A healthy send-off: Top questions to ask before being discharged from the hospital

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Being discharged from the hospital can feel a bit like falling off a cliff, says Rachel Miller, assistant manager of social services at Saint Francis Medical Center: You go from having a whole network of health-care professionals taking care of you in the hospital, to being home alone and responsible for your own care, which may include a confusing new set of medications and symptoms.

But hospitals also have a network of people working to make sure patients have all the information and resources they need to recover at home and avoid readmission to the hospital.

"The discharge process begins when they get here. We start that process of finding out what may be needed," says Pam Buchheit, a social worker at Southeast Hospital. "We want them to be successful when they leave here, to have a successful discharge."

Julie Metzger, director of case management at Southeast, explains that most patients don't stay in the hospital until they feel 100 percent; they stay until their conditions can be managed at home or another facility, such as a nursing or rehab facility.

"You do have needs when you leave, and many people are surprised at that when they're discharged," she says.

Hospital staffers urge patients to be upfront about their concerns and not be afraid to ask questions.

"If you're not understanding something, it's better to ask than go ahead with the wrong thing," Miller says. "Some people do feel like, 'I shouldn't question anything, that the doctor or nurses know more than me, I should just take this and walk away.' But we're open to those discussions."

These discussions also can help patients avoid obstacles to their recovery, such as an injury or illness that could result in another hospital stay.

Here are some important questions to ask before leaving the hospital:

* Do I have any dietary restrictions?

* Will I need any medical equipment? If so, where can I get it, and can I afford it?

"Sometimes people are afraid to ask whether they need home health or other equipment -- they're not sure, they think it could be helpful, but they don't know whether it would be covered or if it's appropriate," Miller says. "You won't know if you don't ask. If you feel that you need a service, case managers and social workers can check and see, and let you know if your insurance would cover it or if it would be affordable. There's never any harm in asking."

You may even be able to arrange for equipment to be delivered to the hospital so you can take it home with you, instead of making a separate trip to pick it up, says Vicki Frank, case manager at Southeast.

* Can we go over all of my medications? If you were already on medications and are being sent home with new medications, it's important to clearly understand what all of the medications are, along with the dosage.

"Every patient is sent home with a discharged medication list, and it may be different from the home medications they were taking before they were let in the hospital," Miller says. "Follow the new medication list as opposed to the old list."

Medication costs are an issue for many patients. If you leave the hospital and go to fill a prescription, only to find out you can't afford it, call back and let the hospital know -- or, better yet, bring up your concerns before leaving the hospital, Frank says. The hospital can offer direction in finding more affordable medications, such as using generics when possible, using coupons from pharmaceutical companies or checking to see if your medications are on the $4 list at any pharmacies.

Also, keep in mind that the hospital does discharges at all hours of the day. If your usual pharmacy will be closed at that time, make arrangements to get your medicine elsewhere so you won't miss a dose.

* What signs and symptoms do I need to watch out for? Or, how do I know if I need to come back to the hospital?

"Make sure to stay on top of your symptoms ... and know when to contact your primary care physician or home health nurse so it doesn't get so serious that you have to be back in the hospital," Miller says.

Being able to make this distinction could also help avoid the financial burden of another hospital stay, she adds.

"Sometimes patients come back with something that could have been managed at home, and other times they wait, when something to prevent it could have been done," Metzger says.

* What resources are available to help me? Ask about any support groups, community services or other resources that could make your recovery go more smoothly.

* When are my follow-up appointments? Saint Francis sends patients home with yellow cards detailing appointment times, dates and contact information, Miller says. If you think you'll have trouble remember the appointment or finding transportation to get there, now is the time to express those concerns so the hospital can make sure you don't miss an appointment.

* Can we review my disease process? If you don't understand your diagnosis or don't know what a term means, don't hesitate to ask.

A few more things to keep in mind:

* You may want to bring a friend or family member. "It's always better to have two sets ears than one," Miller says. "If you have a family member or friend who will be helping you at home, now is an important time for them to go over all that stuff with nurse -- medications, diet, things like that."

* Have a health-care directive in place. It's important to make your health-related issues known and decide who will be the decision-maker if you're ever unable to do so. If you have questions about doing this paperwork and getting it into the right hands, your hospital social worker or case manager can help.

* Know your benefits. If you haven't spent much, or any, time in the hospital, you may not be familiar with exactly what your insurance or Medicare covers. For example, "More and more people have long-term care insurance," Frank notes. Review your benefits every so often so you know what's covered.

* Don't be afraid or embarrassed to admit you need help. Many times patients wait too long to bring up a concern, and by then it has become a "huge ordeal," Buchheit says. Be honest, she says, because "we can help keep it from becoming a crisis situation."

Patients may not want others to know their limitations, such as being hard of hearing or needing care at home. But the hospital staff needs to know what your home environment is like so they can provide proper care.

"We're not trying to be nosy or cast judgment when we ask these questions; we just want to know your situation so we can find the resources to help," Metzger says.