Paving the Road to Recovery: The Witherell’s Discharge Team

When a patient enters the Witherell’s top rated, state-of-the-art short-term rehabilitation facility, our discharge planning team is already at work. This forward-thinking team knows that although discharge may be weeks away, the most important way to ensure recovery and prevent rehospitalization is to have a plan in place from the outset.

“We actually begin the process upon admission,” notes Discharge Department manager Elizabeth Mungai. “We begin by reviewing the patient’s goals and expectations, and we gain an understanding of the family and community support needed.” The team also identifies home barriers and potential equipment needs, and all are addressed prior to discharge. “The goal is for the patient to continue to progress and heal after leaving the Witherell to avoid re-hospitalization.”

This attention to detail and careful planning pays off: The Nathaniel Witherell has been named a “Top Performing” Short-Term Rehabilitation facility by U.S. News & World Report in 2019-20. The Witherell has received this distinction each year since the rating was first launched in 2018-19.  The Nathaniel Witherell is also a 5-star rated facility by the Centers for Medicare and Medicaid Services.

The Witherell’s Discharge Team is an essential unit that wears many hats. Some of the functions they perform for our short-term residents include:

  • Providing patients and families with home options and alternative living choices, including home care, community placement services and assisted living facilities.
  • Helping patients identify and accept barriers/limitations in preparation for returning home.
  • Working with family members who have differing points of view and expectations of what might be best for their loved one.
  • Facilitating scripts and reimbursement forms so patients can quickly obtain medical equipment needed.

Our Discharge Planning team often needs to get creative and pitch in wherever needed to support our residents.

“One of our staff members drove a patient with no family members to New Haven to pick-up needed home equipment for a safe discharge,” notes Elizabeth.

Elizabeth’s team also put their heads together to support a married couple who were both NW patients, but had varying needs. The staff made sure both were accommodated so that a successful recovery could be had by all at home.

Even though we build strong bonds with our short-term rehab residents and we’re sad to see them go, we know we’ve done our job right when they are successfully discharged and on the road to recovery, thanks to our Discharge Planning team!

 

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