Being Discharged From the Hospital? Here Are Your Medical Care Options

Hospitals admit about 33 million Americans each year. And 7 in 10 return home afterwards without medical services. The other 3 in 10 Americans need ongoing treatment and support after they leave. They may also need extra recovery at another facility. Common examples include a long-term acute care hospital, rehabilitation facility, or a skilled nursing facility. But there are additional options available as well. 

Learn more about the difference between these options and which one is right for you.

What determines when you will be discharged from the hospital?

Many factors determine when it is time for someone to be discharged from the hospital — beyond just the severity of their medical condition. Most people can go home within 5 days. More complex health issues may take more time to sort out.

In general, a person is ready for discharge home from the hospital if:

• All necessary diagnostic tests are complete.

• All appropriate medical and surgical treatments are complete or can continue after discharge.

• The patient is able to care for themselves or has caregivers.

• There is a follow-up plan for ongoing care.

Most hospitals have discharge specialists — usually nurses — known as “discharge planners.” They assist with transitioning to home or another care location. Insurance companies influence discharge planning based on what they will cover or "authorize."

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If you think that you or a loved one is being discharged too soon (or unsafely), there is an appeals process. For Medicare patients, the process is the same, no matter the hospital. For those with different forms of insurance, the process is up to the individual plan. Discharge planners or social workers may be able to assist with this process.

What are your care options after leaving the hospital?

A person may still need medical or physical assistance after leaving the hospital. This is referred to as post-acute care (PAC). Each PAC option has a unique role in assisting people with recovery or long-term care. These options are listed below from most intensive to least intensive.

Long-term acute care hospital (LTACH) 

This kind of hospital is designed for people who need at least 3 weeks of intensive medical care. You may be admitted to an LTACH if you have:

• A breathing tube or special respiratory equipment

• Large or complex wounds 

• Severe medical illnesses

• A feeding tube

• Surgical drains

• An infection that requires IV (intravenous) antibiotics

• Kidney failure and need hemodialysis  

LTACHs have a wide array of healthcare providers who all help in your care and recovery. This includes:

• Specialist physicians

• Nurses

• Physical therapists (PT)

• Occupational therapists (OT)

• Speech therapists (ST)

• Respiratory therapists (RT) 

Inpatient rehabilitation facility (IRF)

These facilities are best for achieving the fastest and fullest recoveries. And they aim to help people achieve independence with self-care, mobility, and cognition. This includes:

• Physical, occupational, and speech therapy for 3 hours a day, at least 5 days per week

• Evaluation and treatment with a rehabilitation physician 3 days per week

At an IRF, therapists and nurses simulate the patient’s home and work environments. They’ll guide patients in practicing skills such as:

• Walking

• Speaking and swallowing

• Cooking 

• Driving  

Patients in an IRF usually would stay for two weeks. But some people — especially those with brain and spinal cord injuries — may stay longer.

Skilled nursing facility (SNF)

These facilities may also be referred to as “nursing homes” or “rehab centers.” They are very different from IRFs. SNFs are for people who can’t take part in an intensive therapy program, but still need nursing care. Nurses provide medication, injections, bowel and bladder care, and simple wound care. Physicians check on patients in a SNF at least once a month. Therapy is available up to 1 to 2 hours per day, several times a week. And the average length of stay is 20 to 38 days. 

Long-term care (LTC) 

This is not an actual facility. LTC refers to a combination of services to help people who are not expected to improve a lot from their current state of health. They may need permanent help with getting dressed, bathing, toileting, mobility, and/or decision-making. A combination of family support, guardianship, paid caregivers, home health services, and adult day care may work. 

Long-term care insurance may cover extended SNF stays. But under 1 in 10 Americans over 50 have purchased this insurance. Some patients who need LTC are eligible for Medicaid, which may pay for lifelong SNF level of care. A person in a SNF for long-term care will usually stay there for 2 to 4 years.

Hospice 

Hospice care can happen in a person’s home or in a facility. Hospice provides comfort care. And it is an option for someone with a terminal illness who is unlikely to live longer than 6 months. And when someone has a terminal illness, they may choose to focus on managing uncomfortable symptoms rather than prolonging life. Hospice patients receive skilled nursing assistance and pain management as needed under the care of a provider.

Home health 

This is a type of care for people who are unable to leave their home. It can bring together a wide array of healthcare providers, including:

• Nurses (who can assist with simple wound care, medications, and health checks)

• Aides (who can help with bathing, dressing, and toileting tasks)

• Physical therapists, occupational therapists, and speech therapists

Outpatient therapy

For those who are able to leave their home, outpatient therapy centers can assist with recovery. People who use walking assist devices — such as wheelchairs, walkers, or crutches — need to arrange transportation in advance. Therapy is usually scheduled 2 to 3 times per week over 6 weeks to start.

What if you need non-medical care after leaving the hospital?

Some people don't have ongoing medical care needs but still need other types of help at home. This includes help with cooking meals, cleaning, and taking medicines on time. For these individuals, an assisted living facility may be a good option. But they can be expensive.

Group homes are another option. They are smaller, with a higher staff-to-resident ratio. Many group homes use houses that are accessible. They can accommodate people with mental or physical disabilities. They often have trained caregivers living on-site.

Assisted living facilities and group homes offer different services. These will depend on the local owner or manager. Finding the right fit for you or your loved one begins with making a list of their needs. You can then match a facility’s available services to your list. Some examples include: 

• Cooking and meal preparation 

• Medication reminders

• Bathing or dressing

• Walking

• Round-the-clock supervision given the risk for a fall or wandering

A more affordable option is to have friends and family work together to share tasks. This can include help from:

• Meals on Wheels

• Housekeeping services

• Professional transportation

• Life Alert

• Personal care attendants (PCA) services are options. 

It can be hard to figure out which (if any) of these services is covered by your insurance. Medicare does not cover non-medical care. But Medicaid may cover PCA hours. Some state Medicaid plans will pay a family member to be a PCA.

It’s important to discuss options with your discharge planner before leaving the hospital. There may be other services in your community that the hospital social worker can inform you about. These include services for the blind, medical equipment loans, or low-income housing assistance.

Why trust our experts?

Written by:

Valerie Anne Jones, MD

Val Jones, MD, is a physician who is certified by the American Board of Physical Medicine and Rehabilitation (ABPMR).

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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