The Unforgivable Plight of Poor Discharge Planning

This week my report will be a little different. I am going to tell the story of a family friend’s medical journey. My wife’s friend, Tina (not her real name), is 74. She is an avid gardener and normally, physically active. But her back pain worsened, and after a failure of the usual conservative therapies, she recently opted for surgery.

On Wednesday, July 10, my wife drove her to the hospital at 5 a.m., and she underwent lumbar fusion surgery. And before you ask, no, I did not ask for the CPT® code to determine if it was on the Inpatient-Only List, but Tina was told she would be in the hospital for two days. She was registered as an inpatient. The surgery was done and went well, and she was taken to her room. My wife stayed with her throughout her hospital recovery, sleeping on the couch that converts into an uncomfortable bed.

My wife has heard me participate in enough Monitor Mondays broadcasts to be curious about the forms they might ask her to sign. Well, less than an hour after Tina was brought to her room, someone came in and asked her to sign a form. My wife immediately objected, noting that Tina was barely awake, and clearly not coherent enough to understand anything. The person agreed to return later, but prior to leaving, my wife took pictures of the form; it was the Important Message from Medicare (IMM).

Well, due to uncontrolled pain, Tina remained in the hospital until Saturday, and no one ever returned to get the IMM signed. No first IMM, no follow-up IMM. Not good.

But then it got worse. Since Tina’s mobility was limited, home care was necessary to start her rehab. She was given a choice of four home care agencies that serve her home area. She chose the agency suggested by the case manager, and the referral was sent.

Tina went home, and a nurse from the home care agency came four days later and performed the assessment. That’s great, but remember, Tina had back surgery; what she needed was home physical therapy, not nursing care. Days passed, and finally, on Monday, July 22 a therapist came to the house to perform her assessment. Wait: 12 days since surgery, home for 9 days, and then they finally do an assessment? And according to Tina, it took all of 15 minutes, mostly spent asking questions and having her lift her arms and legs.

I was not happy with this, so the next day I set up a three-way call with Livanta, the Illinois Quality Improvement Organization (QIO), for some immediate advocacy. And after listening to Livanta’s recorded message, begging us six times to submit the appeal via their website, we spoke to a human. And honestly, that person had so little empathy, I began to wonder if I was talking to an artificial intelligence (AI) system. Nonetheless, the QIO ultimately called the home care agency, and the agency did call Tina and commit to improving their care.

Now, an apology was nice, but it did not make up for the delay in Tina’s recovery. And although she will talk to her surgeon about this, no one from the hospital ever called after discharge to check on her. Although the home care agency dropped the ball, the satisfaction rating she gives the hospital will show her dissatisfaction.

Remember, discharge planning not only should begin as early as possible, but it certainly should not end upon discharge. Let’s all do better.