Discharge Planning

The staff at Prairie Lakes Healthcare System is committed to helping you as you prepare for discharge. At Prairie Lakes, the social worker is a key person in the discharge planning process.

The social worker is available to work with you to identify any help you might need and also to assist with contacting those in the community who might be able to help you. A social worker is available 8:00 a.m. to 4:30 p.m. M-F to help you with the discharge planning process at 605-237-1519.

The nursing and therapy staff will also play a role in identifying any assistance you might need. One of the goals of the entire team is to help you safely transition from Prairie Lakes to the next step in your healthcare journey.

The following information will give you and the healthcare team a set of tools to evaluate what sort of discharge arrangements will be needed so you are safely discharged from the acute care setting.

Mobility Assessment

  • I can get in and out of bed by myself
  • I can safely get to and from the bathroom
  • I need someone walking with me to support me
  • I need a walker for safety
  • I have stairs into my home
  • My bathroom/bedroom is upstairs
  • I have fallen or am afraid of falling

Social/Support System

  • I have someone who will stay with me if I need it when I am discharged
  • My spouse can assist me with everything that needs to be done
  • I have friends/family who will check on me daily - I have friends/family who will help with laundry, grocery shopping, meal prep, etc
  • I have services from the Department of Social Services - My social worker’s name is ________________

Personal Care Activities & Daily Living Assessment

  • I will need help with bathing
  • I will need help with a shampoo
  • I will need help with laundry
  • I will need help making the bed
  • I will need help with meal prep
  • I will need help with shopping, groceries, housekeeping, etc.
  • I will need help with medications

Follow-Up Needs

  • Home Health - nursing, therapy aide
  • Therapy services
  • Housekeeping/aide help
  • Meals on Wheels
  • Transportation
  • Swing bed
  • Skilled nursing facility
  • Lifeline

Important Phone Numbers

  • Home Care
  • Hospice
  • Department of Social Services
  • Rehabilitation/Therapy
  • Meals on Wheels
  • Watertown Area Transit
    Free for medical appointments.