Phone Number: (618) 643-2361 ext. 2007
Fax: (618) 643-5827
Monday – Friday: 8:00 am – 4:00 pm
Discharge Planning evaluates patients upon admission and establishes plans for discharge appropriate to their individual needs.
Discharge Planning can discuss difficult situations, provide options and assist in finding helpful solutions to various problems. They also work with patients and their families as well as physicians and other members of the health care team such as nursing and therapy staff to improve communication to better meet patients’ needs. Discharge Planning provides crisis intervention and offers support to help cope with adaptation to injury or illness and works as an advocate for the patient and family.
Examples of services and community resources that Social Services assists with and/or links patients to:
- Home Health Nursing & Rehabilitation, Occupational, and Occupational Therapy Services referrals
- Hospice Services for terminally ill patients
- Home Medical Equipment (referrals for Home Oxygen, walkers, hospital beds, wheel chairs and medical supplies etc.)
- Home delivered meals from Senior Centers (“Meals on Wheels”)
- Emergency Response Systems (necklaces that can be worn by those who live alone to get help in an emergency at home)
- Community Care Program Referrals (for those age 60+ who qualify)
- DORS referrals (Office of Rehabilitation Services “Home Services Program” for the disabled under age 60 who qualify)
- Assisted Living and Supported Living Facilities (SLF) referrals
- Nursing Home placement (options & assistance with short & long-term care decisions and geriatric issues)
- Information & assistance with Advance Directive documents (Health Care Power of Attorney, Living Wills & Mental Health Declarations)
- Financial assistance planning & information
- Mental Health and Substance Abuse treatment options & referral (Outpatient & Inpatient)
- Transportation issues
- Referral to Inpatient/Acute Rehabilitation Services for evaluation
- Senior Enrichment Program
- Patient Advocacy Program which can help a patients with health care concerns even when being cared for away from home.
Discharge Planning coordinates the Extended Care/Swingbed program that offers a hospital-based short-term extension for Skilled Nursing Services and/or Rehabilitation services (Physical, Occupational & Speech Therapy Service).
There is no fee for this services, and is available to anyone in need of information.