Trying to advise a friend on hospital discharge procedures

May 26, 2011 4:13 PM

Asking for a friend re Northern California situation. A friend's close relation was struck by a car while walking in a crosswalk and was seriously injured. She has had several surgeries and will need several more. The family has a personal injury attorney for the claims against the driver. My question on behalf of my friend and her relation is about how to prevent the hospital from discharging her (seemingly) without an appropriate discharge plan.

My friend's relation was seriously injured when she was struck by a car while she was walking in a crosswalk. She was hospitalized for about a week or so -- had a surgery at one hospital, was transferred to hospital number two, had surgery at second hospital.

My friend's concern is that her relative was released while still in great pain, disoriented, unable to care for herself, unable to get out of bed independently, unable to use the bathroom independently, still needing wound care, using a wheelchair with great assistance, unable to negotiate stairs, etc. The relative does not presently qualify for IHSS (California state-supported funds for in-home support services) because she is receiving state disability insurance, putting her over the income requirements. The family has been scrambling to assemble care, and they are wondering if there is a way to get more care out of the medical slash insurance system for the next surgeries.

I've asked around, and the only suggestion I've gotten is to try to convince the treating MD to order physical therapy in a skilled nursing facility or rehabilitation center.

Any additional tips re getting her into a "step down" facility, or thoughts on how to get this type of doctor's order? This person is privately insured, and the hospital is supposed to be state of the art. (But maybe this is just our system, so why am I surprised.)

posted by ClaudiaCenter to health & fitness (9 answers total)

IANAD, IANAL.

Talking to the doctor is the first step, and if she has had those injuries I'd be very surprised if the doctor doesn't order a rehab facility. In the case it didn't happen you will want to talk to the hospital's Patient Advocate. Virtually every hospital has one. The Patient Advocate can make the push for rehab to happen.

Good luck to her.
posted by Mister Fabulous at 4:24 PM on May 26, 2011

I am also not a doctor but had a similar experience with my boyfriend (2 surgeries after a bike accident) also in California. After a week in the hospital they hired an ambulance to drop him at our apartment and EMTs carried him up the stairs. He was in a similar state as your friend's relative-- on heavy drugs, bedbound, requiring wound care, needing bathroom help, etc. Until he could take care of himself I took a month off work and other fabulous MeFites stepped in to help me provide round-the-clock care.

Before he was discharged I spoke with his doctors, the hospital's Patient Advocate, and the social worker several times (well more like "freaked out at" because how the heck was I supposed to help him do the activities of daily life? How can a 140-lb woman lift a 200-lb man out of bed and carry him to the toilet?). They all had sympathy for me and helped us get some other stuff to make our lives easier, like a toilet seat (with bucket for anywhere use), urinals for use in bed, etc.

But he did not meet the "bad enough" criteria to be ordered to a skilled nursing or rehab facility, because 1. while his injuries seemed very severe to me and him, it wasn't according to medical folks; 2. he had a person at home to take care of him. Essentially it seemed that "having an ablebodied adult living with you, regardless of their other duties in life," was a reasonable discharge plan in the minds of the hospital.
posted by holyrood at 4:45 PM on May 26, 2011

IANYD. or L.

I would also suggest talking to the social worker if you get a chance - he/she will be intimately familiar with what will or will not work and can help you to negotiate the system.

Talking to the primary team (i.e. the physicians) will also help. Their goal is to help you to recuperate at home, and prevent an unnecessary trip to the ED or readmission to the hospital - thus making them highly motivated to ensure you are hooked into the right services as an outpatient.
posted by noonday at 4:47 PM on May 26, 2011

This is very very helpful. Any thoughts/reflections on whether filing a complaint via the internal patient advocate type system (which I think I have found) regarding the first discharge experience might help with the future discharges? Or would that make things worse ...? (I appreciate that no one can answer this with total accuracy.)
posted by ClaudiaCenter at 4:57 PM on May 26, 2011

Did the family member have a physical and occupational therapy evaluation yet? Usually this is done to determine whether the patient meets criteria for a short term rehab facility. This resembles the suggestion you've already gotten, and I think this would be more productive than filing a complaint, if the patient has already been discharged. The patient advocate cannot help you arrange rehab, in a hospital that is usually done by the social worker. The patient advocate is there to try to help make patient happier with their care, i.e. offering a sympathetic ear, apologies or assurance that your concerns will be taken into account for the future as they try to improve services.

I'm not sure what you mean by future discharges? You mean for other patients? Or for this same person getting readmitted for some reason?
posted by treehorn+bunny at 5:16 PM on May 26, 2011

Sorry -- same person will be readmitted in about a week for additional surgery at the same hospital. So we're looking at what to do re future discharge from that surgery.
posted by ClaudiaCenter at 5:19 PM on May 26, 2011

Oh, now I see, the person has had surgery and been discharged, but is returning for more surgery. I would stick with my suggestion to ensure that the person gets a PT/OT evaluation. Or just ask the physician how to determine whether the patient meets qualifications for rehab or at least PT/OT on an outpatient basis, even if they don't get to an inpatient rehab facility. If the patient has private insurance it should cover these things if they are recommended, and it sounds like they should be.
posted by treehorn+bunny at 5:21 PM on May 26, 2011

I totally second asking for physical therapy eval & sessions &home/outpatient referral for the second round. the social worker got that going for my situation and the pt folks made me and the bf comfortable with *how* he should relearn to move as well as great advice.

To try for rehab, I'd emphasize that this person does not have inhome care available w/out extreme hardship like a family member quitting a job & moving cross country. I seriously think my bf would have gotten rehab for 1-3 days if he had lived alone/did not have a partner/relatives nearby.
posted by holyrood at 7:48 PM on May 26, 2011

Uh, great advice for the day-to-day. (second ¶, last sentence)
posted by holyrood at 7:57 PM on May 26, 2011