The First 72 Hours After a Parent's Knoxville Hospital Discharge

Before discharge day

Ask the case manager three questions as soon as you can: Is my parent an inpatient or under observation? How many inpatient days have been counted? What level of care does the team recommend next? Medicare's skilled nursing benefit requires three inpatient days, and observation days do not count.

These are the acute-care hospitals in the seven counties, from the state's hospital report:

Choosing the next setting

The usual options are home with Medicare home health and private help, a short skilled nursing stay, an inpatient rehabilitation hospital such as Patricia Neal or Knoxville Rehabilitation Hospital, a return to assisted living, or hospice.

If a rehab nursing home is recommended, ask for the list of homes with open beds, then check each one's CMS record on this site. If long-term care may follow, favor homes certified for both Medicare and TennCare.

Returning to assisted living

Tennessee lets an ACLF keep a current resident who needs IV therapy, tube feeding or suctioning on an intermittent basis for up to three 21-day periods, and keep a resident at nursing-facility level of care if a physician certifies in writing that needs can be met safely. Call the ACLF's nurse before discharge day and ask for written confirmation that your parent can return.

Day one at home or in rehab

Pick up new prescriptions on the way, and compare the discharge medication list with what is in the cabinet at home; duplicate or discontinued drugs are a common source of trouble. Make sure any ordered equipment, such as a walker, shower chair or oxygen, is delivered. Confirm the home health agency's first visit date.

In a rehab home, ask for a care conference in the first week and ask the therapists what level of help they expect at discharge.

Days two and three

Book the follow-up appointment with the primary care doctor within a week; many readmissions start with a missed follow-up. Watch for warning signs the hospital listed, such as fever, shortness of breath, new confusion or a fall, and know who to call after hours.

If a parent was living alone and the stay revealed new limits, this is the time to start touring assisted living, before the next hospital visit forces the decision.

If you disagree with the discharge

Medicare patients have the right to appeal a hospital discharge they believe is too early. The hospital must give a written notice, titled An Important Message from Medicare About Your Rights, that explains how to ask the Medicare quality improvement organization for a fast review. Call the number on the notice before the discharge time; the patient usually can stay while the review happens.

The same idea applies later in a rehab nursing home. When the home decides skilled care is no longer needed, it gives a notice of non-coverage, and you can request an expedited review. Families win these more often than they expect when the therapy notes show continuing progress.

Medications: the most common trouble spot

Hospital stays often change several prescriptions at once. New blood pressure pills, a different diabetes regimen, a short course of antibiotics, a stopped blood thinner. At home, the old bottles are still in the cabinet. Lay every bottle on the table next to the discharge list, set aside anything that was stopped, and ask the pharmacist to review the final list.

If your parent lives in assisted living, send the discharge list to the community's nurse before arrival so the medication record is updated the same day. Tennessee ACLFs administer medications through licensed or certified staff, and they need current orders to do it.

Thinking one step ahead

A hospital stay is often the moment when a family learns how much help a parent really needs. If the therapists say your mother will need help bathing and getting to the bathroom at night for the foreseeable future, that is a different situation from a short recovery. Use the rehab weeks to tour assisted living, ask for written quotes, and confirm whether each community would accept her with the care needs the therapists describe.

Families who plan during rehab avoid the hardest version of this decision, which is choosing a community from a hospital hallway in a single afternoon.

Who can help

ETHRA's AAAD (1-866-836-6678) screens for CHOICES and OPTIONS. In Knox County, the CAC Office on Aging (865-546-3500) can arrange home-delivered meals. TN SHIP (1-877-801-0044) explains how the stay will be billed. A local advisor can check assisted living openings while you handle the hospital, at no cost to your family.