Question: We have been auditing our records and our consultant keeps saying we are not doing enough discharge planning. I thought if we checked the box that says DC planning is what we needed to do. What else is needed for DC planning?
Answer: Your consultant is correct. It helps frame the entire case when you do proper discharge planning from day one. It should be in the evaluation and then in every subsequent note. Discharge plans should be specific and appropriate for the patient’s functional ability and living situation. For example, it would not be reasonable to have a patient with an arm in a sling for 6 weeks have a discharge plan of independent in all ADL. Likewise, if a patient is at home alone for any given period, their discharge needs would be different than someone with 24 hour assistance.
I recommend clearly stating your discharge plans at least by category on your assessments. I advise using templates that show level needed for safe discharge with functional and safety needs met and include items such as: functional levels that would be needed for personal care, mobility, environmental care, and community access.
Very few patients truly need to be discharged at “independent in all ADL”, or even at “maximum potential” like I see on so many charts. Since many of our patients have some sort of private assistance, then they would not need to be independent in say dressing or bathing, because to have their needs safely met, they just need to be safe WITH assistance.
Each note should reflect upon the discharge status you have stated would be appropriate for that patient. If factors change, such as new WB status, or different amount of assistance available, then your discharge planning may in fact change too. Otherwise, you should mention “patient needs to be able to get out of chair and ambulate to front door independently in case of emergency. Patient still unsafe with ambulation and skilled therapy will address. Discharge level appears appropriate, patient aware, should be attained by end of next week.”
Hope this answers your question. Documentation and justified data are key to survival in today’s Medicare Reform. Good luck out there.
