Beginning with Admission
At the moment a patient is admitted, the clock starts ticking down the time that the payer allots for this spell of illness. Patients and families may have no idea that the patient won't remain in that bed until he is completely well, or even able to care for himself again. They need to be educated, and they need to understand that the patient's stay will be short.
You will learn the patterns of how long certain payers will allow a patient to stay, and you will always be begged by some patients or their loved ones to do what you can to help them stay just a little longer. There will be little to nothing that you can do except to instruct them to discuss it with the physician and discharge planner.
Some people will have an attitude with a strong sense of entitlement.
After all, they have paid for this insurance (or into Medicare) for many years, and they should get their money's worth. Health insurance premiums aren't meant to be a savings plan to be spent on the insured's health care, but patients seem to have some idea that they are.
The fact is that medical costs are skyrocketing, and insurance companies are trying to restrain them by limiting hospital stays and in effect forcing patients to take responsibility for their own care and health status.
Simple math will demonstrate that even if this is the way insurance worked, their theory of having paid in so much doesn't really hold water. Say they have paid in $500 per month for premiums for twenty years. That totals $120,000. Subtract out all the money the insurance has paid out over those twenty years and that won't leave much. To be generous, we could say it leaves $60,000. That can be gone in a very short hospital stay! Wait until they see their hospital bills.
Beyond this issue, there is the patient's shock that she will still be sick when she is asked to leave or to pay out of her own pocket to stay. And the three to seven days goes by very quickly. Remind her that today's admission date counts as day one no matter what time she was admitted. When discussing this matter, put the expected stay into terms such as, “By Wednesday, the 4th, you will be discharged, so please plan accordingly.”
There's not a lot of time, and you will be overwhelmed with all your patients and everything that they need to learn to take over their own care. Maximize your quality time. In every encounter with your patients and their family, you need to be doing some teaching about each and every task you are performing, from fluffing pillows to dispensing medications. Perhaps they will have home health services, but you need to start the education process on day one.