Discharge Planning: Re- Entry into the Community🚸
I’ve experienced a number of serious planned and unplanned hospitalizations and subsequent discharges. Medical, psychiatric, physical rehabilitation, you name it, I’ve been discharged from it. Discharge planning should always begin from the moment you enter the facility and become a patient in the hospital. If the facility isn’t planning for your ultimate release and re-entry into the community, there is a BIG problem.
Whether its a question of lengthening your stay for unethical insurance reimbursement when it’s unjustified, or clumsy planning altogether, as a patient, you should always be inquiring into your projected length of stay. Social workers, or case planners, will love to defer answering questions around your projected time spent in a given facility, but you must always persist with asking your worker about your ultimate discharge.
There is a number of reasons why being relentless around discharge planning is important. Firstly, (1) staying focused on your recovery always means thinking about transitioning to a lower level of care, (2) reminding your treatment team about your pending discharge will keep them motivated to put together the best possible plan, (3) future oriented thinking suggests to your team you have a vested interest in your after care and thus, your in-patient treatment will more likely target how to handle ongoing and chronic issues which usually put people at risk of re-hospitalization. There are so many reasons to stay to stay focused on future discharge and your after care plan.
Depending on the reason, or precipitating factor which triggered the hospitalization will impact the work that you and your team will need to invest in discharge planning. If you are in an inpatient psychiatric setting, discharge planning can be very much dependent on your diagnosis, number of hospitalizations under your belt, relative chronicity of your symptoms, intensity of your symptoms, and prognosis given these and other factors which are largely situational and based on your personal life circumstances and psychosocial history.
Discharge planners, given the enormous task of interpreting the aforementioned factors, your current mental status, etc it is unlikely anyone will give a firm and concrete discharge day because there are too many uncertain and unknowns to be addressed. Aside from the known information which is difficult enough to gain a clear clinical picture without years of experience discharge planning for complex cases. Finding a discharge planner willing to commit to a window of time you will be released can be difficult given projecting a sound prognosis for psychiatric admissions is usually more unclear at day one and early on in your hospitalization than medical or rehab for acute injuries and substance abuse.
Upon discharge, you will need to hit the ground running when returning to life, and depending on your health, this may be a challenge. Being (1) realistic about your recovery, (2) understanding you are on a journey and discharge doesn’t mean cured, (3) open and honest with your supports about your situation, (4) ready to ask for additional help or cheering on, (5) allowing yourself time to heal. These are all critical agenda items for anyone who is facing discharge from a long or short term hospitalization. For a successful discharge, you don’t need to be completely healed, just very aware of the follow up and after care pan will greatly reduce the likelihood of relapse or re-admission.
“After Care” plans need to be (1) tailored to your personal circumstances and lifestyle choices, (3) realistic and accessible to use even if your condition worsens or doesn’t improve, (3) contain a plan “b” or what to do next when you have to divert from the plan from either insurance issues, transportation or re scheduling of doctors appointments, or any number of things that can wrong when re-entering the community and taking care of yourself again, living more independently, or adjusting to life outside of an institution. When adjusting, be prepared for anything and everything to happen.
Preparedness goes a long way when you show up for your out-patient care and intake and they tell you there is a six month wait list for services or they stopped taking your insurance. While these may seem like trivial snafus, many tines, these admin issues or technical problems de rail people from their recovery, and shift the focus away from their health. So, instead of focusing on the problems ahead directly problem solve the issue keeping you from connecting to your outpatient patient care. If you are too tired or exhausted and can’t work out these possible connection issues to after care, call the unit or case planner on the unit you were hospitalized and have them make some calls or suggest a new plan.
Re entry into the community can feel strange. It can seem surreal depending on the length of your stay in the hospital. Sometimes, extremely lengthy hospitalizations can create feelings of learned helplessness which can come from being institutionalized. Relying upon others and feeling less motivated to be self driven are some of the side effects of re entering the community after long hospitalizations. Be prepared for adjustment. Expect to feel strange, awkward, exhausted, and everything in between.
In the end, enjoy all of it.
There is nothing more profound than healing and recovery from extreme perilous circumstances and returning to a more normal life again💪