Guest Column: Resource center aids discharge decisions

Allows for placement decisions to be made quickly

By Patrice Spath, RHIT
Brown-Spath Associates
Forest Grove, OR

With patients being discharged from the hospital faster and sicker than ever before, case managers as well as patients and their families, must make hurried decisions about post-hospital care. It can be especially stressful when a patient must be discharged to a nursing home or other care setting. The discharge process can be problematic when family members are unfamiliar with the geographic area or various provider options. Families want to do the right thing for their loved one, yet the task of finding an appropriate post-hospital care facility can be daunting.

To help reduce the anxiety inherent in the discharge planning process, some hospitals have developed a resource center for patients and their families. The resource center, housed within the hospital, is stocked with information that can be used to educate patients and their family about available alternatives for longer-term care. Having instant access to this information allows placement decisions to be made quickly as well as more easily. The resource center includes basic information related to location and services, as well as photographs of the nursing homes and other post-hospital care providers in the area. Prepare a notebook of information about each facility. Make sure that information is presented in a uniform manner so that every facility is fairly represented. Patients and their families should be encouraged to make placement decisions based on the facts, not on the style of presentation. To supplement the printed materials, the hospital may wish to offer video presentations of each facility. The presentations, prepared by hospital staff to ensure consistency, provide a visual look at the facility and its surroundings.

Get them connected

If possible, provide families with Internet access so they can view the web sites of facilities that have an Internet presence. Patients and families also should be encouraged to access web sites that contain comparative performance data about nursing homes and other post-hospital care providers.

The Department of Health and Human Services sponsors a web site where consumers can check out performance ratings on skilled nursing facilities participating in the Medicare and Medicaid programs: www.medicare.gov/nhcompare/home.asp. For quality ratings on health care facilities in California, go to: www.healthscope.org. Performance ratings for hospitals, nursing homes, and home health agencies around the country can be found at: www.healthgrades.com. Many state health departments sponsor web sites that provide consumers with performance data on in-state health care providers.

On the wall of the resource center, hang a large map of the surrounding area with the location of each post-hospital care facility clearly marked. Show the distance from the hospital to each facility (in miles). If you include a string or yardstick with a mileage marker, the family can use it to judge the number of miles from their personal residence to the facility. The map and mileage calculation system also helps case managers communicate information to patients and families when recommending a particular facility. Case managers can print out driving instructions to facilities by accessing MapQuest (www.mapquest.com/map) or Yahoo Maps (maps.yahoo.com) on the Internet.

Patients and their families should be encouraged to use the information in the resource center as soon as it is known that a post-hospital facility will be needed. For instance, people could visit the center before an upcoming hospital admission if they are fairly certain that post-hospital care will be necessary. If your hospital has a formalized pre-admission program, a visit to the resource center might be one of the many stops a patient makes during the pre-admission process. The more people know about their post-hospital care options, the better prepared they will be when faced with discharge decisions.

The resource center can be maintained in the case management office, near the admissions office, or in another location that is convenient for the public to access. Ideally, the facility notebooks and other relevant information are portable so that case managers can take the information to a patient’s room when necessary. Often physicians find the information useful in their discussions with patients and families. If demand for the information is high, you may need to create duplicate notebooks and videos and institute a library-style checkout system.

Establishing a post-hospital care resource center is not difficult, but it does take some time. Before proceeding, determine what types of facilities you want to include in the resource center and the geographic region to be represented. If your patients have a choice of home health agencies, as well as post-hospital facilities, consider expanding the resource center to include all post-hospital care options. The resource center also could include detailed information about community support services. Seek out advice from your physicians: What are the common questions they get from patients and families? Try to design a resource
center that will answer these questions.

Once the scope of the resource center is defined, it’s time to gather information. Send a letter to the administrator of all facilities, agencies, and groups to be represented in the center. Describe your goals in developing the resource center and request their participation.

To assure uniformity in the information obtained from the various facilities, ask them to complete a standard questionnaire. If photos are requested, provide the administrators with your requirements, e.g., what you want pictures of and the size/format to be provided. If you plan to create a video program about the post-hospital care provider or agency, let them know how you would like to proceed. (See Questionnaire Part 1 and Part 2

Patients and their families will greatly appreciate having all the information about post-hospital care providers in one convenient location. The information will help everyone get through stressful discharge planning decisions. The resource center materials can reduce the time it takes for patients and families to find appropriate post-hospital care facilities. Case managers will find the resource center also saves them time. . . . It’s not necessary to answer the same questions over and over again for each patient placement. Everyone, including physicians, will be grateful to the hospital for having an extensive source of information about post-hospital care providers.