A trip to the hospital can be overwhelming for seniors and their families. Our team is completely focused on your family member care. Planning for care after discharge is a vital step to providing the quality care your loved one needs.
Whether the discharge is to home, a rehabilitation facility, or a nursing home or with skilled services. It is critical to the health and well-being of your loved one. Studies prove that appropriate discharges from hospital or rehab facilities can dramatically improve the outcome for patients as they move to the next level of care.
It’s a team effort. Family, patients and healthcare providers all play roles in maintaining a patient’s health after discharge. And although itʼs a significant part of the overall care plan, there can be a lack of quality of discharge planning across the healthcare system.
The Heaven’s Hands Role in the Discharge Process
At Heaven’s Hands we work with case managers, social workers and coordinators to make sure your loved one is fully prepared to return to their home or place of residence. Is is our goal to make sure discharge is a smooth transition. We serve as a resource and guidance for the family in navigating through the complicated health care industry. We advocate for our clients and serve as the second eyes for the overall discharge.
Discharge planning is a process used to help patients transition to one level of care to another. This consist of many things. Patient choice, safety and level of care and quality of care are all priorities. The process of discharge planning can be completed by a social worker, nurse, or case manager, the basics of a discharge plan are:
- Evaluation by qualified personnel
- Discussion with the patient, power of attorney, family member or
- Planning going homecoming, skilled care agency at home or transfer to facility
- Determining whether caregiver training or other support is needed
- Referrals to a home care agency and/or appropriate support organizations in the community
- Arranging for follow-up appointments or tests
If appropriate bringing your family home is probably the safest choice. Home is where the heart is and sometimes just being home puts your loved one in a happy mood to thrive. Our caregivers are experts in helping your loved one rehab at home, by working closely with the skilled home care agencies (Nurses,Physical therapist, Occupational therapist) as a team to provide quality care.
Team work makes the dream work! This process includes all parties involved. Family member both before and after hospitalization; details of the types of care needed; will discharge will be to a facility, skilled services or home; current care plan, activities he or she might need help with; information on medications and diet; equipment, such as a wheelchair, commode, or oxygen; who will handle meal preparation, transportation and chores; and possibly referral to home care services.