Pushing Back Against Unsafe Discharges

By Lauren Moore, Marketing and Communications Manager, BIAA

Depending on the severity of a person’s brain injury, an extended hospital stay may be necessary in order to monitor the patient’s condition and prevent further medical crises. The hospital will have social workers or case managers on staff to help the patient, their loved one, and their medical team determine options for discharge, such as whether a patient should be sent home or if the patient would benefit from transitioning to post-acute rehabilitation, such as a transitional/residential facility, or specialized rehabilitation such as a neurobehavioral unit or substance abuse treatment program, before returning home.

Actively participating in the decision-making process about discharge means the patient and their family or caregiver will be better prepared to make informed decisions and take advantage of the resources available to them.

Because external factors such as health insurance and a person’s financial situation can heavily influence discharge decisions, it is imperative for the patient that their family and loved ones advocate for their well-being and push back against premature or unsafe discharges. Although hospitals may be under pressure to discharge patients quickly in order to make space for other sick or injured patients, existing patients who leave before they are healed, or without having proper accommodations in place for post-acute care, are at risk of further injury, delayed recovery, or being readmitted to the hospital.

Be sure to review any insurance coverage the patient has to see if home care, including home health aides, visiting nurses and physicians, or transportation assistance to inpatient, outpatient, or transitional/residential rehabilitation, is covered.

Some patients may be protected against premature or unsafe discharge under a patient’s bill of rights. Many states, insurance providers, and health care facilities have their own patient bill of rights. For example, in New York State, patients have the right to identify a caregiver who will be included with their discharge planning and sharing of post-discharge care information or instruction, and to participate in all decisions about their treatment and discharge from the hospital. As well, the hospital must provide the patient with a written discharge plan and a written description of how to appeal a discharge. Patients who receive services via Medicare have the right to a fast appeal. With a fast appeal, an independent reviewer will decide if a patient’s services should continue. A patient may be able to stay in the hospital while the reviewer looks over the case. The hospital cannot force a patient to leave before the reviewer reaches a decision.

A patient’s bill of rights can vary from state to state or institution to institution, so it is important to determine whether or not the patient is covered by such protections and, if so, what those protections are.

What to Ask

When discussing the patient’s discharge planning, it’s important to be prepared and gather all the information necessary. Here are some questions to ask the hospital staff:

• Who decides when my loved one is ready for discharge, and how is the decision made?
• Do you have an appeals process in place, and how does that work?
• What is my/our family’s role in the decision-making process?
• What are all of the care options available to us now and in the coming weeks and months?
• What factors could extend or shorten the anticipated discharge date? If the date changes, what sort of notice will we be given?
• What happens if the patient’s discharge option is not viable? For example, if the program or facility that is right for the patient has a waiting list, or if we are unable to provide care or modify the home to accommodate the patient’s needs?
• How can I access a complete set of records for my files upon discharge? Is there a charge for this?

What Pushing Back Can Look Like

When a family member sustains a brain injury, things can feel overwhelming. Navigating a loved one’s medical care and finances, making a home more accessible, and preparing for potential physical and behavioral changes is a lot to take on at once. Fortunately, the National Brain Injury Information Center, operated by BIAA, is available to help. Here’s how NBIIC helped one mother advocate for her son’s best interest:

In 2022, the mother of a young man who sustained a brain injury in a motor vehicle crash called the NBIIC hotline. She needed help understanding the medical terminology being used by hospital staff, and wanted to figure out what to expect in the days and weeks to come. NBIIC operators shared information that would help her understand more about brain injury.

A couple of weeks later, she called again. The hospital was pushing her to take her son home, but she was concerned that his needs were more than she could handle as a single parent. NBIIC suggested she tell the hospital that sending him home would be an unsafe discharge, and that she would work to find a suitable alternative.

The next time she called NBIIC, she thanked them, and said that getting advice from a trusted source helped her feel like she was doing the right thing for her son. The hospital found a facility nearby that could take him, giving the mother the opportunity to visit her son regularly and continue advocating for him. She also felt the additional therapies he would receive in a facility would allow him to improve enough to come home safely with her.

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This article originally appeared in Volume 17, Issue 3 of THE Challenge! published in 2023.