Discharge Planning: Preparing to Leave

Article by Evanston Commission on Aging

Things You Should Know When You Are Being Discharged From a Hospital or Health Care Facility

Discharge Planning: Preparing to Leave
Shortly after you are admitted to a hospital, a long-term care facility, or receive treatment in an emergency room, the staff will begin to talk with you about your plans for care after discharge. The staff should discuss with you any recommendations about your care, including the type of care needed, possible sources for this care and the costs of this care, prior to discharge. The facility, or your insurance company, is required to designate a person (a discharge planner) who will help arrange for the services that you need based on your care needs, wishes and financial situation. Instructions for your care should be given to you in writing, along with any prescriptions.

Possible options for care include:

Home Health Care Physician ordered skilled medical or psychiatric care for individuals who are unable to leave their homes, except with great effort or assistance. The services include medical and psychiatric nursing; physical, occupational, and speech therapy; social work; and home health aide services. The cost of services is covered 100% by Medicare. Private insurance and Medicaid may cover all or a portion of the charges of home health care.

Outpatient Rehabilitation Services The services of physical and occupational therapists and speech pathologists which are covered by Medicare or insurance in an outpatient setting when physician ordered and medically necessary. Medicare covers 80% of charges. Private insurance and Medicaid may cover all or some of the charges.

Hospice Supportive services provided in home, hospital and nursing home settings for the terminally ill and their families. To qualify for services, an individual must be diagnosed by a physician to have less than a six-month life expectancy. The cost of services is covered 100% by Medicare. Private insurance and Medicaid may cover all or a portion of the charges of hospice care.

In-Home Caregivers Caregivers who assist with basic care such as bathing, dressing, toileting, meal preparation, shopping and housekeeping within the home. Caregivers may be hired by the care recipient or may be funded by federal and state funds. Private and long-term care insurance may cover some portion of the cost of a caregiver.

Home Delivered Meals Fresh or frozen meals that are delivered to the home. The cost of the meals may be subsidized by federal funds. Most programs require some type of financial contribution on the part of the client.

Adult Day Services Activity based programs that encourage social interaction, physical activity and memory enhancement. Adult day service programs provide supervision, medication reminders, meals and assistance with some aspects of personal care. Program charges may be covered partially or fully by federal and state funds.

Nursing Homes Facilities that provide skilled, intermediate and sheltered levels of nursing care. Medicare may cover the cost of your care on a certified unit, after a three-day hospital stay, if you require skilled care such as physical rehabilitation or intravenous drug therapies. Private insurance or Medicaid may cover part or all of the cost of care. If you do not require care on a skilled unit, you will likely be responsible for the cost of your care at the nursing home. The facility discharge planner is available to answer questions about nursing home costs and options for covering them. If you are being discharged from a hospital to a nursing home you will be pre-screened by a representative from the Choices for Care Program.

Appealing a Discharge
If you feel that you are not ready for discharge, you have a right to appeal this decision. If the facility staff tell you that you are being discharged because your insurance will no longer cover the cost of your care, ask the facility staff for a written explanation or a Notice of Non-Coverage, if you have not already received one. You may request that Medicare or your insurance provider review your situation to decide if you still qualify for insurance coverage in the facility. This special claim is sometimes called a Demand Bill. You are not required to pay the facility bill until Medicare or your insurance company makes a decision about your situation. The Long-Term Care Ombudsman Program can assist you with appealing your discharge if you are in a nursing home or a hospital-based skilled nursing unit.

Information about the community services available in your area can be obtained from the facility discharge planner. Services available in the area include:

Medicare Appeals
Iowa Foundation for Medical Care
800/383-2856 (for hospitals)

Illinois Peer Review Organization
800/647-8089 (for nursing homes)

Information and Referral to Community Services:

Evanston Commission on Aging
847/866-2919

Evanston/Skokie Valley Senior Services
847/864-3721

Metropolitan Family Services
847/328-2404

Suburban Area Agency on Aging
800/699-9043

Long-Term Care Ombudsman Program (Nursing Home Information, Advocacy)
Evanston Commission on Aging
847/866-2963

Transportation
City of Evanston Subsidized Taxicab Program
847/866-2919

PACE-ADA Paratransit Service
312/917-4357 (application)
847/328-9530 (transportation)