Discharge Planning Resources

As you prepare for your surgical recovery, here are some helpful guidelines and resources to consider. Care managers can connect with you pre-operatively and post-operatively to ensure your discharge plan meets the needs of your recovery and help you feel confident about going home.

Advantages of Discharge to Home

Studies have found that patients who discharge home following their hospitalization do better when they return to their own environment to heal. They face lower risks for infection, medical complications, and hospital readmissions. You will be able to rest comfortably and get back into your daily routine quicker.

Planning

You may need some assistance during the first few weeks with cooking, bathing, housekeeping, shopping, and running errands. Make arrangements for a caregiver, spouse, friend, or family member who can stay with you for at least 3 days. If you do not have any support members available, consider hiring a caregiver privately to assist with these needs. For those who live alone, we understand the challenges that come with limited support after surgery. Please contact our department to connect with possible community resources.

Review insurance and Financial Planning

Thoroughly review your insurance benefits and/or alternative plans for payment. It may be helpful to find out what your insurance plan covers for durable medical equipment (such as walkers), home health services (home physical therapy), Inpatient vs. outpatient deductibles and copayments as well as stays at an inpatient rehab facility.

If you have any questions about your health insurance benefits, please contact the customer service number located on the back of your insurance card. Care Managers can also provide general insurance guidelines and coverage.

Home Physical Therapy

If home physical therapy is recommended, a Care Manager will coordinate services before you leave the hospital. Some surgeons may choose to coordinate home physical therapy prior to surgery - in this case, their office may arrange to have a company contact you directly to schedule. If you are out-of-network with the referred physical therapy agency, your Care Manager will assist with coordinating care with an in-network provider during your hospital stay. In cases where surgeons recommend outpatient physical therapy, this will be prescribed by your surgeon's office. For a list of outpatient physical therapy centers, please click here.

Durable Medical Equipment (DME)

Insurance only covers DME under certain criteria based on medical necessity. Some information to consider: Assistive devices such as walkers may not be covered if you have received one within the last 1-5 years. You may have a copayment if approved. Insurance does not cover adaptive equipment, such as bedside commodes, or cold therapy units. Depending on the type of equipment, you may have the option of renting or buying from a local or online store. For a list of DME stores, click here.

Caregiver

Caregivers may not be covered by your medical insurance. Caregiver services include companion care and personal care, such as meal preparation, medication reminders, shopping, transportation, personal hygiene care, toileting care, walking and mobility assistance. A caregiver list can be found here.

Rehab Facility

If a rehabilitation facility is recommended, a Care Manager will work with you to ensure your discharge is coordinated to a facility covered by your insurance and suited to your preferences. Please note that admission to a facility cannot be guaranteed and will depend on insurance approval and availability. Social factors, such as lack of a caregiver or other non-medical issues, are not considered clinical criteria for authorization under Medicare and health insurance guidelines. Approval is based on clinical criteria which include significant physical/cognitive impairment requiring assistance with daily activities, such as getting out of bed, transferring, or eating, and needing 24-hour support. Criteria for acute rehabilitation hospitals include a recent onset of functional limitations due to conditions such as a stroke, traumatic brain injury, spinal cord disease, amputation, orthopedic disorder, neuromuscular disorder, cardio-pulmonary disease, and/or multiple traumas. These cases typically require intensive therapy, which involves at least three hours per day of occupational, physical, and/or speech therapy. For more help on planning for alternative discharge plans, please contact the HOI Care Management department.

Transportation

Generally, non-emergency transportation is not covered under Medicare or commercial insurance. Private non-emergency transportation options such as wheelchair van or gurney transport can be arranged. Out-of-pocket costs will vary based on services and mileage. A list of private medical transport companies can be found here.

HOI Care Management department can be contacted by voicemail at (949) 727-5439. Please leave your full name, phone number, your surgery information, and message. We will get back to you within one business day. We look forward to speaking with you to ensure you feel confident about your discharge.