Going into the hospital-whether it's for elective knee replacement surgery or emergency bypass surgery after a heart attack-is just the first step in a patient's journey back to good health.

Step two is what goes on after they have been discharged from the hospital.

Waiting until the day the patient is leaving the hospital is the worst time to start planning for the after-care (at home or at a skilled nursing facility) that's going to be needed to ensure full recovery. That's because the discharge process has been telescoped into a 20 or 30 minute chaotic consult with a discharge planner (usually a nurse or hospital social worker) who is juggling paperwork, physician instructions, and patient education-on everything from how to administer pain medication to wound care to the patient's dietary requirements-all at the same time.

"Everyone is so anxious and overwhelmed that they aren't hearing what's being said," explained Mary Ann Caston, Director of Central Operations for Community/In-Home Services at Benjamin Rose. "And because they don't understand how the system works, they don't know the questions to ask or what their options and rights are."

To ensure a full and speedy recovery, begin planning for discharge from the hospital "weeks before you go in, if it's a scheduled procedure, and the day you go in if it's an emergency," Caston said. "This includes doing an assessment of your home if you plan on bringing someone straight home from the hospital."

Check with your insurance provider and/or Medicare "to be clear about what is and is not covered in terms of after care. "And," stressed Caston, "be sure to get everything in writing."

Do as much research as possible about the medical condition responsible for the hospital stay, the hospital procedure done to address it, and what you should expect in terms of degree of recovery and recovery time when the patient is discharged. "The physician-or their nurse-should be able to give you information," said Caston. "But don't stop there. Use the Internet, too."

An easy way to find information on the Internet is to go to a major search engine, such as Google. In the search box, type the name of the ailment or hospital procedure and the phrase discharge planning. For example, type: "stroke" "discharge planning" or "knee replacement" "discharge planning."

Order the support services (Meals on Wheels, a home health nurse or aid, in-home physical therapy, etc.) and special equipment (bedside commode, wheelchair, walker, etc.) that are needed to facilitate recovery so that everything is in ready for use on discharge day. "The hospital's discharge planner can make the calls for you," explained Caston, "because they know the services and resources in the community."

And finally, if recovery requires long-term care or rehab, or major lifestyle changes, tap into support groups, such as those coordinated by the Arthritis Foundation, Benjamin Rose, or the Ostomy Association. "People in these groups are dealing with similar experiences and can share caregiving and coping strategies that help people take control of things as best they can," said explained Mary Kudasick, VP for Education and Community Services at the Arthritis Foundation.

Sources and Resources:
Books:
After Any Diagnosis , Carol Svec
Prepare for Surgery, Heal Faster , Peggy Huddleston
The Comfort of Home: An illustrated step-by-step guide for caregivers , Paula Derr, RN, and Marie M. Meyer

Online resources:
The following provide excellent information on medical diseases, procedures, and/or discharge planning:

A Family Caregivers' Guide to Hospital Discharge Planning - http://www.caregiving.org
Healthfinder - http://www.healthfinder.gov
HealthAtoZ - http://www.healthatoz.com
Health for Life: Preparing to Leave the Hospital (discharge checklist) -
http://www.acs.ohio-state.edu/uinits/osuhosp/patedu/materials/pdfdocs/general/prepare.pdf
Intelihealth - http://www.intelihealth.com
Merck Manual of Medical Information/Merck Manual of Diagnosis and Therapy -
http://www.merck.com/pubs
National Library of Medicine's MedlinePlus - http://www.medlineplus.gov
Netwellness - http://www.netwellness.org