How Healthcare Advocates Can Prevent Unsafe Discharges

How Healthcare Advocates Can Prevent Unsafe Discharges
| by Anne Llewellyn

By Janet Beesting Nelson, RN, BSN, BCPA, Healthcare Advocate from Ormond Beach Florida.

Failed discharges happen all too often. Hospitals are busy places, and case managers and discharge planners are pressured by administration to move patients quickly. There are a lot of factors that play into this culture, but in the end, it comes down to money.

Because of the financial need to “flip beds”, discharge plans can change very quickly, and oftentimes patients are discharged without appropriate orders for follow up care, home health or outpatient services, or appropriate durable medical equipment (DME). It is not uncommon for a patient to be discharged to home even when inpatient rehabilitation is appropriate due to lack of insurance coverage or lack of bed availability at skilled nursing facilities (SNFs). Discharge teaching can be rushed and incomplete, with patients and families having little notice of discharge intentions. Patients and families get the feeling they are being “kicked out” before it’s safe to be discharged. They’re not wrong.

Even if you are having a satisfactory stay in a hospital and are very happy with your care, everything can fall apart at discharge. That’s why it’s wise to hire an independent professional healthcare advocate as soon as you are admitted to the hospital (or even before that point). An independent healthcare advocate will follow your care, communicate with your healthcare team, and advocate for you while you are in the hospital. An advocate will get involved early with the case manager to make sure your discharge plan is appropriate and meets your needs to ensure your transition of care is safe.

A healthcare advocate is equally necessary to facilitate discharge planning from any other facility, such as a long-term acute hospital (LTAC), an acute inpatient rehab facility (IRF), or a skilled nursing facility (SNF).

The Unsafe Discharge Scenario:

I talked to a client today whose father was supposed to go to rehab (SNF), but at the last minute a physical therapist documented he walked far enough that he no longer needed inpatient rehab. The family was planning for their dad to go to a SNF, but suddenly the plans changed, and he was discharged to home. Unfortunately, the case manager failed to obtain orders for home health services or the required DME (walker and bedside commode), nor did the case manager obtain the physician referral to the appropriate specialist for follow up care.

Even if you are having a satisfactory stay in a hospital and are very happy with your care, everything can fall apart at discharge. That’s why it’s wise to hire an independent professional healthcare advocate as soon as you are admitted...

Unfortunately, once you leave the hospital and you realize the error, the case manager cannot coordinate the appropriate orders for you because the hospital physician is no longer treating you. You are on your own if you don’t have an independent advocate on your side .

So, What Can You Do About Unsafe or Inappropriate Discharge Orders?

1. Call your Primary Care Physician to let her know you were just discharged and you have no orders. After reviewing your hospital records, your PCP can write orders for any medically necessary diagnostics, home health services such as PT/OT and speech therapy, medications, or other needs such as equipment.

Regardless, you should see your PCP within 10 days of a hospital discharge, but if you haven’t been to see your PCP recently, he may need to have a face-to-face encounter with you before writing the orders to assess whether the needs are medically necessary. For instance, CMS (Centers for Medicare and Medicaid) states that the physician encounter must occur within the 90 days prior to the start of home care or within 30 days of the start of care and further states, “If the physician orders home health care for a patient based on a new condition that was not evident during a visit within the 90 days prior to the start of care, the certifying physician or NPP must see the patient within 30 days after admission.”

2. If the hospital failed to provide you with a referral to the appropriate specialists, ask your PCP for the referrals and make appointments to be seen within 10-14 days after discharge or sooner.

3. If your PCP determines that you would benefit from and are eligible for inpatient rehab (SNF), the PCP can write orders for and coordinate a “community transfer” to a SNF. Most transfers to SNFs occur directly from hospitals, so many PCPs are not used to doing this so they may need guidance from the SNF intake team.

4. Learn what your rights are and be prepared for next time! Talk to an independent professional healthcare advocate to learn about your rights and what to do if you are being forced to discharge when you don’t feel it is safe.

Janet Beesting Nelsonis a Registered Nurs e and Board Certified Patient Advocate. She is the founder of Breakaway Health Solutions, Inc., a healthcare advocacy firm whose mission is to help patients gain access to high quality health care services. Ms. Nelson’s clinical background as a critical care nurse and as a nurse case manager for a Medicare Advantage plan has given her a unique understanding of the clinical and business sides of the healthcare system and how to navigate both worlds. Her own personal journey caring for and navigating end-of-life decisions for loved ones experiencing Alzheimer’s disease gave her an understanding of those challenges and how to plan for them. As a Board Certified Patient Advocate, Ms. Nelson leverages that expertise to champion her clients. To learn more about Janet, visit her website at or email her at