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Options for Post Hospital Release

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Top Takeaways

  1. There are many options when it comes to continuing care after release from the hospital (discharge). 
  2. Each option varies significantly. Options can differ by the type of facility where care is rendered, the type of care available, why you would choose it, and the pros and cons of each option.
  3. A key factor to consider when choosing is the type of care that’s best for your senior’s medical and other needs.
  4. Cost and insurance coverage can vary widely between the different options. You should always confirm how much the insurance will pay and how much you will need to pay.
  5. This article reviews the ten options available for continuing care after your loved one is discharged from a hospital.

 

Introduction

There’s a good chance that at some point, your loved one will need care in a hospital. After a patient has received care in a hospital and is medically stable, they will be discharged (transferred) to another location for ongoing care. There are many different types of sites to which a patient can be transferred after their hospital stay. Each one differs by type of facility, the kinds of patients it serves, and the level of care it provides. This article will review the ten different options for care after hospital discharge.

 

What are my Options for Post-Hospital Release?

The following options account for almost all post-hospital care:

  1. Transfer to another hospital 
  2. Home care with no services
  3. Home care with a family/friend caregiver
  4. Home care with paid caregivers 
  5. Assisted living
  6. Skilled nursing facility
  7. Sub-acute care
  8. Acute inpatient rehabilitation
  9. Long term acute care
  10. Hospice

Let’s review each of these options.

  1. Transfer to another hospital 

    • Description – This will be another acute care hospital. This happens when more intensive or specialized hospital services are needed.
    • Why choose it The treating physicians at the first hospital may determine that the medical situation is too complex for them to handle.
    • Level of Care – This is the highest level of care.
    • Pros and Cons – If the first hospital doesn’t have the expertise or equipment to care for your senior, it’s often best to transfer them to another hospital. 

  2. Home care with no services

    • Description The patient is discharged from the hospital to their home or the home of a relative/friend, where further recovery will take place.
    • Why choose it This is usually best for someone who at baseline is independent, is not frail, and has near-normal cognition. It also helps if little or no specific care services need to be rendered at home after discharge.
    • Level of Care This is the lowest level of care available.
    • Pros and Cons This level of care is only suitable for carefully selected patients who are essentially independent without complex major medical problems.

  3. Home care with a family/friend caregiver

    • Description – This is similar to home care, with the addition of care and assistance from a family member or friend.
    • Why choose it – This is a good option when only relatively minor medical or personal care help is needed, and the person is reasonably functional. 
    • Level of Care – This is a low level of care.
    • Pros and Cons – This option requires minimal coordination and planning, and is low-cost. Caregivers will need to make themselves available; this can interfere with their other time and job commitments and cause them stress.

  4. Home care with paid caregivers 

    • Description – This is home care with the addition of paid caregivers. These caregivers are usually licensed and/or certified. Although there are exceptions, these caregivers are generally provided on a short-term basis. Short-term home services include:
      • Occupational therapy
      • Physical therapy
      • Speech therapy
      • Registered nurses
      • Licensed vocational nurses
      • Home health aides
    • Why choose it – This allows your loved one to be at home while receiving needed skilled professional services.
    • Level of Care – This is a relatively low level of care.
    • Pros and Cons – Skilled services are rendered by specially trained and licensed/certified professionals. The major con is the cost if insurance is not paying in full for the services. These services are costly. Even if insurance will cover these services, be sure you understand any costs to you, such as:
      • Deductibles (you pay a set amount before insurance starts paying)
      • Copays (you pay a percentage of the price not covered by insurance)

  5. Assisted living

    • Description - This is a residential facility for seniors who need help with activities of daily living (ADL) and/or instrumental activities of daily living (IADL).
      • ADL refers to:
        • Mobility
        • Bathing
        • Transferring
        • Toileting
        • Dressing
        • Eating
        • Grooming
      • IADL refers to higher-level skills for independent living such as: 
        • Meal preparation
        • Shopping
        • Using phones
        • Managing finances
        • Ability to use transportation
        • Safe medication management. 
      • Assisted living facilities offer personal care services, social activities, housekeeping, laundry, administering medications, and meal service.
    • Why choose it Assisted living is a good option for seniors who have significant problems with several ADLs and/or IADLs. Seniors with dementia who need ongoing personal care but don’t need skilled medical care are good candidates for assisted living (usually in memory care units).
    • Level of Care This is a relatively lower level of care.
    • Pros and Cons Assisted living provides semi-independent living with a 24-hour structured care environment. These facilities tend to be quite expensive and are rarely covered by medical insurance. Usually, the cost is paid in full by you or paid by long-term care insurance policies (which are expensive to buy).  

  6. Skilled nursing facility

  7. Sub-acute care

    • Description Sub-acute care is for patients who remain medically fragile after their hospital care and require frequent medical treatments/assessments. Examples include patients who need tube feeding for nutrition, extensive burn or wound care, and artificial respiration with a ventilator (breathing machine).
    • Why choose it This option is appropriate for patients who meet the criteria noted above.
    • Level of Care This is towards the higher levels of intermediate care.
    • Pros and Cons This is appropriate for patients who need ongoing complex medical care for a more prolonged period than a usual length of stay in a hospital. It’s usually chosen regardless of most potential downsides if it’s the most appropriate type of care. As with most levels of care, cost and insurance coverage may be an issue. 

  8. Acute inpatient rehabilitation

    • Description AIR occurs in a facility where the patient stays 24 hours a day. It’s for those who need very intensive rehabilitation services. This can include physical, occupational, and/or speech therapy. This is considered an inpatient level of care (similar to a hospital stay). There must usually be a need for direct physician visits several times weekly to qualify for AIR services.
    • Why choose it – AIR is appropriate for patients with extensive rehabilitation needs that cannot be met at a lower level of care after hospital discharge.
    • Level of Care This is a high level of care. It is considered roughly equivalent to hospital care.
    • Pros and Cons AIR is a good choice for patients who need extensive rehabilitation. It includes close physician involvement in the day-to-day care of the patient. Although it is costly, insurance can cover it as long as all medical necessity criteria are met.

  9. Long term acute care

    • Description LTACs are hospitals intended to provide highly complex medical care when the duration of care is more prolonged than is appropriate for a standard hospital. LTACs typically offer many of the same services as a regular hospital, but when a patient no longer needs an intensive care unit or extensive diagnostic testing. LTACs may be physically located within a traditional hospital.
    • Why choose it An LTAC is often selected for patients who remain very ill after they are ready for standard hospital discharge.
    • Level of Care This is a very high level of care. It’s close to the level of care at a standard hospital. 
    • Pros and Cons LTACs can provide high-level care for patients who remain quite ill. LTACs are inappropriate for patients whose care is manageable by assisted living, SNF, sub-acute care, and AIR care. Insurers apply strict medical necessity guidelines before paying for this type of care since its cost is very high

  10. Hospice

    • Description – Hospice is for end-of-life care. It’s intended for patients with a terminal (life-limiting) illness that’s expected to result in loss of life within six months or less. The focus of care is on alleviating pain and discomfort, not curing disease or restoring prior levels of health.
    • Why choose it – Hospice is appropriate when a patient has a life-limiting illness that cannot be cured or effectively treated. It’s also suitable for patients with life-limiting severe conditions who decline further treatment. Hospice is an excellent choice when comfort and relief of pain are the main priority, with no intent to cure disease or prolong survival.
    • Level of Care – Hospice care can occur in a patients home, a dedicated hospice facility, a skilled nursing facility, or in an acute care hospital.
    • Pros and Cons Doctors and nurses specially trained in comfort care provide the services. There is extensive support for the patient and family offered by clergy and social workers. Hospice is usually covered by Medicare (and many other insurances) as long as a patient is expected to live six months or less. There will be few, if any, attempts at curing disease or restoring function.

 

 

Stephen Engle, MD

Stephen Engle is a United States-trained physician (M.D.) and Diplomate of the American Board of Internal Medicine who is board-certified in internal medicine. He has experience as a medical director in administrative medicine with the largest private payer in the US, as well as experience in internal medicine at all levels (clinic, urgent care, emergency room, inpatient general and intensive care, clinical consultative medicine, and peer review.)

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