The “Art and Heart” of Family Meetings in Hospital Settings

Relationships with our clients and their families often begin when they are in crisis precipitated by an impending discharge from a hospital. By the time they call, they are fearful and sometimes angry. In our experience, four principal factors lead families to this point: 

  1. Difficulties with communication
  2. Nontransparent processes related to discharge planning
  3. Lack of understanding of the pressures posed by insurance coverage requirements
  4. Inexperience on the part of hospital personnel to fully appreciate what it takes to care for a very sick person at home

This month, I explain how we use a family meeting as a starting point to get things back on track. As our colleague Anne Jacoby likes to say, to be successful, these meetings require both art and heart!

What Is a Family Meeting?

As I have mentioned in several previous newsletters, discharge planning begins upon admission. Things happen quickly in an acute hospital setting and most of the time, a plan is outlined that is well communicated, understood, and agreed to by all involved. When that does not occur, the person to reach out to (immediately) with a request for a family meeting is the Case Manager.

Specifically, you should ask that the following team members be present: 

  • The physician overseeing care
  • The nurse responsible for the creation and 24-hour execution of a nursing care plan
  • Any rehabilitation professionals involved
  • The case manager 
  • Others as noted below

Should you encounter resistance to scheduling this meeting promptly, call the person in the hospital responsible for providing support and information, helping determine healthcare options, resolving disputes, and working closely with patients, relatives, and caregivers.

The title of this professional will vary depending on the hospital. They may be called a patient advocate, patient liaison, ombudsman, patient experience officer, or something else. Sometimes there is a department called Patient Experience; other times these people work with the risk management professionals.

Additionally, all hospitals have a Chief Nursing Officer and a Chief Medical Officer who can be contacted.

Planning for a Family Meeting

It is critically important that you prepare in advance for such a meeting by first deciding who, besides the patient, will be present. Then do the following:

  • Assign someone to lead communication during the meeting.
  • Assign a scribe for the meeting, so you do not have to take notes and instead can pay close attention to what is being said, ask for clarification as needed, and formulate additional questions.
  • Create an agenda with a clear objective and specific items. Share the agenda in advance, so that you manage everyone’s expectations.
  • Research and have clear documentation with you about insurance coverage, including what levels of care are covered and what the criteria are to access those levels of care. (This is not easy to do and requires that you read your Evidence of Coverage document and call your insurance company for clarification about anything you do not understand.)
  • Commit to being curious, forthright, honest, and open to listening to others.

What to Expect in the Meeting

Begin by stating the goal. You may say something like: 

“It is our goal to have a better understanding of the health status of our loved one, and a clear understanding of the proposed discharge plan. We can then set priorities for the next sequence of events that must happen to achieve a safe discharge. We prepared a written agenda so that we can be sure to discuss each of the agenda items.”

Here is what you should expect from those present:

The physician overseeing care should provide a comprehensive update on clinical status and outline future care needs.

The nurse should review the current 24-hour nursing care plan to include a discussion of medications and the method of administration; care of wounds and/or equipment needed for care; and a description of what the patient needs assistance with, such as getting out of bed, eating, toileting, bathing, and dressing.

The physical therapist should provide the outcome of their evaluation and recommendations for ongoing rehabilitation from physical, occupational, and speech therapy. (You may request such an evaluation if one has not been done.)

The case manager should provide an update on the proposed discharge date, to what setting, and the status of insurance coverage. It is their role to match the care needs with an appropriate healthcare setting and to initiate communications with that entity and with the insurance company to ensure coverage for services.

The patient advocate should ensure effective communication occurs during the meeting and focus on outlining an action plan with proposed periods in which to complete it. This could potentially lead to a longer hospital stay, giving the family time to execute their portion of the plan. That could include visiting alternative healthcare settings such as a Skilled Nursing Facility (SNF) for short-term rehab or long-term care environments, or securing needed durable medical equipment and making physical accommodations in a home.

The Important Role of Insurance

Like it or not, insurance coverage rules often drive decision making in discharge planning. Hospital personnel are very familiar with how it all works and operate within their understanding of the coverage parameters. They tend to use a lot of “insurance-eze,” much of which most families don’t fully understand; clear explanations and time to process options are key. I highly recommend you do the following:

  • Enroll in your insurance member portal. Focus on fully understanding these four benefits: Inpatient Hospital, Skilled Nursing Facility, Home Health Care, and Durable Medical Equipment (titles may be different in some policies).
  • Read all the requests for authorizations and approvals for care.
  • Call the customer service representatives and internal case managers at the insurance company for questions and explanations.
  • Escalate any concerns within the insurance company. This may include formal insurance appeals according to the rules outlined in the policy.

Summary

It is always my hope that professionals in hospital settings are carefully educating and guiding families toward a successful and safe discharge, thus minimizing the risk of an emergency readmission.

In the event this is not happening, speak up right away. If you are still not satisfied, escalate your concerns and request a family meeting. In our experience, while these meetings may start out a bit contentious, when managed well and when clear explanations are provided, positive outcomes result.