Discharge Planning

 

Numerous studies have shown that appropriate continuum of care and timely discharges to hospice or palliative care services increases patient’s quality of life, decreases hospital re-admissions and in many cases, may increase life expectancy. As discharge planners, your role is critical to the good health and smooth transition home of patients. Faith & Hope’s “patient centered” services and “team collaboration” motto will help manage cost while achieving optimal outcomes for your hospice, and/or palliative care patient discharges.

The following is what you can expect Faith and Hope to provide upon discharge:

  • Explanation of benefits to patients and their families in both hospital and home settings.
  • Ambulance transport to home/facility.
  • DME delivery to home/facility prior to discharge.
  • Qualified nursing staff to welcome, assess, and make patients comfortable upon arrival to home/facility.
  • Start continuous level of home care for patients with uncontrolled symptom management related issues.
  • Teach and educate family on proper use of medical equipment, medication and wound care.
  • Create and explain the plan of care developed by Faith and Hope’s interdisciplinary team upon admission.
  • 24/7 access to a Faith and Hope’s triage nurse to answer and troubleshoot any and all concerns of patients/families via phone/visit.
  • Will arrange placement if/when needed.
Client Referral