Dysfunctional Discharge Dance
It has been a week since Dad was admitted into the hospital by way of the Emergency Room, and he’s made great strides. Today is his release date. I’m excited and have prepared everyone for his arrival: staff on his Memory Care floor as well as the sitter hired a month into COVID. Little did I know of the wide-ranging complications awaiting us.
The hospital endocrinologist determined that Dad needed to continue insulin injections post-release. Realizing Dad lived in a facility, she prescribed only one morning insulin shot supplemented by oral medications. Sliding scale injections, like those done in the hospital, were not needed. This seemed reasonable and simple enough. Not so fast….
Finding someone to administer the insulin injections would prove much more difficult than it sounds. Two days prior to discharge, the hospital discharge nurse began searching for a home health company that could follow the discharge orders. Every home health group stated it could provide occupational and physical therapy, but would not administer daily pre-breakfast insulin injections. The hospital team expected Dad’s Memory Care Unit to administer the injections.
The Memory Care Unit had a different idea and requirements. Per their protocol, insulin injections had to be self-administered or administered by a nurse. Dad has dementia, so is not a good self-administer candidate. “Self” administering did not include family members administering on Dad’s behalf. Our only alternative was to find a nurse. I decided to ask my friend, who is a licensed nurse, to help for the next few weeks. Whew! I’d found the solution.
I called the hospital discharge nurse and informed her that I’d solved our problem; my nurse friend had agreed to administer morning insulin injections for the next few weeks. The discharge nurse called Dad’s facility and the home health group to confirm all bases were covered. That’s when we discovered the other set of applicable rules.
The home health care company’s protocol only allowed staff to teach residents or their families to administer insulin injections. The company Dysfunctional Discharge Dance would not accept responsibility for an independent nurse doing so. Since the discharge order included injections and therapy, the home health company would be responsible for everything, including the nurse’s activities and that was unacceptable. Translation - bringing my friend into the equation was a non-starter. We were empty handed again.
This happened several times before I realized I had to do something to break this cycle. The home health company’s rules were inconsistent with the facility’s guidelines, which left us without a solution that allowed Dad to go home. The hospital discharge nurse would not release Dad until she was confident someone had accepted responsibility for providing all services detailed in the discharge plan.
This process continued for several days. Ultimately one of the home health companies agreed to assume responsibility for daily insulin injections along with the more desirable occupational and physical therapy services. This was the first real solution and it didn’t arrive until nearly a week after Dad’s original discharge date. Then Dad could be – and WAS – discharged.
GOLDEN NUGGETS:
Determine your loved one’s continuing care requirements early to resolve any care questions before discharge day.
Learn and understand the breadth and depth of services provided by your loved one’s facility. Understand the scope of home health services, especially Medicare- imposed limitations.
Recognize hospital staff’s role in ensuring discharged patients receive required post-hospital care. Unless home health or your loved one’s facility assumes responsibility for therapy and other ordered treatment, the hospital will not release your loved one.
Know that hospital staff’s natural disposition is to release senior citizens to skilled nursing facilities for “rehab,” not release them to their homes.
