Winston-Salem Senior AdvisorWhat should we ask before a parent is discharged from a Winston-Salem hospital?
Ask the case manager three things on day one: whether the stay is inpatient or observation, what level of care the team recommends after discharge, and which nursing homes, home health agencies or adult care homes they have already contacted.
Inpatient status for at least three days opens Medicare's skilled nursing benefit; observation does not, even if the patient sleeps in the same bed. The recommendation tells you whether you are looking at short-term rehab, home with home health, or a move to an adult care home. Ask for everything in writing and keep a notebook of names, dates and what each person said.
Can we choose the rehab facility after a hospital stay?
Yes. Medicare patients have the right to choose among facilities that have a bed and accept them, and the hospital must give you a list; Medicare Advantage members choose within the plan's network.
Don't accept the first bed offered without looking it up. Each nursing home in our directory shows its CMS ratings, latest survey, staffing and turnover against the five-county median. Distance matters as well: rehab goes better when family can visit often, ask questions and push for therapy.
What if our parent can go home but needs help?
Ask the doctor to order home health if your parent is homebound and needs skilled nursing or therapy, which Medicare covers, and arrange private or family help for the hours home health does not cover, such as bathing, meals and nights.
Home health visits are short and taper off. If your parent needs someone there for several hours a day, line up a licensed home care agency before discharge, not after the first bad night. In Forsyth County, Senior Services Inc.'s Elder Care Choices Help Line (336-724-2040) can explain local options, and Meals-on-Wheels can start quickly for eligible older adults.
What if an adult care home is the right next step?
Ask the hospital to complete an FL-2 before discharge, because North Carolina adult care homes need one for admission, and start calling homes that have openings and can meet the care needs on the form.
Be honest with each home about the care your parent needs, especially at night and with medications. If money is limited, ask in the first call whether the home accepts State/County Special Assistance. Our assisted living roster lists every licensed home in the five counties with its state star rating and fines.
What if we disagree with the discharge plan?
Medicare patients can appeal a hospital discharge they think is too early by following the Important Message from Medicare notice the hospital must give them, and the hospital generally cannot discharge them while a timely appeal is reviewed.
Most disagreements are settled before that by asking for a care conference with the doctor, nurse and case manager. Say plainly what you are worried about, such as stairs, an empty house at night or a spouse who cannot lift. The aim is a safe discharge, and the team shares that goal.
What it is, and what it is not
| A safe discharge plan includes | A rushed discharge plan leaves out | |
|---|---|---|
| Status | Confirmed inpatient or observation status | The question of Medicare coverage |
| Setting | A chosen rehab, home health agency or adult care home | Whatever bed was free first |
| Paperwork | An FL-2 if an adult care home is next | The form that adult care homes require |
| Help | Named people for nights and weekends | Who will be there after 5 p.m. |
Based on N.C.G.S. Chapter 131D, 10A NCAC 13F and 13G, DHSR and NCDHHS documents, NC Medicaid, CMS, the VA, CareScout and the local agencies named above; see our editorial standards for how each is checked.
