It is an unavoidable fact that many elderly adults will require a hospital stay at some point during their senior years. When the time comes for your elderly parent or relative to be discharged from the hospital, here are some things you’ll need to know.

Coordination and communication between the hospital and at-home caregivers will ensure proper after-hospital care for the elderly.

The goal is to have everything ready for their release as soon as the doctor approves it medically. Additionally, in the late 2010s, a new legislation called the CARE Act was passed in most states that aims to facilitate the transition from hospital to home for elderly patients and their caregivers.

Inform the family caregivers when the loved one is to be discharged from the hospital. Provide the family caregiver with education and instruction on the medical tasks they will need to perform for the patient at home.

Discharge planning helps prevent the elderly from being discharged from the hospital too soon. While only a doctor can officially discharge a patient, the discharge planning is usually accomplished by a small team of people, including a nurse or social worker and the elderly person’s caregiver.

Evaluation of the patient to determine their needs. Discussing the discharge plan with the patient and their caregiver.

Determining what sort of caregiving the patient needs and if it can take place at home or if alternate arrangements need to be considered. The safety of the home will also be taken into consideration.

Often the elderly are weak after a hospital stay and require additional care. It is very important that the caregiver be open and honest about their limitations when discussing discharge so all the elderly patients’ needs can be met.

No, a hospital cannot discharge a patient with nowhere to go. It is unfortunate, but some elderly patients are left without support from their families and are forced to remain in hospitals for extended periods of time due to a lack of alternative options.

Many states are working on plans and task forces to address this challenging situation.

Most patients at UC Davis Medical Center prefer not to stay in the hospital any longer than necessary. Families and friends also want to see loved ones get home rapidly.

They need the beds for that constant flow of patients who require UC Davis Health’s acute-care services, which include highly specialized tertiary and quaternary care. Extreme length of hospital stay – defined as 100 days or more – is not unusual at an academic medical center like UC Davis.

But some patients can’t leave the hospital, even after being medically cleared for discharge. Their hospitalizations can be measured in months, and sometimes in years.

“There’s a perfect storm of factors that keep a number of patients housed in our hospital for extraordinary, unnecessary lengths of time,” said J. Douglas Kirk, chief medical officer for UC Davis Health.

Kirk added that on any given day at the medical center, there might be as many as a dozen patients who’ve been hospitalized for more than three months without the need for specialty nursing care or the expertise of UC Davis’ highly trained physicians. These patients are in health care limbo, stuck in costly hospital rooms because other care facilities – more appropriate to their needs – cannot or will not accept them.

Extreme length of hospital stay – defined as 100 days or more – is not unusual at an academic medical center like UC Davis. A premature infant who requires intensive neonatal care to survive and thrive needs a lot of time in the hospital.

UC Davis Health has unique expertise for these types of lengthy, acute-care cases.

A year or more of unneeded hospitalization is not unusual. One UC Davis patient has been hospitalized nearly as long as a presidential term in office: four years.

Now they have no one and no place to go where their chronic needs can be met. Such patients typically have physical, cognitive, or mental health disabilities, sometimes all together.

They need a certain level of help and care, but not a hospital’s level of care. Finding placement is difficult, and sometimes impossible.

It’s a task that takes case managers at UC Davis Health many months and, in some cases, years of work to find a viable option for placement.

“They involve medical, legal, financial and practical issues that are incredibly difficult and time consuming. The usual paperwork, phone calls and governmental bureaucracies alone are hard enough to navigate on behalf of a patient.

Lonigan noted that the medical center serves not only Sacramento, but it is also the Level 1 Trauma Center for a 33-county area in Northern California, from the San Joaquin Valley to the Oregon border. Securing court-appointed guardians (conservatorships) for those patients without the capacity to make their healthcare decisions, and with no family to act on their behalf, is very challenging locally.

Douglas Kirk, chief medical officer. As a result, the patients remain hospitalized and UC Davis Health absorbs the costs of their unnecessary care day after day, month after month, year after year.

In a hospital that regularly runs at over 95% capacity, each occupied bed is one less available to another patient who needs it.

Other types of facilities offer group activities, interactions with other people, outdoor exercise, and even the fresh air of a walk outside. An academic medical center like UC Davis is not designed for any of that.”.

These costs include transportation, medications, housing, medical equipment and other supportive services such as legal for conservatorship and behavioral health aides to support facilities to accept and manage patient’s behavior. UC Davis Health has seen this financial burden drastically increase in the last 24 months.

It is not surprising that it’s difficult to find a group home or assisted living facility that will accept one of the medical center’s extreme long-term patients. Those who remain at UC Davis Medical Center after being medically cleared are still very challenging to care for.

Other patients are impaired by severe mental illness and may have aggressive behaviors toward others. Both types of patients can have chronic conditions such as diabetes, heart disease or paralysis, which don’t require a trauma center’s expertise but still require close attention and skilled resources, especially when the patient’s decision -making capacity is impaired by their illness.

“We have patients housed without medical necessity, for example, who have such severe underlying psychiatric disorders that they need wrap-around services wherever they live,” said Jessica Vetter, a board certified psychiatric mental health nurse practitioner. “They can also have a chronic medical condition such as dangerously fluctuating sodium levels that require strict dietary management.

Vetter said the combination of mental health problems and the need to carefully manage a chronic medical condition makes it very difficult to find specialized facilities that can adequately manage both. “Facilities won’t take them,” said Vetter, because of the significant staffing resources those individual patients require.

It can also be very difficult for UC Davis Health’s discharge team to find a care facility for adult patients with developmental or intellectual disabilities. Our medical social workers partner with case managers and providers to assure access to any benefits or resources but can meet significant barriers.

“If a person with an intellectual or developmental disability was not enrolled in regional center services before the age of 18, it becomes incredibly difficult to enroll them as an adult,” said Vetter. “These patients are not in the system, as far as government agencies are concerned.

Without those critical specialized resources to support them in the community, patients with disabilities, especially those with no one to advocate for them, can remain hospitalized for months and years.”. Lonigan, who helps oversee patient care services, also added that patients who don’t leave the hospital for months or years can affect the morale of physicians, nurses and other team members engaged in their care.

“Our nurses are trained for critical care, surgical and cancer patients. They’re highly skilled and caring.

“This presents challenges for the shared hospital rooms, where we’re caring for other patients, too.

Additionally, it is better for the patient’s health and wellness to be in an appropriate treatment setting where they can receive care and connect to the support they need in the community.”. UC Davis Health officials point to a number of factors that need to be improved to benefit patients, staff, and the Sacramento community:.

“It’s not good for anyone’s health or well-being to remain hospitalized long after they’ve been treated and healed. It’s also not good for the rest of the community, for the health care costs we all have to pay, and it’s especially unfair to the other patients who need our services and hospital beds.”.

It had been a long day, but Chris Wilson decided to take on one more fare before heading home to Greenwood. He’d been making the rounds driving Uber in Anderson all afternoon on Oct.

Wilson accepted the ride, but what he found when he arrived at the hospital left him shaken. As he waited out front, a nurse rolled his passenger out in a wheelchair – an elderly woman, clad in nothing but a hospital gown, moaning in pain.

It appeared the woman, 59-year-old Tambralyn Hill, was too weak to walk, and hospital staff had to lift her into the backseat of his car, Wilson said. The listed destination was a nearby pharmacy, but when Wilson asked where to take Hill after that, the nurse was unable to offer much guidance.

“They couldn’t tell me anything about where this woman was going,” Wilson said. “I was a little bit shell shocked about it, I was a little bit surprised, but at the same time, I kept thinking to myself, this lady needs help, I need to help this woman get somewhere safe.”.

From the driver’s seat, he agonized over what to do with the sobbing woman in the back of his car. Hill told The Greenville News on Nov.

She said she also suffers from respiratory and digestive conditions. Days after her Oct.

In an emailed statement, AnMed spokeswoman Lizz Walker said the hospital is reviewing Hill’s Oct. 26 discharge after Wilson wrote a post about his concerns on social media.

“While we stand ready to connect patients with many types of assistance, including transportation, prescription access, food, and housing, we also respect the patient’s right to choose when and how they access these services.”.

Certainly, it is not good care and it’s self-defeating care. By getting someone out of the hospital but not in a good place, it’s entirely predictable that they would get sick again and come back to the hospital.”.

The patients are almost always uninsured and unable to pay their medical bills, so extended stays can put additional stress on the hospital’s staff and resources — especially if they’re regularly re-admitted. And most shelters are not equipped to care for someone recovering from a serious illness or injury.

That can lead to situations like the one Wilson encountered, Watts said. In recent years, a handful of states have passed legislation making it illegal to discharge homeless patients before finding them safe and suitable lodging.

When Wilson left the hospital that evening, the sun was waning over Anderson. As he drove, he periodically asked Hill questions and she answered, but mostly, she kept her eyes tightly shut and wept.

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Here’s our special offer. When he arrived at the pharmacy, it had just closed, and he set about trying to find a place for Hill to stay.

When Hurt came out of the house, which sits about 10 minutes away from the hospital, Wilson saw she used a wheelchair and worried she’d be unable to care for her ailing sister. But there was nowhere else he could take her.

Hill couldn’t make it from the car to the front door on her own, Wilson said, so he had to pick her up and carry her into the house. Inside, he placed her in one of Hurt’s spare wheelchairs before he left for home.

“And her sister was pretty angry. She said she was going to call the hospital and basically curse them out for booting her out that way with nowhere to go.”.

She couldn’t walk and was barely able to talk to her sister. “She was hollering and crying the whole time she was here,” Hurt said.

A few days after she was discharged, Hill fell and hurt herself, and her sister was unable to pick her up. Hurt called 911, and an ambulance came and took Hill back to AnMed.

12 — 17 days after Wilson picked her up — Hill sat in her bed at Anmed with two paper-clipped packets she said hospital staff gave her earlier that day — a list of homeless shelters and phone numbers printed on each one. Hill, who said her mounting health issues often leave her disoriented, spent part of that afternoon parsing through the list, trying to find somewhere she could stay when she was discharged again.

She planned to start making calls again first thing in the morning. “I just don’t know what I’m going to do,” she said through tears.

Walker said patient privacy laws prevent her from speaking to Hill’s case specifically, but AnMed refers homeless patients to local shelters such as The Salvation Army and Haven of Rest as needed.

But such agencies are virtually nonexistent in the area.

“It is a very, very big need.”. In another emailed statement, Walker said the hospital — which spent an annual average of $16.7 million on charity care between 2016 and 2018 — sometimes delays a patient’s discharge for nonclinical safety concerns, such as housing arrangements.

According to Watts, developing comprehensive discharge plans for homeless patients on the front end can dramatically cut down on costs to the hospital in the long run. A 2006 study published in the American Journal of Public Health found in a survey of 225 hospitalized homeless adults that those with access to respite centers like Cook’s are less likely to be re-admitted after discharge.

It is difficult for a patient to recover from an acute medical problem or serious injury while living on the street or in a homeless shelter that lacks the resources to properly care for them, Watts said. “If you don’t have a place to live, you have to deal with that illness, but without any comforts or even necessities,” he said.

Respite care allows homeless patients to recuperate fully, potentially avoiding future hospital visits, as well as connecting them to a continuum of other services.

New Horizon Family Health Services operates the all-male, six-bed center out of Miracle Hill’s Greenville Rescue Mission. The respite care facility came about after roughly six years of coordination among homeless service providers in the area who recognized the county’s dearth of a transitional medical facility as a serious issue.

Since January, the center has served just more than a dozen patients, including a man who stayed at the facility for more than 200 days after he was struck by a semi truck. Cook said the program, which is funded entirely through federal grants, is growing steadily, but more is needed to meet the Upstate’s need.

After Hill was re-admitted to AnMed, Hurt said one way or another, she hopes her sister gets the assistance she needs. “Tammy needs help,” she said.

Tazha Zeira left Harrison Medical Center with nothing but the paper clothes she received in the emergency room. Zeira says she wasn’t even wearing socks.

Homeless and suffering an assortment of health problems, Zeira had gone to Harrison’s emergency room two years ago seeking help.

Bedsores covered her lower back, the result of Zeira sitting in her motorized wheelchair for prolonged periods. Her clothes were soiled after spending several days unsheltered and without anyone to help her go to the bathroom.

But after an overnight stay in the ER, Zeira was sent back to the streets. “She was discharged from the hospital to the street as there was actually no place for her to go,” reads a doctor’s note in Zeira’s medical records.

A cabulance first took Zeira to Harrison’s wound care clinic across the street from the hospital, where health workers dressed her in medical scrubs and socks. But that happened after an advocate accompanying Zeira protested to staff, according to allegations in a whistle-blower complaint.

Zeira says she spent the night sleeping outside. the Salvation Army’s winter shelter had closed for the season.

“You feel like a piece of garbage that no one cares about.”. That practice was common at Harrison Medical Center, according to Zeira, who says she was often discharged by the hospital only to be dropped off without any care.

She remembers being left in spots around downtown Bremerton, like behind the Salvation Army or at the parking lot of the nearby 7-Eleven, regardless of whether the city’s homeless shelters were open or had filled for the night. More:Washington state sees first virus death in U.S., declares emergency.

Harrison officials disputed claims about discharging patients in paper hospital clothes. They say hospital staff work diligently to discharge homeless patients safely, helping connect high-risk patients to local resources, housing programs and shelter options, even as the challenges of homelessness go far beyond medical care.

But according to homeless advocates and staff at Bremerton’s two downtown shelters, that isn’t always the case. Instead, they say it’s all too common for the hospital to drop off homeless patients with little plans for where they might land.

Harrison’s discharge process has been a longstanding frustration for homeless patients, advocates and shelter staff, drawing concerns about “patient dumping” — a practice where hospitals dump off patients to the street or shelters without plans for their recovery.

In Arizona, the case of a mentally impaired man found at a bus stop with an amputated foot prompted a state investigation, the Arizona Republic reported. Complaints against Harrison Medical Center have resulted in at least two investigations by the Washington State Department of Health, one of which found the hospital ”failed to implement safe and effective discharge plans.”.

Just five days prior to her ER visit in May 2018, Zeira spent a two-week stint at Harrison for several health issues, according to hundreds of pages of medical records reviewed by the Kitsap Sun.

doctors repeatedly noted how living on the streets had worsened many of her health issues, including the wounds on her feet. Medical records indicate conversations about placing Zeira in a long-term nursing facility, but Zeira says she was told those plans fell through because of her history of drug abuse.

Discharged to home.” It’s unclear where Zeira was initially discharged. medical records don’t include a drop-off spot and Zeira couldn’t remember.

But what is clear: Zeira would quickly end up unsheltered and alone. She was found in her motorized wheelchair, where she had been sitting in her own feces for several days.

Zeira’s story was one of three similar cases outlined in a 2018 whistle-blower complaint to the state health department — allegations that triggered an investigation early last year into how Harrison hospital discharges high-risk patients.

State health investigators ultimately faulted Harrison’s discharge planning for several deficiencies.

“Failure to do so created risk that post-hospital care would be implemented that was not adequate to meet patient needs and/or may result in patient harm,” stated the investigation’s report. For example, state investigators reviewed the case of one patient who was admitted for dehydration weakness and fatigue.

In the middle of the patient’s stay, one nursing care manager noted, “No (discharge) barriers identified,” according to the investigation.

A second state investigation later in 2019 — stemming from a complaint about discharging “a confused patient” back to poor living conditions — found no violations on Harrison’s behalf. Instead, investigators reported that Harrison followed its policies and procedures, working with Adult Protective Service to provide support for the patient.

Lori Kerr, Harrison’s case management director, says the hospital works closely with individual patients to figure out their needs after exiting the hospital.

We don’t just go, ‘Here we go you are out on the streets,’” she said. “Our goal is to place them in a safe discharge situation.”.

Those issues haven’t gone away. At the Bremerton Salvation Army’s winter shelter, staff have ended up performing a variety of tasks usually performed by health care workers, like cleaning open wounds, emptying colostomy bags and fixing catheters, said shelter manager Dawn Michele Wilson.

Wilson says the Salvation Army shelter gets medically fragile patients, usually from Harrison hospital, every month or so. “Harrison tends to look at us as their aftercare,” she said.

Staff at the Kitsap Rescue Mission, the other homeless shelter in downtown Bremerton, reported similar experiences.

“If we look at the 100 people who are going to be in our dayroom today, probably around 10 percent of them really aren’t people we should be taking care of because of medical issues,” said Nate Sylling, the Kitsap Rescue Mission’s operations director. “But we are gracefully catering to that because there is no where else for them to go.”.

The Kitsap Rescue Mission has only 26 beds and requires guests to call ahead each morning to get a shelter bed. But staff say Harrison has routinely dropped off patients without calling ahead, though they are not the only health care provider to do so.

Sanders recounted one instance this past fall where a man with a degenerative brain disease was dropped off at the Kitsap Rescue Mission still wearing Harrison’s hospital clothes. No one had called to reserve a bed for the man.

So we took him in,” Sanders said. “He had no plan to go.

That’s long been the case at Bremerton’s downtown shelters, according to Sheryl Piercy, Salvation Army’s former social services director, who said discharged Harrison patients would show up all hours of the day, often without any warning.

Just standing there,” she said. “And that’s what we got.”.

“I’m not aware of anyone providing anyone with a paper gown,” Kerr said. The hospital typically offers several discharge options, Kerr said, depending on a patient’s insurance or what services they are eli.

EDITOR’S NOTE: This report first published April 4, 2022, won an Emmy at the most recent 2023 Southeast Emmys. CONYERS, Ga.

When police arrived, they found 68-year-old Jerry with tubes still attached to his body. “Looks like he just came from the hospital but he is passed out on the ground, near the stoplight, the stoplight.” The 911 caller continued, “he’s not responding.

Police, fire and EMS responded to the scene on Oct. 14, 2021.

The police department was so outraged by what happened, Deputy Chief Scott Freeman spoke out, saying “a regulatory body needs to take a look inside to see what’s going on inside this hospital.”. CBS46 Investigates team started digging to find out what happened to Jerry and uncovered a history of patients being discharged unsafely.

The New Orleans native has weathered the worst storms, from Hurricane Katrina to cancer. His loved ones say this heartbreaking incident feels nearly as traumatic.

One, that they would do it in such an inhumane way, and number two, that they didn’t call anybody,” Jerry’s roommate told CBS46. Surveillance video shows at 10:17 a.m., Jerry was wheeled out of his Piedmont Rockdale Hospital room.

22 minutes after first being taken from his room, Conyers Police responded to the report of Jerry being found unconscious on the sidewalk. “Oh my god.

“Fire rescue personnel as well as EMS personnel..their initial response was he needs to be in the emergency room.”. In fact, Department of Health and Human Services (HHS) documents show earlier that day, a nurse at Piedmont Rockdale told a director that Jerry was too weak and that she ‘can’t believe he was being discharged.’”.

According to his roommate and beloved family friend “his Medicare and Medicaid coverage ran out. I think they can only home him for 30 days so on day 30—out the door he went.”.

In the report obtained by CBS46 Investigates, it says ‘Jerry had been in the hospital approximately 35 days.’ Claiming, ‘he was homeless and just staying to have a place to stay.’ Adding, ‘he’d been cleared as fit by two physicians and the hospital wanted him gone.’. Jerry’s roommate says he was not homeless, that she took him to most of his medical visits throughout the years.

“I shouldn’t have to sit and tell a room full of doctors and nurses you don’t discharge a person having a medical issue that needs to be hospitalized.” Deputy Chief Freeman questioned, “Why does the police need to do that. ”.

We uncovered records showing HHS investigated Piedmont Rockdale four times related to discharging between 2007 through 2017. Inspections were initiated due to complaints, at the time of on-site visits, reports note the facility was in compliance.

“If you had to quantify, how many would you say,” CBS46′s Ciara Cummings asked the deputy chief. “It’s hard, it’s hard to quantify.

Local advocate and former nurse Claire Thevenot says there are rules hospitals are required to follow. “The primary tenant of discharge is they have to be discharged to a safe environment,” Thevenot said.

“In a lot of ways they think they’re doing the patient a service, too.” Thevenot explained from a hospital’s perspective, “’Oh, we don’t want to keep him here at the expense of a big hospital bill, their insurance isn’t going to reimburse them.’”. Regardless of intent or insurance issues, hospitals must follow discharge policies to remain in compliance with The HHS Centers for Medicaid & Medicare Services (CMS).

Policies to which HHS found Piedmont Rockdale did not adhere. CBS46 began requesting HHS records related to Piedmont Rockdale’s dangerous discharge concerns starting Jan.

By Jan. 27, HHS identified the site as a hospital in ‘immediate jeopardy.’ Citing it, ‘failed to ensure their discharge planning was enforced and followed.’ According to the HHS report completed on Jan.

The HHS Centers for Medicare & Medicaid Services (CMS) told CBS46, the Rockdale facility has now achieved substantial compliance as of Feb. 22.

Our requests have gone unanswered. However, back in October, when Conyers Police initially made allegations against the hospital, Piedmont issued this statement.

We do our best to connect patients in need with community partners and social service organizations to provide appropriate after-hospital care, but ultimately accepting these services is at the discretion of the patient. CMS advises that if you feel as if a hospital discharged you or a loved one too early, file an appeal or a complaint.

Additionally, filing a complaint about a safety concern against a hospital, regardless of your insurance, can be done through The Joint Commission, a national accrediting body in healthcare. The full list of state hospital policies can be found here.

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