Returning Home

Your discharge planning process should:

• Provide a translator to facilitate appropriate person-centered planning, either in-person or virtually
• Have written materials in multiple languages that convey necessary information in plain language
• For additional guidance on addressing LEP, please see Ensuring Language Access and Effective Communication during Response and Recovery: A Checklist for Emergency Responders
  

Your discharge planning process should:

• Provide an ASL translator, either in-person or virtually
• Have written materials to convey necessary information in plain language or use two-way texting devices
• If other auxiliary speech or hearing devices, such as hearing aids, are needed, ensure the individual has access to functioning devices
• For assistance obtaining technology, see the State Grant for Assistive Technology (AT) Programs
•  Acquire specialty PPE (if needed) such as clear face masks to facilitate lip reading

Your discharge planning process should:

• Provide written materials in Braille and/or through spoken word

Your discharge planning process should:

• If the individual was already receiving HCBS or LTSS prior to admission to the hospital, ensure that they are still able to receive these services in-person when they return home
• If not, can they transition to virtual services, or do they need another form of assistance?
• If the individual needs HCBS or LTSS, work to establish those services, either in-person or virtually
• For assistance in establishing these services, see the Aging and Disability Resource Centers (ADRCs) / No Wrong Door System, or your established local referral source.

Your discharge planning process should:

Ensure they have access to appropriate medications or other therapeutics, including DME, as individuals with underlying chronic conditions are at increased risk for severe illness from COVID-19.

Your discharge planning process should:

Connect them with programs for home-delivered meals and/or groceries. For examples of programs, please see Information on Federal Programs to Sustain Nutrition for At-risk Individuals

Your discharge planning process should:

• Facilitate access to PPE for both the individual and direct service workers (DSWs; if applicable) to reduce the risk of infection
• Provide regular screening for COVID-19, and testing for the individual and DSWs (if appropriate)
• If the individual is discharged while still COVID+ follow the CDC Guidance on Disposition of Patients with SARS-CoV-2 Infection

Your discharge planning process should:

Ensure the service animal remains with the individual throughout the discharge process and upon returning home. For more information on accommodating service animals, please see Understanding How to Accommodate Service Animals in Healthcare Facilities

Your discharge planning process should:

• Ensure the individual has access to any necessary mobility devices, such as wheelchairs or walkers, and other DME
• For an assessment to address functional needs, see the State Grant for Assistive Technology (AT) Programs

Your discharge planning process should:

• The individual may experience increased anxiety or other psychological distress and therefore need additional behavioral health supports that are delivered in an accessible, culturally competent manner
• For social programs and technologies, see the Aging and Disability Resource Centers (ADRCs) / No Wrong Door System, or other local coordinating entity. 

Your discharge planning process should:

• Connect the individual to transportation services that support their independence such as accommodations for DME, mobility devices, or service animals
• To connect with transportation services, see the Aging and Disability Resource Centers (ADRCs) / No Wrong Door System, or other local coordinating entity.