Charleston Senior AdvisorWhat should a family do first when a Charleston hospital starts talking about discharge?
Ask for a meeting with the case manager or social worker the same day, confirm in writing whether your parent is an admitted inpatient or under observation, and ask what level of care the team expects after discharge: home, home with home health, a skilled nursing facility, or assisted living.
Inpatient status matters because Medicare covers skilled nursing facility care only after three inpatient days; observation days do not count. The hospitals that send most Lowcountry discharges, among them MUSC Medical Center, Roper Hospital, Bon Secours St. Francis, Trident, Summerville, East Cooper and Roper St. Francis Berkeley, all have discharge planning teams, but they move quickly once a bed is needed.
How do we choose a rehab facility after a hospital stay?
Ask the discharge planner for the list of certified skilled nursing facilities with open beds that accept your parent's insurance, then compare them on CMS ratings, therapy availability and distance from the family members who will visit most.
Medicare patients may choose among certified homes with open beds; Medicare Advantage members choose within the plan's network and often need prior authorization. Our nursing home roster sorts every Lowcountry home by CMS rating and shows the latest inspection date. Crossing the Ravenel Bridge or I-526 at rush hour every day adds up, so weigh the drive honestly.
What if a parent is going home but should not be alone?
Line up help before the discharge date: Medicare-covered home health if a doctor orders skilled visits, privately paid in-home care for daily tasks and nights, and meals and equipment through the hospital's discharge plan.
DPH licenses 136 in-home care providers with offices in Charleston, Berkeley and Dorchester counties: 91 in Charleston County, 28 in Berkeley County, 17 in Dorchester County. Many agencies need 24 to 48 hours to staff a new case, so call before the discharge day. If Medicaid applies, the Community Choices waiver can pay for personal care at home after assessment, but approval takes time; ask the Trident Area Agency on Aging (843-554-2275) about short-term help while it is pending.
Can a parent go straight from the hospital to assisted living?
Yes, if the parent's needs fall within a CRCF's admission rules: no daily skilled nursing, no IV therapy, no sliding-scale insulin, no stage 2 or worse pressure ulcers and no tube feeding they cannot manage, among the limits in Regulation 60-84, Section 801.C.
The CRCF also needs a physical exam dated within 30 days before admission, which the hospital can often provide. Short-term nursing for up to 14 consecutive days can be brought in by a home health agency during recovery.
What should we take from the hospital before leaving?
The discharge summary, a reconciled medication list, follow-up appointments, therapy orders, equipment orders and the name of the doctor who will follow your parent after discharge.
Bring those papers to the rehab facility, CRCF or first home health visit. Medication errors are most common in the first days after discharge, so compare the new list with the pill bottles at home.
Side by side
| A good discharge plan includes | A good discharge plan does not rely on | |
|---|---|---|
| Status | Confirmed inpatient or observation status in writing | Assuming Medicare will pay for rehab |
| Destination | A chosen rehab, CRCF or home plan with services arranged | Whatever bed opens first |
| Medications | A reconciled list checked against home supplies | Old prescriptions in the cabinet |
| Follow-up | A named doctor and appointment dates | Calling around after the first problem |
Sources: S.C. Code Regs. 60-84, DPH Healthcare Quality, SCDHHS bulletins and charts, CareScout, CMS and VA rate tables, as cited in each answer. See our editorial standards.
