“Your Parent is Being Discharged Today” — Oh No!

I don't know what it is about Friday's but every week we get a phone call from a stressed and desperate adult kid who is on the verge of tears. They just received a phone call and were told that their parent is being discharged from a hospital or a sub acute rehab today and they are going to need help at home. Perhaps they just now picked up the message from the previous day. Or maybe because you work 60+ hours a week, raise your own kids, worry about mom living at home alone while you are squeezing in visits to the hospital to see dad, you just might have missed the call?! Either way, the adult kid, who is usually the primary caregiver, is in panic mode.

I always fight back my immediate reaction when I get calls to our home care agency like this. I want to respond "Why in heaven's name are you calling us now?! This is your parent! It's not like you are shopping to fix a faucet or a heater?!" I do get frustrated when preventable things happen--key word here is preventable. Both parties are responsible--the healthcare provider and the primary caregiver. But life is not perfect and instead of pointing fingers, let's talk about how to avoid situations like this and the one key person that is vital to helping you.

Per my experience, a decision to discharge someone from a hospital or a sub acute rehab is not made in a vacuum. Usually all providers (physicians, nurses, therapists, social workers, etc) involved in someone's care during their stay will meet at least weekly to review their progress and make recommendations. Family members can be invited to these meetings, especially the one that discusses discharge. Everyone is busy--especially in a hospital setting. You have to keep asking about when these meetings are taking place and whether or not you can join in on them. It is one of the most important thing you can do to prepare for the discharge.

Many factors are considered when determining whether someone is ready to go home--response to medical, physical, and occupational therapy, for example, is a major factor. Medicare benefits is usually another major factor that impacts the length of the stay. I am no expert on Medicare so I refer to the experts--and there are plenty of resources out there (check out a Diane Daniel's podcast on Medicare Medicare Nation Podcast Website). The more you know, the better position you'll be in tomake the right decision without as much emotion. I know a leaky faucet or a heater on the blitz can be emotional, but we're talking about caring for our parents. Recall what you went through if you ever had to hire a babysitter for the kids or your pet.

What may sound a little absurd, but is a necessity, for a primary caregiver to think about from the very minute a parent is admitted to a hospital or sub acute rehab in any situation, is that entrance = exit. You must start planning for their discharge from this point. There are many questions to think about: What is now going to change for mom or dad? Is their home safe? Will we need to make some home modifications? Will we need extra help? Can we afford it? Does insurance cover it? Can I take days off to help out? Can any other relatives, neighbors, friends chip in? The good news is that some of this can be planned out in advance and you can prevent a lot of stress for yourself and your parent. There is one person available to you that you need to get to know.

The professional who is usually your "go to person" in the hospital or sub acute rehab setting is the social worker. They may also be known as the case manager and especially during discharges, the discharge planner. You most likely met them coming in on the first day. But you forget about them. Who is to blame you? Think about that first day--probably a fall or medical condition created an emergency situation, you're rushing mom or dad to the hospital, you have a million things going through your head (who is going to watch the kids, can I miss work, what about the other parent, and oh yeah....is mom or dad going to be okay?!). You probably met a few people on the first day--various physicians, nurses, admission director, nutritionist, physical therapist, etc etc. Hard to keep straight. Believe it or not, the most important person for you to remain in contact throughout the entire stay is the social worker. They will help you make your life easier and avoid that dreadful call to tell you your parent is suddenly going home. Here are 5 reasons why, based on my experience, you should be speaking with your social worker throughout your parent's stay:

  1. They know medicare. The are very familiar with medicare benefits and can explain them to you in layman's terms. They can also point to other resources so that you can be more knowledgeable and prepared for what medicare pays for and what it doesn't.
  2. They are usually "in the know" with mom or dad's care. They are kind of the glue with all the moving parts. And if they don't know, they can find out probably faster than you trying to hunt down each individual.
  3. They are usually soothing--I know this sounds weird, but a real good, experienced social worker has the ability to put you more at ease by spending time with you, educating you, helping you think through options, share many resources, and hold your hand through what can be a very emotional experience.
  4. They can be the voice of reason. You can be the best kid ever that a parent raised, but during emotional times, a parent may not want to listen to what their kid has to say no matter how rationale. A third party, someone who is credible and trustworthy, like a social worker, can be the last ditch effort to make sure mom or dad agree to the care they need when they go home.
  5. They know people. An experienced social worker has worked with many professional providers in every aspect of health care for seniors--medicare home care providers, private duty home care providers, hospice, physical therapy, skilled nursing, etc. Usually if you are told that mom or dad needs help at home, and as a caregiver, you need to hire help to do that, a social worker can provide you a list of reputable health care providers. The list can be daunting. You just want them to point to one. Professionally and even ethically, they shouldn't do that. But I get it. You don't have a lot of time to make the phone calls down the list. You are overwhelmed with decision making. So perhaps try asking your social worker the following "If you needed help for your mom or dad, which three would you call first?". A social worker may or may not respond to that, but it's worth a try. Or you can ask "Which three have you the most experience with?". Three is certainly better than throwing a dart at a dozen.

A caveat to having a social worker accessible to you at all times is....they are not so accessible. Think about their day. They are either on the phone or having in person meetings all day long with patients, family members (sometimes many of them!), providers, other social workers, etc. So building a relationship with your social worker from day one, respecting each other's time and needs, communicating efficiently and effectively, and researching the resources they provide you will help you prevent that dreaded phone call and you will be in a great position to help care for your parents.

To learn more about social workers, you can check out their website National Association of Social Workers. If you would like more tips in helping you prepare for how to care for your parents, check out Raising 'Rents (as in paRents) Podcast. Not familiar with podcasts? Here's a beginner's guide if you want to learn more. Wired article The beginners guide to podcasts.

- Zack Demopoulos