How To Avoid Being Blind Sided By Rehab Staff on Discharge

There is no adequate way to explain to my clients why rehab/skilled nursing facilities staff do not communicate with them.  It seems to be endemic throughout the country.  There are many reasons why communication is essential for the family, foremost being the need to know if discharge is imminent. I tell my clients to be vigilant and constantly track people down in the facility to ask questions about the progress of the family member.  People need real time information on progress.

I like to arrange a case conference with the players at least a 10-14 days after the  admission.  A conference will bring most of the players to the table including medical, nursing, social work/case management and rehab services.  The idea is that each discipline will offer an update on  progress.  Short and long term goals can be addressed.  Information is so important to families in understanding what is happening to their loved one.  A conference can be a time for explanation of treatments and a time for families to air any concerns.

I encourage families to have a list of questions prior to the meeting.  One of my clients organized a list, made copies and handed it to everyone.  It was one of the most productive meetings I have been to because the staff team felt obligated to address the concerns.  Much more information was shared, new medical orders were put in place and increased rehab was begun.  I recommend this appoarch to everyone now.

I  tell clients that if they are approached by the case manager about having a case conference or sometimes known as a family meeting, it usually indicates a discharge date is going to be given.  Unfortunately, if this is the case, then it also means the date is probably soon.  These case conferences can be stressful and unpleasant.  The typical line is, the patient has plateaued and insurance will not pay for supervision.

I have been in situations where I have been told on Monday, discharge was not happening for at least several weeks.  On friday when I asked again, I was told the following Monday was the new plan.  Not once in this situation, did the facility ask if the home was safe or had the necessary disabled accessibility.  That is why I tell my clients to start thinking what changes to the home will be necessary or if the home is safe early on in treatment.  Discharge happens very fast and usually leaves little time for major home changes.

The facility can not discharge someone to an unsafe situation.  However, the pressure from the facility to discharge will be relentless.  There will be the constant threat of having to pay out of pocket if the insurance stops paying.  I don’t understand why rehab/skilled nursing facilities are so blind to the stress created by not communicating and suddenly announcing a discharge date.  It is the job of the staff to be aware of the progress of a patient and cognizant of the nearing of goals. Why not communicate this to families?

I can say there are two constants relevant to all facilities.  Discharge dates come on suddenly and communication is poor. I think facilities staff believe they are providing information if you ask.  The problem is, you first have to find the person to ask.  It is not an easy task.