Discharge Planning
Our case management staff is available to help you prepare for continuing care
after your hospital stay. These arrangements may include ordering equipment
such as wheelchairs, hospital beds, etc. for your home use, supplying lists
of rehabilitation centers, skilled nursing facilities and board and care
homes, or arranging details of your transfer home or to another facility.
Depending on your needs, case managers may also refer you to the home health
liaison nurse.
To reach the case management department, dial the operator. Or you may
ask your nurse for the case manager overseeing your discharge.
Checkout Time/Preparing for Discharge
Please plan to check out by 11 am. Your doctor will write your discharge
orders on your chart. If you stay in your room after 11 am, additional
charges may be necessary. Insurance usually will not cover an extra stay
after a patient has been released by the doctor. Please make transportation
arrangements prior to discharge, so the transition from hospital to home
will be as smooth as possible.
Before discharge, your nurse will review with you, your doctor’s
instructions about diet, activity, medications and follow-up care.
Subacute Care
Some patients need more care, especially if they have had major surgery,
or have a complex medical problem that needs to be watched a little longer.
They do not require acute care services, but are not ready to be cared for
by their families at home.
These patients may only need a few more days of the skilled care of nurses, or a
couple of weeks to start learning new skills for living with the help of
physical and occupational therapists. They may need important education
about diabetes or dialysis. Sometimes families need to be there, learning
information that will be important in the weeks to come, because they will
be helping to care for the patient at home. If you need this level of care,
your case manager will assist in making the arrangements for subacute care.
The St. Joseph Health System – Sonoma County provides subacute services
at the Sotoyome Campus of Santa Rosa sites. An Acute Rehabilitation Unit is located at the
Fulton Campus.
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Home Care
Sometimes patients require home care following their discharge from the
hospital. St. Joseph Home Care
provides services in your home including case management, medication
management, dietary counseling and symptom management. Home care
professionals include nurses, therapists, home health aides, social workers
and chaplains. If you think you might need home care, please ask your doctor
or nurse to contact your case manager early in your hospital stay to arrange
for a consultation. If you wish to make the contact yourself, please dial
206-9124, or ask the operator for assistance.
Observation Program
The Observation Program is available at Santa Rosa Memorial Hospital for
people who need professional supervision in a hospital setting, yet do not
require admission as an inpatient. Normally this program is for 24 hours,
but can be extended in some cases.
As a patient, you or your family member may be admitted to the
Observation Program from your doctor’s office, the Emergency Department,
Same Day Surgery or a convalescent hospital. Reasons for supervision under
the Observation Program include:
- Diagnostic work-up performed by a physician
- Unclear diagnosis and condition warrants further observation
- Observation required after completion of testing or other procedure,
including surgical procedures
- Physician anticipates patient will respond to treatment in a short
time
Hospital charges for the Observation Program are billed as outpatient
charges to your insurance company. Often a co-payment is required of you by
the insurance company. If Medicare is the insurance, Medicare is billed
under Part B and you are responsible for a portion of the charges. The
patient portion may be covered by a supplemental insurance. Observation
Program patients are charged at an hourly rate.
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