Reframing Hospital to Home Discharge from "Should We?" to "How Can We?": COVID-19 and Beyond.

Abstract

The pressure to discharge patients from the hospital quickly has intensified with the ongoing coronavirus‐2019 (COVID‐19) pandemic as bed and staff availability are paramount. 1 , 2 In addition, patients and caregivers are eager to return home where the risk of viral transmission is less. This is especially important for older adults who are at the greatest risk for complications and mortality if they contract COVID‐19. 3 , 4 Rehabilitation providers contribute uniquely to interdisciplinary discharge planning by providing critical evaluation of a patient's functional abilities and rehabilitation prognosis in the context of the individual's medical complexity, hospital course, psychosocial factors, and environmental features (i.e., home set‐up). 5 , 6 The COVID‐19 pandemic has retained these elements as critical to discharge planning. 7 However, there has been a major shift in perspective from which we view and make discharge decisions from “Should we discharge this person to home?” to “How can we make a discharge to home possible?” To be clear, safe and coordinated discharge planning has remained a priority during the pandemic. Some hospitalized older adults still require discharge to post‐acute care facilities (e.g., inpatient rehabilitation facilities, skilled nursing facilities, transitional care units) to maximize their functional recovery before returning home. Yet, for hospitalized older adults who may be considered “on the fence” for discharge to home versus a post‐acute rehabilitation facility, many rehabilitation and interdisciplinary providers have now reframed how they involve the patient and support network in the discharge planning. The purpose of this commentary is to outline a shift in the perspectives of rehabilitation providers on discharge decision‐making during the COVID‐19 pandemic by incorporating greater integration of caregivers in the discharge planning and increasing the use of shared‐decision making approaches. If changes in the process of hospital discharge decision‐making continue beyond the end of the COVID‐19 pandemic, then further evaluation of their effects (intended and unintended consequences) on system, clinical, and patient‐centered outcomes is warranted.