Discharge from the hospital or a rehabilitation stay can be scary, confusing, and overwhelming. Things move fast, and lack of preparation can lead to unsafe outcomes.
Join Elder Care Advocate Laura Daniels, RN, as she provides an essential discharge planning checklist and walks you through every step you need to take for a safe transition home or to a new care setting. Learn how to advocate for yourself or your loved one from day one, what to expect during a hospital stay, and the key questions to ask your medical team regarding medication, follow-up care, and recovery support. Laura emphasizes that the most important care happens after the hospital stay and offers a free Medicare discharge checklist resource to ensure you're prepared.
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Learn the stages of a hospital stay and how to navigate the system.
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Understand the importance of proactive, day-one discharge planning.
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Discover key action items, like coordinating equipment, follow-up appointments, and support services for the crucial first 72 hours at home.
Chapters
00:02 Introduction to Navigating Elder Care with Host Laura Daniels, RN.
00:20 Laura's background as an Elder Care Advocate and founder of Care Advocates.
01:16 Care Advocates' process: Customized care planning and options (assisted living, memory care, in-home care).
02:38 Today's Topic: The overwhelming moment of hospital or rehab discharge.
03:32 Introduction to the Discharge Planning Checklist and key action items.
04:02 Offer for a free, four-page Medicare Discharge Checklist.
04:47 What to Expect During a Hospital Stay: Understanding the process.
05:27 Stage 1: Admission (Emergency Room vs. Planned Admission).
06:36 Stage 2: The Inpatient Phase (Specialists, Vitals, Rounds, Task-Driven Care).
07:44 How to Advocate for Yourself or a Loved One.
08:46 Key Questions to Ask from Day One: Plan, goals, concerns, therapy.
09:14 Taking Ownership of your admission and outcomes (bring a notebook!).
10:04 Asking about medication changes and starting discharge planning on day one.
10:48 Your Rights: Speaking up if you don't feel ready for discharge.
11:29 Questions to ask about the post-discharge plan (rehab, SNF, home health).
12:20 Hospital stay is a temporary stop; focus on what comes next.
13:42 Why Discharge Planning is Crucial: High risk of readmissions and complications.
14:50 The patient/caregiver is a key partner in the discharge process.
15:40 Overview of the Medicare Discharge Checklist components.
16:05 Checklist items: Home assessment, follow-up appointments, transportation.
17:04 Support Services: Home health, meal prep, and community resources.
17:34 Equipment and Medications: Ensuring they are ordered in time.
17:54 Emergency plan and 24-hour contact list.
18:28 The Crucial First 72 Hours post-discharge and need for support.
19:5 6Skilled Nursing Facility (SNF) discharge considerations.
20:25 Resources & Next Steps: CMS checklist, referral service contacts, Medicare helpline.
21:18 Final encouragement and a client story about an unsafe discharge.
22:39 Outro: Contact information and services offered by Care Advocates.
24:07 Free Consultation and contact details: 210-669-2222.
25:06 Closing remarks.
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