Planning Your Discharge

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Alexander Lester
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1 Planning Your Discharge Going home from hospital UHN Information for patients and families This pamphlet has information about: how discharge works at UHN care options after your discharge what you need to know about going to long-term care Please visit the UHN Patient Education website for more health information: University Health Network. All rights reserved. This information is to be used for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis or treatment. Please consult your health care provider for advice about a specific medical condition. A single copy of these materials may be reprinted for non-commercial personal use only. Author: Annabelle Bryden Created: 12/2005 Form: D-3360 (04/2014)

2 Planning for your care needs Planning to leave the hospital, called discharge, begins before or when you are admitted to hospital. Your health care team is here to support you, and provide the best plan possible for your safe return home. In some cases, you may be going to another facility when you leave the hospital. How discharge works at UHN When you and your health care team have set your care goals or your doctor decides that you no longer need the level of care we provide in our hospital, you will be discharged. On the day of your discharge, please arrange to have someone take you home. If you cannot leave before your discharge time, you are welcome to wait in the patient lounge until your ride arrives. Home first Going home safely is the first choice. If you need help when you return home, UHN or Community Care Access Centre (CCAC) staff will help you make those plans. They can check if you are eligible for services such as homemaking, meals on-wheels, nursing and personal care. 2

3 Discharge to another facility If your needs cannot be met at home, UHN and CCAC staff will help you apply to and transfer to another facility that has the care you need. For example, your needs may best be met in: retirement home or supportive housing convalescent care rehabilitation centre complex continuing care (CCC) long-term care (LTC) palliative care return to a hospital in your home community or the hospital you came from What if there is a waiting list? If there is a waiting list for the facility you need, we will see if you can wait at home with more support until you are called to move. You may hear the term ALC. This means you are waiting in hospital to move on to an alternate level of care (ALC) that is better able to meet your needs. What happens next? All patients who wait in hospital for LTC or CCC need to pay a daily fee. This is called a chronic care co-payment fee that is set by the Ministry of Health and Long-Term Care. If you wait at home, you do not have to pay this fee. Corporate Billing and Accounts Receivable will contact you to explain this fee. 3

4 What you need to know about going to Long-Term Care Choosing your preferred long-term care (LTC) homes If the CCAC says you are eligible for long-term care (LTC), a CCAC coordinator helps you apply. The coordinator gives you a list of LTC homes to choose from that meet your needs. Then you choose 5 from the list. At least 3 of the choices should have a waiting time that is less than 3 months or as short as possible. When you talk to the CCAC coordinator, you need to submit your first choice within 7 days and your full choice list within 2 weeks. Transferring to a LTC home When a spot on your list becomes available, you will be called right away. You need to accept the offer within 24 hours and move there within 5 days. Waiting at home for a spot to become available We will help you plan for other support you need while you are waiting at home. Some services may include adult day programs, homemaking, mealson-wheels, nursing and personal care services, retirement homes, support from CCAC, and others. You may need to pay for some services, supplies or equipment. 4

5 You can get more information on community resources by: talking to any member of your care team calling 211 visiting these websites: or Waiting in an LTC home that is not your first choice Since you must accept the first facility that becomes available from your list, it may not be your first choice. In this case, you can still stay on, or be added to waiting lists for other (higher ranked) LTC homes. You will not lose your place on any waiting list if you decide to wait in a LTC home that is not your first choice. Refusing a bed offer If you refuse an offer from a LTC home that you applied to, or if you do not move into the LTC home that was offered to you within 5 days of the offer being made, the hospital will discharge you. Choosing a substitute decision maker If a patient is evaluated as incapable and they do not have a substitute decision maker (SDM), the Office of the Public Guardian and Trustee will appoint a public guardian to help apply to an LTC home. We advise patients to choose an SDM and to fill out a Power of Attorney for Personal Care, if needed. Questions? If you have questions about your discharge, please ask any member of your care team. 5

South West LHIN. Hospital Discharge Planning Tool Kit. June 13, 2014

South West LHIN. Hospital Discharge Planning Tool Kit. June 13, 2014 South West LHIN Hospital Discharge Planning Tool Kit June 13, 2014 1 Table of Contents Introduction... 3 Discharge Policy Components for Hospitals in the South West LHIN... 4 Appendix A... 8 Appendix B...