PBS’s ‘This Emotional Life’: Surviving the Hospital Discharge

“Our goals can only be reached through a vehicle of a plan, in which we must fervently believe, and upon which we must vigorously act. There is no other route to success.”

Pablo Ruiz Picasso, Spanish painter, draughtsman and sculptor

“Nosocomephobia,” defined as an excessive fear of hospitals, is not a word you often hear in healthcare settings. But maybe you should. At any given moment, a typical hospital stay balances disease and diagnosis, joy and despair, pitting physical and mental tribulations against hope. Oddly enough, “Nostophobia,” the excessive fear of returning home, can be just as prevalent to patients who find themselves in need of long term medical care outside the safety and security of the hospital environment.

For most people, the most significant moment of any hospital stay is when they are told they can leave, and how carefully they prepare for this anticipated departure is in many ways as important as the treatment they receive while under a doctor’s care. Referred to as discharge planning, hospitals understand the importance of developing a careful and appropriate agenda to address what will inevitably occur outside the hospital walls. Whether the patient is headed to his or her own home, the home of a friend or loved one, or to a rehabilitation center or nursing home, knowing what to expect goes a long way toward reducing stress and ensuring the best outcome for everyone involved.

Discharge planners — who can be hospital administrators, social workers, doctors, or nurse case managers — often work closely with families to explain a patient’s outlook, offer direction on continued care and help identify the most appropriate facility to suit the patient’s needs. Depending on the patient’s condition, a good discharge plan may be as simple to execute as taking a few days off work to help at home or as complex as researching health care facilities and coordinating assistance among family members. Generally, discharge is a five stage process:

Stage One: The patient’s mental and physical conditions are evaluated by the attending physician and nursing staff, with particular focus on whether or not the patient can safely return to his or her original living situation.

Stage Two: The discharge planner explains the doctor’s evaluation to the patient and any available caregivers, focusing on future care, including whether to transfer the patient to his or her own home, that of a family member, a nursing home or rehabilitation facility.

Stage Three: The discharge planner will now begin to personalize the patient’s plan, discussing any necessary caregiver training, possible third party care, and whether any extra equipment (such as wheelchairs or breathing assistance devices) will be necessary.

Stage Four: The discharge planner may now recommend third party facilities or home care services that are available to suit the patient’s needs, taking into consideration geographic, religious, language and/or cultural issues that might affect quality of care.

Stage Five: This final phase is designed to ensure that the appointed caregiver has all the information necessary to carry out the task at hand, including a summary of the hospital stay, a list of medications and important contact information in case of questions or concerns. There may also be a discussion about potential warning signs in the event that a patient’s condition should worsen.

When you or a loved one are recommended to a third party medical facility for long or short-term care, there are many factors to review. Because your time to make a decision may be limited, it is a good idea to consider the following when making your selection:

  • Why was this type of facility chosen?
  • What specific medical needs does this facility address?
  • Is this facility capable of meeting all the patient’s needs, or will additional assistance be necessary?
  • How close and convenient is this facility for the primary caregivers and family?
  • Is it clean, quiet and comfortable?
  • Does this facility address any cultural or language related issues the patient might have?

When the Burden of Care Falls on a Loved One
Often, patients find themselves in a situation where their needs are not severe enough to require a third party service, but they cannot fully care for themselves in a home setting. In such instances, a patient’s family or friends may be called upon to assist during the rehabilitation process.

When a loved one returns home to recuperate, his or her needs are often diverse, and the job of the caregiver can be complicated. The following are the essential elements of primary care during recovery:

Health and Hygiene: The caregiver may assume such tasks as bathing and dressing the patient, as well as assisting the patient with going to the bathroom, grooming and eating.

Household Chores: While convalescing, the patient will most likely need help with cooking his or her food, cleaning the living quarters, and washing articles of clothing as well as shopping for supplies and medications.

Medical Services: The primary caregiver will likely need to provide a certain amount of medical assistance, helping the patient with everything from wound care and bandaging to administering medications, including the possibility of giving injections.

Companionship: The emotional aspect of rehabilitation are often directly linked to a patient’s physical progress, and positive daily conversations help to reassure the patient that he or she is not facing these challenges alone.

If you find yourself in the position of family caregiver, know what to expect as you take on these new responsibilities. Providing post-hospitalization support for anyone can be a time consuming, high pressure task. Those who find themselves undertaking such a role should be mindful not to ignore their own needs and obligations in their effort to assist a loved one.

While the discharge process marks the conclusion of the hospital stay, it is often just the first step on a long road to recovery. The challenges facing newly discharged patients and their caregivers can be a complex mix of mental, physical, emotional, and financial hurdles. By planning for this step at an early stage, both the patient and his or her caregivers will be more prepared to address the hurdles that go hand in hand with convalescence, leaving them free to focus their time and energy on the task of returning the patient to a healthy, productive lifestyle.

This Emotional Life is a two-year campaign to foster awareness, connections and solutions around emotional wellness. Join our community at www.pbs.org/thisemotionallife.