Sometimes DP has no great options
Experts offer advice on planning
Sometimes health care professionals involved in the hospital discharge process have no great options for transitioning patients, particularly when the patient is undocumented and/or uninsured.
This is why hospital discharge planners should come up with a plan that includes all available options for handling such unfortunate cases, well before this sort of case occurs on their turf.
For instance, hospitals in rural and remote areas where there are fewer charitable health care institutions or group homes that might take over the care of an indigent, uninsured patient, could seek help from an organization outside their immediate area. But hospital discharge planners would need to develop relationships with these outside organizations well before the ties are essential.
"I don't envy discharge planners in their efforts to find alternatives," says Linda S. Quick, president of the South Florida Hospital & Healthcare Association of Hollywood, FL.
Another key strategy is to have early and multiple conversations with the patient's family or guardian about their expectations and the reality of what is available for discharge, Quick says.
"I think ideally you have to start having a conversation with the patient as soon as they're competent to have that conversation," Quick says. "Or, from the get-go, speak with the patient's family, friends, neighbors, and anyone who appears to have a relationship with the patient."
Hospital discharge planners should explain that the hospital is ill-suited to be a residential facility, so an acceptable discharge plan should be made, Quick adds.
Health care professionals should keep at least these three things in mind as they prepare for a discharge of an undocumented and/or uninsured patient, Dwyer says:
1. The patient's safety: "Is this a safe discharge plan?" Dwyer says. "Sometimes hospitals are deceiving themselves and will arrange a repatriation of a patient, saying they're sending this person to the rehabilitation hospital in Guatemala, but the truth is they know the patient will be there only a couple of weeks, and then that hospital will discharge the patient to the family."
Everyone involved in the discharge process should ask a series of critical questions regarding the patient's safety, he adds.
2. Fair share of uncompensated care: "Hospitals should ask themselves whether they are taking on a fair share of this uncompensated care," Dwyer says. "Sure, the hospital has to meet its margin, but they also have to meet their accreditation requirements."
If the current recession forces hospitals to take on too much of the burden of uncompensated care, then it might be time to find a public and political solution, he notes.
Health care reform, which doesn't address care for illegal immigrants, could at least help citizens who are uninsured find health care coverage.
3. Long-term solutions: "I'd also have discharge planners ask themselves whether they're working for a long-term solution to the problem," Dwyer says. "Of course, they have to deal with the immediate case, but when immediate cases are dilemmas for hospitals, it's because the overall solutions are out of whack."
This suggests that a hospital's discharge planning has not been as thorough in anticipating problems as it should be, and more preparation and imagination are needed.
Sometimes health care professionals involved in the hospital discharge process have no great options for transitioning patients, particularly when the patient is undocumented and/or uninsured.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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