What to ask at a hospital discharge meeting

The meeting is short, and you're the only person in it who will still be dealing with the outcome next month.

Somebody says the word "discharge" and a clock starts. It isn't your clock. It belongs to a hospital managing beds, an insurer with rules about how many days it covers, and a team that has done this a thousand times and will do it again this afternoon.

You'll probably be asked to make decisions about the rest of somebody's life in a corridor, in about twenty minutes, while still absorbing whatever put them in the hospital. What follows is how to spend those twenty minutes.

Who is in the room

Usually some combination of a discharge planner or case manager, a nurse, a social worker, sometimes a physician, sometimes a therapist. Not always all of them, and not always at once.

It helps to know what their job is. A discharge planner arranges a safe destination and the services attached to it. That is a real job and they're usually good at it. It isn't the same job as making sure the arrangement holds up in six weeks, which is your job, and the questions below are the difference.

Before you go in

Four things, none of which takes long.

Bring somebody. Two people in the room hear roughly twice as much. If you can't, ask to put someone on speakerphone.

Bring a pen. You won't remember it. Nobody remembers it.

Write down what home is actually like. Stairs, bathroom on which floor, who else lives there, who is around in the daytime, whether anybody drives. The team is planning for a house they have never seen, using your description of it.

Decide in advance what you can't do. If you can't be there overnight, or can't lift, or can't take six weeks off work, know that before you're asked, because in the room you'll be inclined to say yes.

The questions

What happened, in plain words? Ask for it without the abbreviations. You're allowed to say "can you say that again in the way you would say it to a neighbor."

What is different now from before? This is the question that actually predicts the next month. Not the diagnosis: the change. Can they still get themselves to the bathroom at night. Can they still manage stairs, their own medications, a meal.

What is the plan, and who does each part of it? Every plan has parts that belong to a professional and parts that quietly belong to the family. Ask which is which, out loud, and write the names down.

What does a bad week look like? Ask what would tell you this isn't working. Specific signs, and what to do about each one. This single question is the difference between a readmission and a phone call.

What medications changed? Ask for the full list as it now stands, not the list of changes. People are routinely discharged holding both the old bottle and the new one.

Who do I call, and when? Get one name and number for the first two weeks, and ask what to do outside office hours. "Call the doctor" isn't a plan at nine on a Saturday night.

What is already arranged, and what am I arranging? Equipment, home services, therapy, follow-up appointments. Ask which are booked, which are referrals, and which are suggestions. These three words get used interchangeably and they mean completely different things.

What to ask for on paper

Ask for the discharge summary, the current medication list, and the contact details, before you leave the building. If they can't give it to you yet, ask when and how, and write that down too.

If somebody is being discharged with equipment or a dressing or an injection, ask to be shown once and then to do it yourself while somebody watches. Being told isn't the same as having done it.

If the date feels wrong

Say so, in the room, plainly. "I don't think this is safe yet, and here is why" is a sentence the team is used to hearing and is allowed to act on.

Ask what the process is if you disagree with the discharge date. There is usually a formal one, and for a patient on Medicare the hospital is required to give a written notice explaining how to ask for a review. Ask for it by name and ask for it in writing.

Two things to be clear-eyed about. Pushing back sometimes works and sometimes doesn't. And "not safe yet" is a stronger position when you can name what specifically is unsafe: nobody at home in the daytime, no bathroom on that floor, nobody who can manage the injection.

The question people wish they had asked

"What happens if this doesn't work?"

Almost nobody asks it, because in the room it sounds like planning to fail. It is the opposite. A team that has answered it has given you the next step in advance, and having the next step in advance is what stops the next crisis being another corridor and another twenty minutes.

After

Keep the first evening at home clear, if you possibly can. The first seventy-two hours are when most of the surprises land, and most of them are small and fixable if somebody is there to notice.

Then, within the first week, look at the plan again with fresh eyes. The version agreed in a hospital corridor is a draft written by people who couldn't see the house.

Ask about the second discharge

Most families prepare for one discharge and get two. If your person is going to a transitional care unit or a nursing home for rehabilitation first, that stay has its own clock and its own ending, and the second ending is the one that catches people out because by then the crisis feels over.

Ask, in the first meeting, what the plan is after rehab, who decides when rehab stops, and what happens if the person isn't ready. Ask it early even though it sounds premature. The answer shapes what you should be arranging now rather than in three weeks. If the answer is vague, write down who you asked and when, and ask the same question again at the rehab admission meeting, where a different team owns it.

Take the medication list, and read it at home

Ask for the discharge medication list on paper before you leave, then sit down at home with it and the bottles in the cupboard. Two lists rarely match after a hospital stay: doses change, things get stopped, something new is added under a name nobody recognizes.

You aren't checking the hospital's work. You're catching the gap between what the hospital thinks is being taken and what is actually in the house, which is where most of the trouble after a discharge starts. Anything that doesn't match goes to the pharmacist or the physician, not to a search engine.

If you think the discharge is too soon

You can say so, and with Medicare there's a formal route. A hospital patient on Medicare is given a notice called "An Important Message from Medicare about Your Rights" within two days of admission and again before discharge. If you disagree with the discharge date, that notice tells you how to ask for a fast appeal, which is decided by a Beneficiary and Family Centered Care Quality Improvement Organization.

The timing is strict: the request has to be made no later than the day discharge is scheduled. Meet that deadline and you won't pay for the extra stay while the review happens, apart from any coinsurance or deductible that already applied. Miss it and the appeal still exists, but the bill may follow you.

Frequently asked questions

What does a hospital discharge planner actually do?

They arrange a safe destination and the services attached to it, and they're usually good at it. What they aren't responsible for is whether the arrangement still holds up six weeks later. That part belongs to the family, which is why the questions worth asking are the ones about the weeks after, not the day itself.

Can I refuse a hospital discharge I think is unsafe?

You can ask for a fast appeal. Medicare patients are given a notice called An Important Message from Medicare about Your Rights, which explains how. The request has to be made no later than the day discharge is scheduled, and if you meet that deadline you won't pay for the extra days while a Quality Improvement Organization reviews it, beyond any coinsurance or deductible.

What should I bring to a discharge meeting?

Somebody else, a pen, and a plain description of the house: stairs, which floor the bathroom is on, who else lives there, who is around in the daytime, whether anybody drives. The team is planning for a home they have never seen, using your description of it.

What is a transitional care unit?

A short-term rehabilitation unit, usually inside a nursing home or attached to a hospital, where somebody goes after a hospital stay to regain strength before going home or somewhere else. It has its own discharge, and that second one is the one families are least ready for.

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If this is where you're

If the answer to "who does each part of it" is nobody yet, this is the part we do: care after a hospital stay

Abloom Senior Living runs a small residence in Woodbury, and the nurses and certified caregivers who staff it also work in people's own homes across Saint Paul, Maplewood, Woodbury, Cottage Grove and Stillwater. If you would rather talk to somebody than read another article, tell us about your week and we will read it before we reply. We won't put you on a list.

This article is general information from a care provider. It is not legal, financial, or medical advice. For questions about a specific person's health, medication or safety, talk to their physician.