Home
  * Can go home if independent
  * If not independent or needs 24H care, must have someone at home 24/7
  * Can get Home Health at Home for IV abx, wound care, PT or OT
  * To be eligible for PT/OT, patient will need to have Medicare or a good insurance that has rehab as a benefit; also, PT/OT needs to be recommended by the inpatient Rehab dept
SNF (Skilled Nursing Facility)
  * Social Work does all the referrals, and they will not look for a SNF until “Medically stable for transfer to SNF” is written in note under Dispo
  * If a patient has Emergency Medi-Cal, they would need to change to Full-scope Medi-Cal via PRUCOL
  * SNFs like Medi-Care Part A
  * Some commercial insurances have SNF benefits but most don’t so a Letter of Acceptance (LOA) must be done and arranged between UR/insurance/SNF
  * Patients must have a skilled need in order to go (IV abx, wound care, rehab)
  * If patient does not have a skilled need, he or she can be “custodial care” (i.e., 24H care, needs assistance with ADLs, family cannot take care of pt anymore) 
  * Can also have SNF w/ hospice
  * Meds do not need to be filled at our pharmacy; SNF likes to use their own pharmacy
  * IF you go to SNF with hospice, needs POLST form
Other Hospital
  * If patient has insurance and has a capitated hospital, then the patient must go to that capitated hospital or the patient may face financial responsibility
  * UR nurse arranges all of these transfers, but an MD to MD conversation must happen before the patient gets accepted to the capitated hospital
Rancho Los Amigos Hospital (RLAH)
  * Patients can be transferred here for continued medical treatment (i.e., IV abx for patients who are current IVDA and homeless)
  * Can transfer here for rehab
  * Must be recommended by 2 departments (PT/OT/SW)
  * Must be able to do 3 hours of rehab per day to be considered
  * Order is placed through ORCHID (Consult to Rancho-Medicine/Rehab)
  * Care Coordinator can follow up with UR and RLAH admissions
  * RLA Acute Rehab criteria
  * RLA Medicine Admission criteria 
Recuperative Care/Interim Housing
  * Homeless patients can go here temporarily while “recuperating”
  * Pts must be independent to be considered there. There is no nurse there. Some places will have a Licensed Vocational Nurse (LVN) during the day but aren’t there to given meds, i.e., patients should be able to administer their own subQ or PO meds
  * Can go to recup care is patients need IV abx or wound care, but will need additional Home Health order 
    * Bed must be secured first before HH can be arranged because HH needs the housing address and phone number before processing that order
  * Order SW for this on ORCHID
  * SW will ask MD to fill out Recup form
  * Usually takes ~3 days to get accepted depending on the waitlist
  * Patient must have at least 30 days of Rx with them 
Shelter
  * For homeless patients who are independent (i.e., must be able to ambulate at least 200ft or propel wheelchair at least 200ft)
  * Place SW order for this
  * Patients must leave no later than 2PM if going to a shelter
  * All meds, supplies and DC order should be in early in the morning
Housing for Health
  * SW always assesses homeless patients for this option
  * Patient leaves the hospital without housing but they will need to follow up for updates on the application status of their housing
Board and Care
  * Eligible if patient has some ability to complete ADLs
  * Can receive IV abx here through HH
  * Need SW order for this
  * Sometimes patients will need to agree on giving their source of income/money (SSI or general relief funds) to the B&C in order to be accepted
Jail
  * Must complete DC summary along with DC order for the Jail liaison to work on transfer back to Jail
  * No need to prescribe meds, just give recommendations in DC summary that Jail MD can follow
  * Patients get sent back either to General Population or infirmary/CTC
  * There is sometimes a waiting list for patients to go back to CTC/infirmary (hospital beds in Jail)
Inpatient Substance Abuse Rehab
  * Will need SAC (substance abuse counselor) to see patient and be able to refer the patient
  * Order SW; SW will see patient and refer patient to SAC
  * If patient stable and with home, patients can also return home and call inpatient facility for an “interview” of acceptance
  * Patient must be willing to stay in rehab for 30 days without a break, i.e., no outside appointments can be attended
  * SAC will arrange for transportation
  * Pt must have 30 days' worth of Rx if transferring from hospital to inpatient rehab facility
Psychiatric Facility
  * Can transfer to inpatient Psych facility if Psychiatry says so
  * Needs to be Medically stable for transfer to Psych facility
  * There’s a MCW (Medical Case Worker) Psych worker that refers patients to different psychiatric facilities
  * Sometimes, it’s faster to transfer a patient to other psych facilites if they are still in the ED or OBS
Hospice
Securing DME for inpatients: WEEKENDS and AFTER-HOURS
  * Wheelchairs, Crutches, Walkers 
    * Licensed provider orders the DME in ORCHID order under the Medication tab
    * Order MUST include height and weight of patient
    * Nursing calls 9-2381 to obtain above items
    * Warehouse delivers the items
    * Nursing completes HS-1 Form with the items delivered, including sticking a patient label with Name & MRUN on the HS-1 Form. Nurse assigns the discharging unit as the cost center
  * Hospital Beds, 3-in-1 shower chair, bedside commode (Hospital bed may require at least 24 hour notice and cannot be delivered after hours) 
    * Nursing calls home health nurse on call (213-919-0509)
    * Licensed provider orders the DME in ORCHID order under Medication tab
    * Licensed provider completes a Certificate of Medical Necessity for the hospital bed (CMN)
    * Licensed provider documents medical necessity in the progress note
    * Home health nurse will call Calox to schedule DME delivery (323-255-5175, Option 1)
    * Calox will deliver DME at the patient’s home
Discharge Lounge 
  * Patients can be discharged from the discharge lounge if they are waiting for a ride - no need to “hold patient discharge for ride” if they meet criteria below 
  * DC Lounge Criteria
NERF process
  * Follow the process below to link eligible patients to LAC&USC primary care 
  * NERF Process
HD placement for patients being discharged on a weekend
  * Obtaining HD Placement on Weekends