Leaving the Hospital, Going To The Nursing Home
Author: Tammy Gonzales

Admitting yourself or someone you love to a nursing home for rehabilitation is something that we have to do and not what we want to do. As we age the risk increases for a health accident even if we are healthy. Unfortunately, nat all of the care we will ned can be provided in a hospital or at a rehabilitation specialty center. Some of us will need to go to a skilled unit at a nursing home.

Near the end of your or your loved ones hospital stay, you will be contacted by the Discharge Planner or Case Manager of the hospital to discuss the alternatives of continued care. You or your loved one may no longer meet the criteria for a hospital stay. Once a patient is stable they must be moved towards a lower level of care.

The Interdisciplinary Care Team of the hospital will assess the needs of the patient’s care based on the acuteness of the care and the monitoring required for the patient, the patient’s rehabilitation potential, the ability of the patient or their family’s ability to care for the patient and the nature of the home environment that supports the patient. In all cases, the goal is to establish a safe discharge plan that meets the needs of the patient.

For the aged and for people with multiple disease progressions the recommendation maybe for the patient to be admitted to a long-term care facility (nursing home) that provides skilled nursing and rehabilitation. The hospital Discharge Planner usually provides a list of nursing homes that they are contracted with or provide reliable service for you to tour and select. The discharge planner will not choose for you.

I recommend that you take the time to see at least three nursing homes for the following reasons:

To find out if environment is conducive to your patients needs and comfort levels.
Bed availability. Some skilled units have 2 bed rooms, 3 bed rooms and 4 bed rooms.
Do they have the skilled staff to provide the services required? Physical therapist, occupational therapist and speech language pathologist.
Responsiveness of nursing staff. Are they staffed? Do they respond in a timely manner?
Observe resident in the nursing home. Are they clean? Are the staff attentive to them?

Once you make the selection the Discharge Planner will check for bed availability at that nursing home. The nursing home may send out their nurse liaison to the hospital to assess the resident and make sure that the nursing home can provide the care and has the appropriate equipment for the patient as well as get the needed information to verify that the patient has met Medicare criteria for a skilled rehabilitation stay and to obtain information to verify the payer source. This information is then passed on to the nursing home’s Admissions Coordinator to review. Once it has been decided that the nursing home will accept the patient the Discharge Planner is contacted. The Discharge Planner will obtained the necessary physicians orders to discharge the patient to the nursing home and make the transportation arrangements. As a courtesy to the nursing home sometimes the Discharge Planner will fax the orders on to the Admissions Coordinator so the receiving nurse can verify the equipment needed and order the medications required for the patient. Otherwise, the orders come with the patient.

While at the nursing home the Admissions Coordinator is verifying the payer source. If the payer source is traditional Medicare they will verify the days available that Medicare will pay for. If, an HMO is the payer source they will obtain required authorization, level of care and the days authorized to provide care. The Admissions Coordinator will disseminate all the hospital information to the Interdisciplinary Team of the nursing home to prepare to receive the patient.

By the time the patient arrives at the nursing home the room should be ready with all of the necessary equipment needed. The Admissions Coordinator will have an agreement ready for the patient or the responsible party to review and sign. Once in the nursing home the patient is referred to as a “Resident”. The nursing home is a different environment. It’s not a hospital, nor home for a skilled patient.







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Tammy Gonzales, Life Coach and Advocate to Caregivers, of Revitalife Coaching & Consulting, LLC guides Baby-Boomers and the Sandwich Generation on how to take initiative to manage aging and caregiving before it becomes a crisis. Visit www.caregiverinfonline.com for more information.

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How Do You Keep a Family Strong?
Author: Jill Curtis

Pick up any newspaper and read about the changing partners of the famous and not-so-famous. It’s a sad fact that the couples who remain happily together for almost a lifetime do not make the headlines. They are not ‘news.’ So whilst we can read interviews from the many who will kiss and tell about the breakup of their relationships, we know very little about what makes a marriage last, and so what keeps a family strong.

The underlying message passed onto the readers of the newspaper articles is that ‘everybody’ does it, and if one partner doesn’t suit you, then trade him or her in for another. Yet fortunately there are many couples who have had long and successful married lives. Some of these were prepared to share with me the reasons why they thought their marriage had been a success.

When I was researching for my book Making and Breaking Families I posted messages in magazines and newspapers and on the Internet asking ‘What makes a family?’ and I was inundated with replies - it seemed everyone had an opinion.

‘Respect for each other’ were words I heard again and again from those whose marriages had been a success; also, emphasis was placed on the need for consideration for each other. ‘Structure’, ‘lines of demarcation’, ‘what is proper or improper’, and ‘consistency in discipline’ were terms offered by parents who felt their families to be strong and who wanted to pass on to others their own standards. I heard repeatedly the view that if there is a warm, loving home, it provides a sound atmosphere that creates positive memories which last a lifetime. If this is in place, there is less likelihood of someone falling through the net, or risking it all by having an affair. Couples who had stayed together for years were pleased to have their opinions listened to. As I heard from one man: he and his wife of ten years often ‘the odd ones out’ when meeting up with friends who sometimes had a second or even third partner.

Gordon: ‘It’s ridiculous, but true, I often have to remind myself that we are the ones who have got it right. When friends are describing their relationships, they may sound exciting, but I often think of the tears there must be in private.’

Advice came pouring in: ‘Be open and affectionate in front of the children.’ ‘Learn to say sorry, and mean it.’ ‘Be independent at times, and dependent at others’. ‘Take time to decide on marriage and then make it work’. ‘It doesn’t just happen, make it happen.’

Jonathan: ‘We have been married for twenty-two years. We talk a lot. We chat and chat and chat. And we don’t argue. Penny is my great friend as well as my lover and my wife. My first marriage failed because all these good things were completely absent. The constant arguing killed off the whole enterprise. Hence my advice "Don’t argue." These are words of experience, more than words of wisdom.’

Gilbert, fifty years married: ‘Our secret? Just get on with it, and don’t bear grudges. If you marry for love, it will see you through.’

Andrew, married in 1965: ‘Call a spade a spade. A "fling"’ or a "one night stand" is adultery and a betrayal and should be seen as such.’

I heard from men and women desperate to know how to protect or reconstitute a family. Jack: ‘ Please help me. My wife has left two husbands and is now leaving me and our children.’ Jack was frantic to know how to teach his son the value of human relationships, love and commitment.

Many marriages go through difficulties and periods of serious differences. The skill is for a couple to discuss, maybe argue and then to negotiate. This is a way towards a mutually agreeable solution. A wise partner can judge the time to withdraw from a previously held position; this should be a strength, not a weakness.

Barbara: ‘My parents were divorced, and I was determined to work at keeping my own marriage strong.’

What does working at a marriage mean? It means noticing the other person’s needs, being aware of small changes and not taking anything for granted. After the honeymoon phase many couples reported that they just got on with living. Yet love, there initially, can wither and die if not nurtured. Somehow a kind of lassitude creeps in and changed attitudes are not noticed, subtle warnings are not heeded.

Successful relationships require time. Many couples told me ‘Turn off the television one night a week and talk instead.’ or ‘Share the chores’. Quality time is not enough - quantity counts too.

Jane: ‘I’ll bring work home to do after the kids go to bed if I have to, but we are all together at the dinner table.’

All the comments I received did point to the members of families sharing time and leisure, or interest or common ground or hobbies, and with each other.

Perhaps the last word should be from Molly who has just celebrated her diamond wedding Molly: ‘I am an old lady now, but I do know this. Families are all about love and care and must provide the environment to protect the young and the old, and the sick. A family is also a place to share a lot of fun with, too.’

© Jill Curtis 2001








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Jill Curtis is a psychotherapist, parent, and author of books and articles on family issues. Her latest book is Find Your Way Through Divorce. She hosts a website at http://www.familyonwards.com

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