Discharge Challenge Case Study

PROBLEM

A 63-year-old patient who suffered a brain bleed was transferred to an inpatient rehabilitation hospital. After two weeks of therapy and making gains, he was denied further insurance coverage and there was a discharge plan put into place. The patient’s family called worried about their father’s discharge in a panic. They felt he wasn’t ready to return home. He was left with two options, return home or go to a nursing home. The family felt frustrated and felt a lack of consistent communication. They wanted someone to be on their side to help mediate the situation and assure a safe discharge. When these situations occur, action needs to take place quickly. Once discharge has been initiated and there is no longer care coverage, there isn’t much time.

SOLUTION

Medical Advocacy Plus served as the mediator and discharge plan facilitator for the family. As a result, their father was discharged home safely.

RESULTS

The home was properly set up including:

• A hospital bed
• An entry ramp was built for entering and leaving the home
• Medications were prescribed and available at the time of arrival home
• Tube feedings were ordered
• A list of home care agencies was provided