By Lynn Heatley. In the healthcare profession of discharge planning and case management, we know the importance of explaining all the possible options to a patient and their family or DPOA in order to help them make the most informed decision. This summary is designed to assist you in your conversations with your patients and families.

If the Patient is Expected to Recover at Home

1. Discharge to Home; Patient is able to care for self without further assistance – If a patient is able to care for self after their hospitalization, they are simply discharged home with any medications and/or medical equipment that will be needed in the recuperation or ongoing management of their disease or recovery.
2. Discharge to Home; Patient needs some additional assistance in recovery
3. Home Health is often used to assist patients who might need some additional help with IVtherapy, Wound Care, assistance with new Stomas, Physical, Occupational or Speech Therapy or Social Services. Home Health is covered by insurance plans but might have a co-pay associated with it, so check with your discharge planner for specific information.
4. Support Services at Home are agencies within every community that are hired by the family to come in and assist the patient with personal hygiene, supervision, transportation and a variety of other needs. Usually the agency requires a minimum of a 2 hour shift (some agencies require a minimum of 4 hours). The usual hourly rate can vary between $16-22 per hour. Most agencies also provide 24hour care for a reduced rate. This service is not paid for by your healthcare insurance but might be covered if the patient has a long term care policy (otherwise, the patient/family is responsible to pay for these services). Your discharge planner can give you information on these helpful agencies.

If the Patient Needs Ongoing Assistance and Can No Longer Be Alone

1. Family becomes the role of caregiver and oversees care of the patient at their home or at the family member’s home. Medical equipment can be brought in to assist the patient at home. Community classes are available for the family to become more skilled in the area of caregiving.
2. Patient transfers to a Board & Care Home (homes located in communities that house up to 6 residents and have around the clock caregivers present to assist patients with all of their needs along with meals). The patient can not have skilled needs requiring a nurse (Feeding tubes, IV’s, Ventilators, etc) in a Board & Care home. If the patient is on Hospice and the Board & Care home has a “Hospice Waiver”, the Board and Care can take some patients that have more skilled needs (the waiver means that they are able to care for patients who are more toward their end of life and have additional skilled needs). The base cost of a Board and Care Home usually ranges from 2,000-4,000 per month. There are good Board & Care homes in every community; ask your discharge planner for a list. The cost to reside at a Board and Care home is not covered by healthcare insurance but may be covered if the patient has Long Term Care insurance.
3. Patient transfers to an Assisted Living Center. These facilities are larger with more residents and provide social activities and meals and also 24 hour assistance with any personal needs. They are not licensed to take patients with Skilled Needs (Feeding tubes, IV’s, Ventilators, etc) although if they have a hospice waiver, they might be able to take patients with some skilled needs. The base cost for Room & Board usually ranges from 3,000-5,500 per month, and increases with additional skills that are needed. The cost to reside at an Assisted Living Center is not covered by healthcare insurance but may be covered if the patient has Long Term Care insurance. There are many good Assisted Living Centers in every community; ask your discharge planner for a list.
4. Patient transfers to a Skilled Nursing Facility. Skilled Nursing Facilities have trained healthcare personnel to care for patients with skilled needs (Feeding tubes, IV’s, Ventilators, etc). If the patient has Medi-Cal, the room and board may be covered. If the patient has Medicare or another form of private insurance, the patient or family is responsible for payment of room and board. The cost to reside in a Skilled Nursing Home usually ranges from 5,000-7,500 per month. There are many good Skilled Nursing Facilities in every community; ask your discharge planner for a list.

The decision to have a loved one receive care from another person or caregiver or to live in another location is not an easy decision to make. Talk with your discharge planner or social worker with questions you might have regarding these options or any other concerns you might have.

A Definition of Terms and Pathways

Essentially, there are 3 Pathways in healthcare. The first pathway is directed towards CURE. The second pathway is directed towards PALLIATIVE CARE and the third pathway is directed towards comfort with HOSPICE. Here are some simple ways to look at the 3 Pathways:

1. CURE / HOSPITALIZATION– The majority of people within the healthcare system are on this pathway. It involves ongoing medical care through your doctor and, when needed, hospitalizations and other aggressive measures designed to cure whatever ailment is presenting. This also involves preventative care and rehabilitation services.
2. PALLIATIVE CARE- is specialized care for people with serious illnesses. It is focused on providing patients with relief from the symptoms with the goal of improving quality of life for both the patient and the family. Palliative care is provided by a team of doctors, nurses, and other specialists that provide an extra layer of support alongside the patient’s regular medical team. It is appropriate at any age and at any stage in a serious illness and can be provided along with curative treatment. Ask your discharge planner if you desire to pursue Palliative Care and continue with aggressive care along with symptom management for pain and other areas.
3. COMFORT / HOSPICE – Hospice care is for a patient who has a terminal diagnosis and no longer desires curative & aggressive measures. Hospice care focuses on relieving symptoms, pain management and supporting patients who are expected to live for months, not years. Hospice care can be provided at: a Home, a Residential Care Facility (Board & Care or Assisted Living), a Skilled Nursing Facility and at a Hospice Inpatient Unit. The Hospice team consists of a team of doctors, nurses, social workers, chaplains and other specialists who work together to provide support to the patient and the family. Hospice is covered 100% by MediCare and MediCal. Most Private Insurances also cover Hospice services (sometimes with a co-pay).

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