitalization, is a frightening experience. Hospitals are frequently thought of as locations where the critically ill go to be treated, and as places of last resort.

Returning home or to another, less-equipped institution, where physicians and nurses may not just a second’s buzz away, becomes a horrifying prospect.

Regardless of your emotions as you prepare to take the major step of leaving those crowded and doctor-filled halls, knowledge and preparation can often make any type of transition easier emotionally – and they can certainly assist you and your loved one in developing the most appropriate immediate and long-term plan!

This individual comes from a medical background and is well-versed in the ins and outs of entering and exiting a hospital.

As a resource, social workers may be invaluable since they have all of the necessary community connections as well as knowledge of who and where to turn for help.

Getting Ready for Discharge – Questions to Ask

  1. What am I doing here? Is it the best option for my unique situation and medical condition? Going home is, without a doubt, the preferred option for everyone concerned, but it is not always the best one. Whether you should stay or go depends on the severity of your ailment, as well as the sorts of help you will be able to get at home. What prescriptions should I expect to take, how often should I expect to take them, and in what way should I expect to take them are all questions I have. Are there any negative side effects to be aware of
  2. What are the signals that I should return to the hospital and what should I do if I see any of them? What sorts of therapy should I continue and follow up on and what should I avoid doing so? What is speech therapy? What about physical therapy? What exactly is occupational therapy? Counseling for mental health issues? Continuous therapy would be advantageous for me, would it not? At what point should I make an appointment with my doctor? What physicians do I need to see and when do I need to see them
  3. Do I require any specific equipment, such as braces or supports? If you have any worries about accessing various aspects of your home, such as stairs, restrooms, kitchen appliances, and so on, make an appointment with an occupational therapist and/or physical therapist. Do you have any recommendations for resources that I might use? Is there anything I should consider changing regarding my insurance policy, or something I might consider participating in a community group?

Always keep in mind that you are not alone in this struggle! You are now a member of a group of people who have communicationcognitive issues. Whether you have had a stroke, a brain injury, many concussions, or are now discovering that dementia is affecting you, you are not alone in your struggles. Make contact with others in your neighborhood and on the internet to discover support groups.

Senior Rehab Centers: Care After a Hospital Stay

Did you know that families have a variety of alternatives when it comes to choose where to send their elderly loved ones for rehabilitation after they’ve been discharged from the hospital? Learn about the various alternatives available to help your loved one get better as quickly and securely as possible, ranging from skilled nursing facilities that provide 24-hour care to rehabilitation treatments that may be completed at home or in an assisted living facility.

What is a rehabilitation center for seniors?

Pain management and function improvement are the goals of senior rehabilitation clinics, which are meant to assist seniors recuperating from an injury or major medical incident. Senior rehabilitation institutions frequently provide services such as:

  • Physical therapy can aid in the improvement of mobility, balance, and flexibility, as well as the development in strength and the management of pain. To aid with activities of daily living (ADLs), the use of adapted equipment, or fine motor skills, occupational therapy is prescribed. Attention deficit hyperactivity disorder (ADHD) speech therapy to assist with disorders that impair speaking, swallowing, or cognitive functions, such as attention or memory issues

Inpatient and outpatient rehabilitation services for the elderly

Inpatient and outpatient services for seniors may be available at senior rehabilitation centers. If your loved one need round-the-clock care and ongoing monitoring, inpatient rehabilitation may be the best option for them. Inpatient rehabilitation necessitates the hospitalization of patients suffering from a traumatic accident, debilitating disease, or significant surgery for an extended length of time. When choosing this sort of rehabilitation, you may expect extensive treatment that may involve daily physical, occupational, or speech therapy.

Physical, occupational, and speech therapy are all available as part of outpatient rehabilitation.

Short-term vs. long-term rehabilitation for elderly patients

A number of elder rehab facilities provide both short- and long-term inpatient rehabilitation choices. The level of rehabilitation required by your loved one will be determined by their health. Suppose your parent has a minor operation and only requires a brief stay at a senior rehabilitation center. Chronic, significant diseases, such as heart disease or a stroke, may necessitate many months of rehabilitation in a skilled nursing facility that provides care around the clock, seven days a week.

You and your parent can determine whether a skilled nursing facility or another type of rehabilitation is the most safest place for your parent to meet his or her rehabilitation objectives.

Choosing a senior rehabilitation location after hospitalization

Senior rehabilitation can take place in a number of different environments.

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Senior rehab therapy at skilled nursing facilities

In addition to providing 24-hour nursing care and professional medical care, skilled nursing institutions (sometimes known as rehab hospitals) also provide short-term accommodation and rehabilitation services for persons who require such services. These inpatient treatment centers are often equipped with hospital beds and communal rooms, giving them a clinical atmosphere. In many cases, meals are provided, as well as dietary counseling and social services.Approved skilled nursing facilities may be covered by Medicare if your loved one enters the facility within 30 days of a hospital stay that lasted at least three days.If your loved one is affected by COVID-19, or is unable to stay at home during the coronavirus pandemic, they may be able to get Medicare coverage for a skilled nursing facility without first completing a qualifying hospital stay.

In-home rehab for elderly after a hospital stay

Some elder rehabilitation services can be provided in the comfort of the patient’s own home by home health organizations. Medicare or insurance companies cover the cost of home health services. Licensed medical professionals who visit to the house to do a specific duty that has been prescribed by a physician are known as home health care providers. These responsibilities may include things like keeping track of a patient’s health, giving injections, caring for wounds, and establishing a strength training and physical therapy exercise program.

That is, when the therapist is not there, seniors who get these services must be encouraged to continue their rehabilitation program on their own.

Seniors who receive assistance and socializing are more likely to have the extra drive they require during their recovery.

Talk with a Senior Living Advisor

Every year, our experts assist more than 300,000 families in finding the best elder care for their loved ones.

Elderly rehabilitation at assisted living communities

Many individuals are unaware that rehabilitation may also be accomplished in assisted living facilities, which are becoming increasingly popular. Home health experts can provide particular treatments and nursing services that are covered by Medicare, just as they do at home, with the added benefit of 24-hour help from the staff of the assisted living facility. Many assisted living organizations feature a physical therapy and occupational therapy space in their facility, allowing residents to take advantage of high-tech equipment on a regular basis.

A respite stay at an assisted living facility may also be an excellent alternative for your loved one who has finished treatment but is not yet ready to return home on his or her own.

The peace of mind knowing someone is there for assistance and rapid reaction to situations 24 hours a day may be quite beneficial for older citizens.

Questions to ask about your hospital discharge plan

Before you take your loved one home from the hospital, ask their doctor the following questions to aid in determining their recovery options:

  • What kinds of therapy will my parent need
  • What medical services will be covered by health insurance or Medicare
  • Will my parent require assistance with dressing or bathing
  • Will my loved one require assistance with cooking and cleaning
  • And so on. Would my loved one be secure at home once they are discharged, or will someone need to be with them 24 hours a day, seven days a week? In general, how long does it take for someone to recover? What kinds of difficulties, symptoms, and side effects should we be on the lookout for
  • When it comes to any probable negative effects or issues, what should we do
  • What each medication accomplishes and why it is required are explained in detail. The prescription doses and adverse effects are discussed in detail. Identifying who to contact if we have issues concerning medical equipment, such as oxygen or walking aids

Making the transition from hospital to rehab or home – Best of Care

Kevin Smith contributed to this article. It is 40 years after your mother’s death that she has a stroke in the home that she and your father have lived for the last 40 years. You make your way to the hospital. Mom looks to be in poor health. Her speech is garbled and slurred. She’s having a hard time getting her arms to move. Despite this, she appears to be in excellent spirits. You’re grateful that your father dialed 911, that the ambulance arrived fast, and that the stroke was discovered and treated swiftly.

  1. Mom is to be discharged from the hospital to a rehabilitation center in three days, according to the care manager.
  2. What used to be a routine part of mom’s day — showering, cleaning, cooking, running errands, moving around the house, walking the dog – has suddenly become difficult for her to accomplish.
  3. But where do you even begin?
  4. For more than three decades, our home care organization has provided guidance to hundreds of families dealing with similar challenges.
  5. Here is a concise primer on the kind of questions to ask and concerns to consider while assisting your loved one in making the transition from a clinical setting back to their own home environment.
  • Kevin Smith contributed to this report. It is 40 years after your mother’s death that she has a stroke in the home that she and your father have lived for the last four decades. You have to get to the hospital as quickly as possible. Mom seems to be in poor health. A slur may be heard in her voice. Getting her arms to move is a struggle for her. Despite this, she appears to be in a cheerful mood. You’re grateful that your father dialed 911, that the ambulance arrived fast, and that the stroke was discovered and treated immediately. Your anticipation for what will happen next is, nonetheless, palpable. Mum will be transferred to a rehabilitation facility within three days, according to the hospital’s care manager. Her journey will take her back to her father’s house, who has also gotten more ill. All of the activities that were formerly a routine part of mom’s day — showering, cleaning, cooking, doing errands, moving around the house, walking the dog – have suddenly become impossible. You are well aware that in order for mom and dad to be able to continue in their home and age in place, significant modifications will need to occur. How can I get started, though? The following scenario is played out thousands of times a week in towns all around the United States of America. For more than three decades, our home care organization has provided guidance to hundreds of families on a variety of topics. Our clients’ senior relatives have also benefited from our assistance in coping with newly-limited skills as a result of accident, illness, or chronic illnesses. Here is a concise primer on the kind of questions to ask and concerns to consider while assisting your loved one in making the transition from a clinical setting back to their home environment. As long as your family member is still in the hospital, Inquiries for the hospital’s staff and the primary physician for your loved one include the following:

For the hospital discharge manager or social worker, here are some questions.

  • What are the possibilities for my family member’s rehabilitation facility? Please provide me with more than one. In the event that Mom is returning home for rehabilitation, what do I need to be aware of and do as a family caregiver? In the alternative, if she will first go to rehab and then to her house, what are my choices for obtaining home health care assistance?

Prior to your loved one being admitted to a rehabilitation program,

  • Examine the rehab facility’s quality and reputation to make an informed decision. Do they have accreditation from the state and the federal government? In terms of both positive results and bad incidents, what is their track record like? If feasible, take a tour of the facility and visit with the management and staff. Try to speak with family members of patients who are presently getting care at the institution, if at all feasible.

The transition from the hospital to rehabilitation

  • Make an appointment with your loved one and discuss their transition from the hospital to the rehabilitation facility. Assemble a few easily-transportable things of comfort from their house (a favorite blanket, book, tiny family photographs, and so on) and bring them to their room at the rehabilitation center

Following your loved one’s admission to treatment,

  • Communicate with your primary clinical contact at the rehabilitation center on a daily basis to keep track of your loved one’s development and to stay informed about the estimated timetable for discharge. Collaborate with your loved one’s family to pay as many visits to their rehabilitation facility as feasible in order to assess both their development and the quality of treatment they are getting. At each visit, make an effort to speak with the rehab facility’s attending physicians, physical, occupational, and speech therapists, and floor nurses. As soon as your loved one is admitted to a rehabilitation center, begin examining home care service choices for him or her. Identify and interview prospective home care agencies to evaluate whether they are a good “match” for your needs. Upon discharge from a rehabilitation center, your loved one’s physician will need to do a medical evaluation to identify their in-home care requirements based on the activities of daily living, or ADLs, that will need to be assisted
  • Following the doctor’s requirements evaluation, collaborate with the home care service you choose to design a plan of care for your loved one that includes the following components: What services will be offered, who will deliver them, and how often will they be supplied? What fraction of in-home care may be supported by government programs and subsidies? What financial resources does the family have to pay for these charges – what will be the out-of-pocket costs? Create a care plan and timetable based on the information you’ve gathered. Meet with the home care staff that will be allocated to your loved one in advance to discuss their needs. It is possible that your loved one’s care team will comprise a combination of clinical (nurses, certified nursing assistants (CNAs), home health aides), non-clinical (homemakers and companions), and supervisory staff, depending on his or her specific requirements.

What portion of my loved one’s rehabilitation stay is covered by Medicare? Unless there are extenuating circumstances, Medicare does not normally fund long-term care at a rehab center unless it is medically necessary. For a comprehensive overview of Medicare coverage in skilled nursing facilities, please visit this page. Prior to being able to get Medicare coverage for treatment in a skilled nursing or rehabilitation facility, Medicare enrollees must be admitted to the hospital for a minimum of three nights and have a doctor’s order.

If the patient has returned to a level of mobility and health that is comparable to their ‘baseline’ health state prior to the event that brought them to the hospital, Medicare will normally no longer fund skilled nursing or rehabilitation services provided within the institution.

The following options are available to families whose loved ones’ short-term Medicare benefits are about to expire:

  • Consult with a doctor and submit an application for an extension of Medicare coverage. Out-of-pocket expenses for additional nursing/rehabilitation facility care Alternatively, ensure that competent home care services are in place prior to the loved one returning home.

After a long journey, I have arrived at my destination. It is never simple to come to terms with one’s “new normal” of reduced mobility and daily living requirements in one’s own house. Bring a “stranger” in to give home care might impose additional burden on both the elderly loved one and her family (at least initially). Here are some suggestions on how you might assist with the transition:

  • Check to see whether the professional caregiver is a suitable match for your loved one before hiring them. Obviously, the home care service has major duty in this regard. Work with the home care organization to determine the level of safety in your loved one’s residence. Pick out the high-risk spots: loose-fitting carpets, floor transitions from one room to another, the security of bars and railings, sitting patterns, and access to the kitchen and bathroom. To increase access and safety, contact home remodeling professionals to install ramps, railings, and other supporting structures, expand doors, or rearrange the layout of sink, toilet, and tub fixtures as needed. You might want to consider installing home security and remote monitoring systems that will allow you to communicate with your loved one through video connection or a smartphone application. Cooperate with the caregivers who have been appointed by the home care service to provide care for your loved one. Inform them about your loved one’s preferences and dislikes (in terms of food, home care, entertainment, and so on)
  • Plan a get-to-know-you meeting in the hospital or rehab facility before your loved one returns home
  • This will allow the caregivers to get to know each other. Insist on having the caregiver there in the home when your loved one returns from the hospital or rehabilitation
  • Plan to spend time with your loved one after work or on weekends so that you may be with her caregiver. Listen to both of them separately to get a sense of how the connection is developing

Lastly, some recommendations Moving a loved one from the hospital, through rehabilitation, and into home care may be incredibly difficult, especially if his or her health, mobility, and mental condition have all deteriorated significantly over the process. Keep the following in mind during the process:

  • Prepare a list of questions in advance of each meeting. There are no bad or foolish questions
  • There are only good questions. Anticipate and plan for the next phase of your loved one’s care far in advance of when you actually reach that stage. Keep a notepad and jot down notes from your interactions with physicians, discharge specialists, rehabilitation specialists, and the home care personnel you employ. Pay close attention to both your loved one and their carer to ensure that they are a good match
  • Allow yourself the permission to take time for yourself – to relax and replenish your batteries. Your older relative, as well as your entire family, will profit.

Kevin Smith is the President and Chief Operating Officer of Best of Care, Inc., which has offices in Quincy, Raynham, New Bedford, and South Dennis, Massachusetts, and services the Greater Boston, South Shore, South Coast, and Cape Cod regions. Personal care services, homemakers and companions, hospice care, nursing care management, and speciality services related to dementia and acquired brain injury care are all available through Best of Care’s concierge-level services. In 2014, the Family Business Association of Massachusetts selected Best of Care Inc.

President of the Massachusetts Council for Home Care Aides, Smith is also a member of the Executive Committee and the Board of Directors.

We invite you to follow Best of Care on Twitter at @BestofCare and to like us on Facebook at

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