It's Scary to be Discharged on a Friday

This skit demonstrates how a person on Medicare can appeal their hospital discharge plan, demand their rights and save their life. Every state has a QIO, or Quality Improvement Organization that monitors hospitals and doctors that bill Medicare. There are rules hospitals must follow. For example, they must notify you in writing 48 hours in advance of your discharge. These are federal rules that hospitals are legally required to follow. Don't leave the hospital until you are ready. Know your rights!

San Francisco Homecoming Services Network

If you are in San Francisco and need help transitioning from the hospital to home, or if you are a social worker or discharge planner who needs help making sure clients get everything they need, contact Homecoming Transitional Care Program.

Hospital Discharge Stories

Go here to share your hospital story:
TELL US YOUR HOSPITAL STORY

Personal stories are a critical part of organizing communities and putting a personal face to a policy problem or service gap. Therefore, we encourage all seniors, adults with disabilities, caregivers and service providers to record your personal stories, especially about issues (good or bad) related to homecare and discharge planning.

 HAVE YOU BEEN TO THE HOSPITAL?

• How were you treated?

• Did you get everything you needed when you were discharged?

• Did a discharge planner or nurse talk to you about what services you would need when you returned home?

• Did you understand the discharge planning process?

• Did you feel anxiety about leaving the hospital?

• What would you change about your experience?

• Do you have everything you need now?

The California Discharge Planning Collaborative wants to hear from you!
We want to hear your story!
We are collecting testimonies from people who were (or are) hospitalized in San Francisco and California.

• Help to improve discharge planning policy.

• You can submit your story in writing, in person or over the telephone. All information is strictly confidential.

Call James at (415) 703-0188 ext 304 or james@planningforelders.org, visit the link at the top of this post "TELL US YOUR HOSPITAL STORY', or just write it below.

Advocates Fight for Elder Patients’ Rights, Safety

California Discharge Planning Collaborative from New America Media on Vimeo.

Advocates Fight for Elder Patients’ Rights, Safety

New America Media, News Feature, Paul Kleyman / Video: Cliff Parker, Posted: Dec 21, 2009 Review it on NewsTrust

California Discharge Planning Collaborative from New America Media on Vimeo.

David Grant was elated to be going home as he phoned a taxi one recent Friday afternoon from the lobby of a San Francisco hospital. But by the time he reached his apartment, he was so weak he could barely make it up the steps and in the door.

For the first time, Grant fully grasped how vulnerable patients can be -- patients like those he has advocated for over the years -- when they are discharged from a medical facility without proper planning and assistance.

Grant and his fellow members of the California Discharge Planning Collaborative recently launched a multicultural campaign to inform elders that they have a right to be safely returned from hospital to home — and not simply discharged with scant help.

The effort is one of numerous projects around the United States aimed at ensuring patients’ safe transition to home care. It could save the more than $17 billion lost to Medicare each year in unnecessary hospital readmissions, according to a study published this year in the New England Journal of Medicine. The University of Colorado study showed that more than one-third of Medicare patients are re-hospitalized within 90 days each year. That’s 4 million people – and this number will grow rapidly as boomers start becoming eligible for Medicare only a year from now.

These findings led members of Congress to introduce the Medicare Transitional Care Act of 2009. According to the bill, “Insufficient communication among older adults, family caregivers and health care providers contribute to poor continuity of care, inadequate management of complex health care needs and preventable hospital admissions.” The Act would set up demonstration projects to test ways for improving patients’ continuity of care.
Discharging Your Rights

"You Have a Right to a Safe Discharge" is a handy brochure now available in English, Spanish, Chinese and Russian from the California Discharge Planning Collaborative. California patients and their caregivers concerned about their transition from a hospital or other medical facilities to their home can obtain free advice at 877-223-6107.

The brochure states that in California, you have the right to

* A safe and planned discharge
* Have all material presented in your language
* Know of all the services you are entitled to
* Understand what medications you are taking
* A refill of your hospital prescription
* Refuse to leave if you do not feel well enough.

For a PDF of the brochure in an available language, contact Planning for Elders at 415-703-0188, or e-mail James Chionsini, info@planningforelders.org.

The California campaign's brochures -- printed so far in English, Spanish, Chinese and Russian -- highlight a toll-free number that patients and their caregivers can call for free assistance if they have complaints about their treatment or discharge from the hospital. The collaborative even enlisted a senior theater troupe to dramatize hospital scenes and spur seniors to share their experiences. The group performs in senior centers and other locations across California.

"When you get home from the hospital, you're not tap dancing up the steps. You're still sick," stated Grant, a consultant for community health organizations and the former director of San Francisco's Senior Action Network. "I'm only 58 and relatively healthy, and I thought, 'What if I were 80 and living alone?'"

Like most people just released from a hospital but still needing to recuperate, Grant arrived home exhausted. After slumping into a chair where he slept for hours, he awoke to a house without food, or enough strength to walk to a store.

Despite having created a computer spread sheet to keep track of his medications, Grant found himself confused: Was this prescription for four pills every six hours and that one for two pills every four hours, or the other way around?

Unlike Grant, though, the most vulnerable and costly patients have serious chronic health conditions, such as congestive heart failure, stroke or diabetes. They also have medical challenges at home. Often these patients or their family caregivers must learn and manage multiple medications and complex technologies, such as glucose monitors or tube feeding -- technologies that have only been available for use in hospitals for 15 or 20 years.

Those needing the most help, such as 61-year-old Anaperla Aureoles, have multiple chronic conditions. This group accounts for a whopping 75 percent of all Medicare spending for seniors and those with disabilities.

Last spring, Aureoles found that poor hospital discharge planning could be "devastating." Only days after her operation to remove a pituitary tumor from her brain, she recovered well enough to be transferred elsewhere.

Aureoles, who immigrated with her family to the United States from Mexico City as a child, was born with a type of encephalitis that has left her struggling progressively with seizures, as well as declining vision, hearing and mobility.

She gets along with the help of her service dog, Henry. However, the hospital erroneously told her that Medicare would not cover her transfer to a rehabilitation facility with her dog. Frightened of being without her beloved canine, she returned to her San Francisco apartment -- with its 32 steps and no elevator.

At home, she said in an interview, she reacted to her post-surgery medication with severe nightmares and hallucinations, couldn't walk, had surgery-related nose bleeds and broke into cold sweats. "I had a terrible reaction. I went into a deep depression and had suicidal thoughts," she said.

The occupational therapist sent to treat her immediately called an ambulance. Although Aureoles was readmitted to the hospital, they sent her home the next morning.

Her surgeons and the hospital social worker then tried to get Aureoles admitted to a rehab facility, only to be reminded that Medicare rules require transfer only from a hospital, not from a patient's home. This technicality is typical of the bureaucratic rules that keep people from getting the seamless continuing care they need.

"The surgery part was wonderful," Aureoles said, "but when I left, everything fell through. I was totally unprepared."

For patients with limited English-language proficiency, the results of a poorly planned medical discharge can be even more challenging. "From Hospital to Home," a 2006 study by the University of California School of Public Health, quoted caregivers who found themselves unable to communicate with health care providers.

One caregiver recalled, "I really wasn't prepared for it, and emotionally I felt terrible because I arrived [in] this country alone with my husband. My two children are in El Salvador, so I felt I had no support from anyone."

Among numerous stories that the California collaborative has documented, a 74-year-old Albanian immigrant, who asked not to be identified, received no translation services following his surgery for stomach cancer. He couldn't communicate with the facility staff, and the hospital did little to assist his family when the staff ordered their father discharged one night.

Only six hours after taking him home, family members rushed him to the hospital's emergency room, where he was readmitted with pneumonia. The man was reconnected to feeding equipment for nourishment. Still, the hospital sent him home hours later -- only to see him returned to the facility the following day, this time for a two-month stay before he could safely return home.

"Successful, programs for assuring a smooth transition from hospital to home must involve the patient's family caregivers -- relatives, friends and neighbors," said Carol Levine, director of Families and Health Care Project at the United Hospital Fund of New York.

Levine said the United Hospital Fund's Next Step in Care program (www.nextstepincare.org) provides family caregivers and health care providers with guidelines for hospital discharge, medication management and other tools for navigating the system.

Although the approaches of the many programs differ, Levine explained, they all turn on the same principles of "meeting the patient and family where they are," not where the health care system wants them to be.

Levine, a MacArthur "genius" grant winner, emphasized that effective transitional care cannot be half-hearted, only offering patient education or volunteer programs.

Key to effective care, she said, is having a professionally guided discharge plan with follow-up through the critical period following hospitalization. That approach can result in better outcomes and fewer unnecessary re-hospitalizations -- and even save money, according to Levine.

Meanwhile, the California Discharge Planning Collaborative is spreading the multilingual word about its toll-free number for free advice on "everything you need to know before you go home from the hospital."

Related Articles:

* Health Care Reform's Missing Piece: Elder Care
* Health Care ‘Reform’ Could Overwhelm Family Caregivers
* Experts Expose Health Reform Gaps for Ethnic Elders

DO YOU WANT TO DEMAND YOUR RIGHTS? IF SO HOW MANY OF YOU ARE THERE?

Hello Discharge Planning community.

The hospital industry has a financial incentive to discharge patients "sicker and quicker" for a variety of reasons. Well, this blog is focused on making sure patients know how to demand the care they deserve. Please contact me with feedback.

We want to know your stories also. If you have been discharged from the hospital and you felt it was inappropriate, please send us your story. Thank you and be well.

James Chionsini, MSW
HealthCare Action Team
Planning for Elders in the Central City
965 Mission St #550
San Francisco CA 94103
(415) 703-0188 ext 304
james@planningforelders.org
AFL-CIO-OPEIU3/JC

check out our website: http://www.planningforelders.org

San Francisco IHSS Public Authority Peer Mentoring Program

San Francisco IHSS Public Authority
Consumer Peer Mentor Program
• Started in October 2008.
• Text: “The Public Authority is pleased to announce the launch of the new Consumer Peer Mentor Support Program. We believe that people with disabilities who are managing successfully with their disability can be called upon to share their experience with other individuals who have disabilities. Our peer mentors will inspire hope for independence and will actively assist those who have disabilities.”
• Actually, we have learned a lot since our start in October 2008. One of the things that we realized after operating for over a year is that the word “peer” in this definition simply means someone who is similar to you—be it in age, gender, race, education or especially disability.
• Mentoring simply means serving as a trusted counselor or teacher. Peer mentors then are individuals with disabilities who have faced some of the experiences and challenges that a mentee may face in the future.
• Peer mentors have learned from their own experiences. Our peer mentors are knowledgeable about resources as regards independent living, because most of them have made the transition to an independent lifestyle themselves.
• Peer mentors will help set reasonable goals and provide emotional support, because quite frankly, they’ve been there themselves.
• Simply put, peer mentors can show mentees how to do things. For example, I have a mentor who recently assisted a mentee in transferring; he showed him how to safely transfer from his bed to his wheelchair for the first time.
• Some of our other mentors have taught mentees how to get on and off MUNI bus lifts, taken their mentees shopping at Safeway, shown them how to get a Paratransit ID, and how to ride a ramp taxi safely.
• Let’s remember again that peer mentors are people with disabilities who are managing successfully and can be called upon to share their experiences with other individuals who have disabilities. Peer mentors will inspire hope for independence and will actively assist those mentees who live in institutions—like Laguna Honda Hospital or St. Mary’s Rehabilitation Unit or Valley Medical or any institution in the City and County of San Francisco—to realize the dream of living independently.
• To be a peer mentor for the San Francisco IHSS Public Authority, one must have (a) a disability, (b) been living independently successfully for at least 3 to 5 years, (c) or have made a successful transition to an independent living lifestyle on their own.
END


For more information contact Sergio Alunan (415-593-8112; salunan@sfihsspa.org)

amednews: Discharge missteps can send seniors back to hospital :: Feb. 15, 2010 ... American Medical News

amednews: Discharge missteps can send seniors back to hospital :: Feb. 15, 2010 ... American Medical News

Discharge missteps can send seniors back to hospital

Geriatric Consult. By Beatriz Korc, MD, amednews contributor and Susan J. Landers amednews staff. Posted Feb. 15, 2010.

Scenario
GERIATRIC CONSULT
A column about treating a growing demographic

Mr. Park, 85, recently was admitted to the hospital with community-acquired pneumonia and, after five days of intravenous antibiotic therapy, he was discharged home.

Case history

Mr. Park lives with his daughter. He has hypertension, benign prostate hyperplasia and mild Alzheimer's disease. His medications at home included bisoprolol/HCTZ, 5/6.25 mg; tamsulosin, 0.4 mg; and donepezil, 10 mg once a day. While he was in the hospital, the bisoprolol was switched to 50 mg of metoprolol twice a day because bisoprolol was not on the formulary. At the time of his discharge, an intern reviewed his hospital medication list and wrote out the prescriptions, which were given to Mr. Park by a nurse. Mr. Park's daughter filled the new prescriptions. When he returned home, Mr. Park resumed taking his usual medications, plus the new ones prescribed in the hospital. The combination of bisoprolol and metoprolol made Mr. Park bradycardic and dizzy. He fell on his way to the bathroom. When the emergency medical technicians arrived at his home, his heart rate was just 38 beats per minute. Mr. Park was readmitted to the hospital.
Discussion

Patients often are discharged from the hospital to their homes unprepared to care adequately for themselves. Because of postdischarge missteps, many involving a medication mistake, patients too often may find themselves back in the hospital. Given the medications Mr. Park was mistakenly taking after he returned home, his dizziness and bradycardia could have been predicted and his readmission avoided.

* Case history
* Discussion
* Key considerations:
What discharge list
should include

Mr. Park is not alone. A 2003 study in the Annals of Internal Medicine found that 76 of 400 patients, with an average age of 57, experienced an adverse event after discharge from a tertiary care academic hospital to their homes. Researchers determined that 23 of the events were preventable, and another 24 could have been less severe with appropriate management. The most common adverse events were drug-related. Poor communication is one of the most important reasons for such events.

The risks for very elderly patients are even more apparent, since many have cognitive impairments or several chronic conditions for which they take an array of medications, compounding the likelihood of drug-drug or drug-disease interactions.

A Transitions of Care Consensus Policy Statement developed by several medical societies, including the American College of Physicians and the American Geriatrics Society, cited findings from a study of 2,644 patient discharges. The 2004 study showed that about 40% of the patients had pending test results at the time of discharge and that 10% of the results had required some follow-up action. Yet the patients and their primary care physicians were unaware of the tests. The consensus statement was published in the July/August 2009 Journal of Hospital Medicine.

The prevention of such missteps should be a primary focus of discharge planning, which is required of hospitals by all of the major health care regulatory agencies and accrediting agencies. The Joint Commission has included discharge instructions as a core performance measure in the care of heart failure patients. Hospital performance on this measure is reported publicly on the Centers for Medicare & Medicaid Web site.

There are many reasons transitions can be risky. Among them is the absence of a coordinating agency, according to the Transitions of Care Consensus Policy Statement. Studies indicate that patient-centered medical homes can make a difference.

Among the principles recognized as vital for a seamless transition is clear communication at several levels, whether between hospital physician and primary care physician or among hospital physician, patient and caregiver.

But a 2007 study in the Journal of the American Medical Association found that direct communication between hospital physicians and primary care physicians occurs infrequently and that discharge summaries are rarely available to the primary care doctor at the first postdischarge visit. In a review of 55 studies published between 1970 and 2005, the researchers found that even when discharge summaries were available, they often lacked important information such as diagnostic test results, treatment course, discharge medications, test results pending at discharge, patient or family counseling, and follow-up plans.

Since a patient's family member or caregiver has an important role to play in transitions of care, that person also must receive information at discharge about posthospital needs.

Several studies have shown that discharge from the hospital is a time of anxiety for patients and their families. But it doesn't have to be that way, says Eric Coleman, MD, MPH, professor of medicine at the University of Colorado at Denver and director of the university's Care Transitions Program, a one-month training course for patients with complex needs and their family caregivers. Patients and families work with a coach and learn self-management skills that ensure their needs are met during the transition from hospital to home.

Patients who received this program were significantly less likely to be readmitted to the hospital, Dr. Coleman told a Senate committee in 2008. The program, which received funding from the Robert Wood Johnson Foundation and the John A. Hartford Foundation, was developed with input from patients and caregivers.

A new position paper released Jan. 12 by the American College of Physicians also offers guidance to physicians about establishing and maintaining relationships with patients' caregivers.

Privacy provisions from the Health Insurance Portability and Accountability Act do not preclude the sharing of relevant information with family caregivers, as long as the patient does not object, the ACP states. After reconciling the patient's inpatient and outpatient medications, Mr. Park's daughter should have been contacted at the time of discharge. The physician or the nurse should review the medication list with the patient and caregiver, and educate them on possible side effects.

Barriers of language, education, values and culture may compound the communication difficulties faced by patients, families and caregivers during discharge from hospitals. A 2004 study by the Agency for Healthcare Research and Quality found that low health literacy is linked to higher rates of hospitalization and higher use of expensive emergency services. If a language barrier is identified, the use of a translator is warranted.

Dr. Korc is a practicing geriatrician as well as the chief of geriatric services in the Dept. of Medicine at the Memorial Sloan-Kettering Cancer Center in New York. Landers is a staff writer.

The print version of this content appeared in the Feb 22, 2010 issue of American Medical News.

ADDITIONAL INFORMATION:
Key considerations: What discharge list should include

A study on deficits in communication between hospital-based and primary care physicians made several suggestions for smoothing the transition for patients being discharged from the hospital. The authors suggest discharge summaries include:

* Primary and secondary diagnoses
* Pertinent medical history and physical findings
* Dates of hospitalization, treatment provided and a brief summary of hospital course
* Results of procedures and abnormal lab test results
* Recommendations by any subspecialty consultants
* Information given to the patient and family
* The patient's condition or functional status at discharge
* Reconciled discharge medication regimen, with reasons for any changes and indications for newly prescribed medications
* Details of follow-up arrangements
* Specific follow-up needs, including appointments or procedures to be scheduled and tests pending at discharge
* Name and contact information of the responsible hospital physician

Source: "Deficits in Communication and Information Transfer Between Hospital-Based and Primary Care Physicians: Implications for Patient Safety and Continuity of Care," Journal of the American Medical Association, Feb. 28, 2007 (jama.ama-assn.org/cgi/content/abstract/297/8/831/)


"Deficits in Communication and Information Transfer Between Hospital-Based and Primary Care Physicians: Implications for Patient Safety and Continuity of Care,"abstract, Journal of the American Medical Association, Feb. 28, 2007 (jama.ama-assn.org/cgi/content/abstract/297/8/831)

"The Incidence and Severity of Adverse Events Affecting Patients after Discharge from the Hospital," abstract, Annals of Internal Medicine, Feb. 4, 2003 (annals.org/content/138/3/161) .

Copyright 2010 American Medical Association. All rights reserved.