At some point, a patient is discharged from the hospital or inpatient rehab facility because skilled care is no longer medically necessary. The driving force is that Medicare coverage for treatment has ended, and the patient is now on self-pay status, which they cannot afford. Hence the Notice of Discharge.
The Notice of Discharge has to be written and issued, ideally, at least a day or two in advance. Then, the patient has to sign the notice.
Often the notice is effective immediately and the discharge itself will take place within 4 hours. Families are caught off guard by this and quickly become overwhelmed. The issue is: discharged to where? Is it a safe place for the patient under the circumstances? If not, then the facility and the family must work together to overcome this challenge.
The family should appeal the notice for an expedited review by the local Quality Improvement Organization (QIC). The necessary information has to be included in the notice. 24 CFR §§ 412.42 – 48. The facility will exert pressure on the family to somehow take the patient home. The caregiver must insist that the discharge only take place when there is somewhere safe to go. These can be tough conversations; stick to your guns. A facility cannot just dump the patient onto the street, so-to-speak.
