Discharge planning recommendations

A significant degree of discharge planning is identifying the home healthcare services that an elder would benefit from, such as physical therapy, occupational therapy, speech therapy, skilled nursing, respiratory therapy, infusion services or even custodial care services.

The role of a geriatric care manager in discharge planning begins at the time of the initial assessment and continues until the discharge plans are in place.

As care managers, it is vital that we closely monitor the treatment plan of care in order to assist in identifying the appropriate discharge recommendations, as well as execute them with, or on behalf of, the elder, his or her medical team members, and informal or formal networks.