When you are in the hospital, part of the process is to plan for your release from the facility. It may be that you are released to a rehabilitation hospital, if intensive therapy would benefit your recovery. Or, you may go to a skilled nursing facility, if a lesser level of care is needed. Maybe you will be strong enough to return to the home setting. Whatever is decided for you will be planned at a "discharge planning meeting."



1. What is a "discharge planner"?

There are staff designated as discharge planners at most hospitals. The job of the discharge planner is to plan what is best for you when you leave the hospital. This person coordinates ordering equipment, home health services, outpatient therapy, and many other services. He or she will make sure that the doctor has issued prescription orders for all services you will receive after you leave the hospital. Find out who the discharge planner is so you can direct your questions to the appropriate person.

2. What is a "discharge planning meeting"?

This is a meeting held at the hospital. It is usually attended by the nursing staff, any therapists involved in the patient's care, and sometime by the doctor and the patient's family. At the discharge planning meeting, with input from the medical staff, it is decided if the most appropriate placement will be to a rehabilitation hospital, a skilled nursing facility, home with help from hospice, or home perhaps with help from a caregiver, family member, or friend. This determination is based on the patient's expected rate of recovery, current strength level, and estimate of future nursing needs.

3. How does it get decided where the patient will go after the hospital?

The hospital staff is very skilled at watching the patient's recovery and estimating how much care the patient will need over the coming days and weeks. If the patient is too weak to go home and needs more time in therapy to regain strength, then the recommendation is to be discharged to a rehabilitation hospital. When a patient needs a level of care beyond that which can be provided in the home setting, the release from the hospital will most likely be to a skilled nursing facility. If the patient is going to be able to be safe at home, and is strong enough to get into and out of bed and on/off the toilet safely, then the recommendation is for the patient to return home.

4. Is the patient or family always included in this "discharge planning" process?

No, not always. Sometimes plans are made for you and your family without your knowing or being invited to the discharge planning meeting. Be sure to attend this meeting, or have someone attend as your representative, so that your concerns can be considered.

5. How would I get included in the "discharge planning" meeting? Start by asking the nurse whether the hospital has a discharge planner, and if so, that person's name and phone number. Call that person (or have a family member call), introduce yourself, and ask if there has been a discharge meeting scheduled yet. Ask to be included. If the hospital does not have a designated person to act as the discharge planner, ask someone on the medical staff the name and contact information for the person who will be handling your discharge planning issues so that you can attend that meeting.

By being proactive, and using a bit of the hospital personnel's jargon (e.g., "discharge planner"), you will usually end up receiving more information about your care than you would have had you not begun asking questions and being involved.