Topic Overview

What is discharge planning?

Discharge planning helps to make sure that you leave the hospital safely and smoothly and get the right care after that.

You, the person who is caring for you, and your discharge planner work together to address your concerns in a discharge plan. Whether you go home, to a relative’s home, to a rehabilitation facility, or to another health care setting, your plan outlines the care you need.

A day or two before you expect to leave the hospital, ask to meet with your discharge planner.

Your discharge planner can tell you why you are going home or to another health care setting and why your care is changing. You will work together on:

• What care and services you may need after you leave. This can include nursing, physical therapy, occupational therapy, or speech therapy. An agency may set up a program to check your blood pressure, pulse, oxygen saturation, or weight.
• What equipment you may need, such as a walker or oxygen.
• Whether or not you can get care at your home. You may need to go to another health care setting, such as a skilled nursing facility, a rehabilitation hospital, or an assisted living facility. Or family or friends may stay with you at your home, or you may stay with them.
• How to best move you from the hospital to your home or to another health care setting.

Write down any questions you have about what will happen when you get home, what your family can do to help, or who’s going to pay for your care.

To help you plan what you’ll need after leaving the hospital, use this hospital discharge checklist.

What if you don’t feel ready to leave?

Why would your doctor say you’re ready to go home when you may not feel ready?

Talk to your doctor about your worries. Even though you don’t feel strong enough to go home, your doctor can explain why it’s important for you to go home or go to another health care setting.

If you’re really not comfortable with your doctor’s recommendation that you go home, ask for help from the hospital’s patient advocate.

What if you’re going to another health care setting?

If you have been living in another health care setting—for example, a nursing home or a rehabilitation hospital—you’ll have to talk with someone about leaving for your hospital stay and then coming back afterward. Find out what you’ll have to do to get the same bed and room, and ask about any costs.

If you have been living at home but will need to go to another setting when you leave the hospital, the discharge planner can give you a list of options. You, a family member, or a friend will have to call around to see which one you prefer. Things to think about when choosing another setting include:

• How you’ll receive your prescriptions, such as on-site or by mail order or delivery.
• If there are any problems with using any medical equipment.
• How easy it is for your family or caregiver to get to it and visit you.

What if you’re going home?

Before you leave the hospital, talk to your nurse or other hospital staff about things you’ll have to do at home. Get information in writing about:

• Your medicines. Get a list of medicines and how you take them. Have your doctor highlight any new medicines or medicines that need to be stopped or changed since before your hospital stay.
• When you need to see the doctor again and any follow-up tests you need.
• How and when to change bandages and dressings.
• How active you can be. This may include fall precautions and physical therapy.
• What you can and can’t eat.
• Whether you need any special equipment or supplies, such as a walker or oxygen.
• What to do if you have questions or if there is an emergency.

It’s easy to think you can do everything, but it can be hard. If you feel you or your caregiver won’t or can’t do certain tasks, say so. Try to make other arrangements.

Staying healthy

After you leave the hospital, the best way to benefit from your treatment is to take good care of yourself. Remember that you are the most important member of your health care team.

Follow your doctor’s instructions, which may include things like taking medicines as prescribed, getting needed exercise, or knowing how to take care of an incision from surgery.

Taking good care of yourself after you get back home is the best way to avoid a return trip to the hospital.