Stop 05 of 08
The hospital called, Mom was admitted, and you live 500 miles away: what to do from the airport
The hospital called. Mom was admitted. You live 500 miles away, and you are reading this at a gate, or in a parking lot with a suitcase you packed in four minutes. You cannot be at the bedside for six hours. You can, from this chair, make five phone calls and read one document, and those will shape the week after she comes home more than anything you do once you land.
One thing to hold onto before the calls. Federal rules do not treat you as a visitor. Under 42 CFR 482.43, a hospital must have a discharge planning process that focuses on the patient's goals and treatment preferences and includes the patient and his or her caregivers or support persons as active partners in planning for post-discharge care. You are a support person. From an airport, on speaker, you are still one.
Before you board: five calls, in this order
- The unit. Call the main number and ask for the floor she is on, then the nurse assigned to her. Ask two things only: is she stable, and who is her case manager or social worker. Do not ask the nurse to explain the diagnosis to you on the phone; ask when the doctor rounds and whether you can be on speaker. Barnes-Jewish, to take one example, lists social work among its guest services and publishes a general information number, 314.747.3000. Every hospital in the metro has a version of that page.
- The case manager or discharge planner. This is the call that matters most, and it is the one daughters skip because it feels premature on day one. It is not. The same federal rule requires that a hospital's discharge planning evaluation include an evaluation of the patient's likely need for post-hospital services, including home health services and non-health care services and community-based care providers, and whether those services are available and the patient can access them. Say one sentence: "I am her daughter, I live out of state, she lives alone, and I want to be part of the discharge plan. What is your direct line?"
- The neighbor with a key. Ask them to go in, turn off the stove, feed whatever needs feeding, lock up, and bring her glasses, hearing aids, dentures, phone charger and the pill organizer to the hospital, box and all, so the team can see what she actually takes. Do not ask the neighbor to read you the labels. The list of medicines is the care team's to reconcile, not yours to relay.
- The sibling. Even the one who never helps. Family Caregiver Alliance notes that discord most often surfaces from the unequal division of caregiving duties, with one sibling taking on the primary role because they live closest. A hospital admission is where that division gets set for the next year. Make the call before the resentment does.
- The help for the first nights home. If she lives alone, the discharge planner will ask who is going to be in the house. "I am flying in" covers a week. It does not cover the second week. Ask the planner whether Medicare home health is likely to be part of the plan, and know its shape: Medicare says you must need part-time or intermittent skilled services and be homebound to qualify, and that it does not pay for 24-hour-a-day care at home, meal delivery, or custodial or personal care that helps with daily living when that is the only care you need. The gap between what home health covers and what an empty house needs is what the paid placement on this site exists for. New Plan Care, an independently owned non-medical in-home care company in Chesterfield, can have someone in the house for the nights and mornings after discharge and call you after each visit. It is a client of OwnersFirm, which publishes this site, and it pays to be named here. Call (314) 405-0887 from the gate, or read what it does once you are in the air.
On the plane: the checklist Medicare wrote for you
Download Medicare's Your Discharge Planning Checklist before you lose the signal. It tells patients and caregivers that the doctor and staff will work with them to plan for discharge, and that they are important members of the planning team. Read that line twice; it is the permission you were looking for. The checklist then asks the questions you will be asked at the bedside, so answer them on the flight: where she will get care after discharge, whether options such as home health care are available, and what she prefers. Its most useful page is a list of ordinary things to circle: whether she is ready for bathing, dressing, using the bathroom, climbing stairs, cooking, food shopping, house cleaning, paying bills and driving to appointments. Circle honestly. Every circle is a row in the plan and a reason to say "she lives alone" out loud.
The Agency for Healthcare Research and Quality's IDEAL discharge planning strategy tells hospitals to include the patient and family as full partners, to educate in plain language throughout the stay, to assess understanding with teach-back, and to listen to the family's goals, preferences, observations and concerns. Teach-back means they explain and you repeat it back. Ask for it. "Can you explain that to me the way you would to her, and let me say it back?" It is not rude. It is the method they are supposed to use.
Two pieces of paper with deadlines
If she has Medicare, two notices have clocks on them, and a daughter in another state is the one most likely to miss them. First, within two days of hospital admission and prior to discharge she should get a notice called An Important Message from Medicare about Your Rights. Ask the nurse whether it has been given and signed, and ask for a photo of it. Second, if the discharge feels too soon, Medicare says you may have the right to ask for a fast appeal, and that if you ask no later than the day she is scheduled to be discharged, she can stay in the hospital while the review organization decides, without paying for that stay except applicable coinsurance or deductibles. CMS requires hospitals to deliver the Important Message to every Medicare inpatient, and the notice itself explains those appeal rights. This is not a way to fight the hospital. It is a way to get a second look when the plan for an empty house does not hold together.
Two other rules to know from the same federal section. The hospital must inform patients and families of their freedom to choose among participating Medicare providers and must not specify or otherwise limit the qualified providers available to the patient. So if you are handed a list, it is a list, not an instruction, and you may ask for the quality data the rule says they must share.
Where the local hospitals put their family pages
These are pointers, not opinions. Each system publishes a page for patients and families, and each one is where the discharge conversation is described in that hospital's own words. Mercy Hospital St. Louis, at 615 S. New Ballas Road, lists (314) 251-6000 on its location page. Missouri Baptist Medical Center, at 3015 N. Ballas Road, lists 314-996-5000 and is open 24 hours. SSM Health's patient rights page states that patients have the right to take part in developing their plan of care and discharge planning, including deciding about care options and choice of agencies. Barnes-Jewish is linked in call one above. Anywhere else, search the hospital's name with "patients and visitors" and the same kind of page appears.
What to do tonight, from the gate
- Make calls one and two before you board. Write the case manager's direct line in the shared document from Stop 08, or start that document now.
- Text the neighbor the list: glasses, hearing aids, dentures, charger, the pill organizer with everything in it.
- Download the Medicare checklist. Circle the activities she needs help with. Take a photo of the page.
- Ask the nurse whether the Important Message from Medicare has been given. If yes, ask for a photo of it.
- Decide who is in the house the first three nights after discharge. Say the names out loud to the planner.
When to ask the care team or the doctor
Everything about why she was admitted, what the tests mean, what the medicines are and whether they changed, what "stable" means today and what it will mean tomorrow, and whether she is safe to go home to an empty house: all of it belongs to the physician and the nurses on that floor. This page covers phone calls and paperwork. It does not cover her body. Ask to be on speaker when the doctor rounds. Ask for teach-back. Ask the case manager what the plan is if the plan fails. And when a nurse says a word you do not understand, ask them to spell it, then ask them what it means, rather than asking a website at 30,000 feet.