Is This Senior Patient Ready to Go Home?
After hip replacement surgery, it's time for this patient to be discharged. She says she's ready. Is her home environment suitable to support her recovery?
The American College of Emergency Physicians recently reported that many senior patients are discharged home even though that might not be the safest choice. Why do doctors sometimes make the wrong call? One problem is that doctors may be relying on what the patient tells them—and patients may be unwilling or unable to be candid about their limitations. Said Dr. Timothy Platts-Mills of the University of North Carolina at Chapel Hill, "Accurately determining the ability of these patients to care for themselves at home is critical for emergency physicians as they make decisions about whether to discharge patients home or elsewhere. A patient who reports they can walk with an assistive device but actually requires human assistance to walk is likely to be bed-bound or fall if they go home alone."
Whether it's after a hospital admission or after a trip to the emergency room, being discharged without adequate support can result in an unnecessary return trip to the hospital, and even to a rapid decline in a senior's health and well-being. Medicare recently began penalizing hospitals for unnecessary rehospitalizations, so there's an increased incentive to provide thorough aftercare instructions. But can senior patients follow those instructions? Do they even understand them? Patients may be in physical pain and on medications that cause confusion—not the best time to remember what a nurse says! And recent studies caution that hospitals often send patients home with written instructions that are hard for the average layperson to understand.
New emphasis on family caregivers
Recognizing that family caregivers play an important role in helping senior patients successfully recover at home, a number of states now require hospitals to educate and involve caregivers in their loved one's post-hospital care needs. For example, on January 1, 2016, California's SB 675 went into effect, requiring hospitals to make an effort to identify a family caregiver for patients and to keep that person in the loop during the hospitalization and after discharge. Caregivers are to receive detailed information and instructions about their loved one's care needs, medications, and medical tasks that the caregiver will need to perform. According to the Kaiser Family Foundation, 17 other states have recently passed similar legislation.
But many medical and personal care tasks that a convalescing person requires can be physically and emotionally difficult for family. A wife with arthritis and heart trouble may struggle to help her stroke patient husband into bed or to the bathroom. Adult children have time-consuming work and family responsibilities, and often live at a distance. Sometimes a senior's particular circumstances and family dynamics make it undesirable to ask for or receive care from family members. And a growing number of seniors lack a support network to help—the so-called "elder orphans."
To fill in the caregiving gap during a senior’s convalescence at home, many families these days enlist the help of professional in-home care. Skilled nursing care is available in the home, and may be covered by Medicare, Medicaid and private insurance. And at a lower cost, nonmedical in-home care is a good choice when a patient needs help with:
Care coordination—Following the doctor's instructions during recovery can be challenging! Patients are likely to be confused, unsure of their footing and unable to drive—just at the time when they need to make their way to follow-up appointments and rehabilitation sessions. Professional caregivers help patients keep track of these various appointments, and then can provide transportation and other assistance. With the patient's permission, they can communicate with other family members to keep them up to date on their loved one's condition.
Medication reminders—At the point when they go to the hospital, most seniors—up to 90 percent of those age 80 and older—are already taking a number of prescription and over-the-counter drugs to help manage their various health conditions. Then add those prescriptions they bring home from the hospital and it can be overwhelming! It's all too easy to forget to take a medication, or to take too much, or too little, or in the wrong way. This can make the medications less effective and lead to dangerous side effects. In-home caregivers provide medication reminders and go to the pharmacy to pick up prescriptions.
Personal and household care—Many everyday tasks are difficult when a person is recovering from an illness, injury or surgery. And senior patients already may have been dealing with previous health conditions and the normal physical changes of aging. Professional caregivers step in to provide housekeeping, laundry, and assistance with personal care such as dressing, showering and going to the toilet. They are trained to help clients safely transfer from bed or chair, and to help clients use a walker, cane or other assistive device.
Support for exercise—After patients are discharged from the hospital, they often are prescribed therapeutic exercises and perhaps a timeline for returning to regular activities. But patients may feel unsteady on their feet, with limited energy. Professional caregivers can help them stay on track with their activity program, providing encouragement and the sense of confidence that comes from knowing there's a watchful set of eyes and a steady hand nearby.
Nutrition assistance—When it's hard for seniors to prepare meals and they can't get to the grocery store, malnutrition is a real possibility. Some seniors lose a dangerous amount of weight; others, subsisting on easy-to-prepare packaged food and junk food, may gain an unhealthy amount of weight even as they fail to consume the nutrients they need for optimum recovery. Professional caregivers can go to the grocery store, prepare meals and snacks that meet the client's preferences and the doctor's dietary orders, and provide assistance with eating if necessary.
In-home care can be provided for a few hours a week, or 24/7. It’s a great way to promote optimum recovery after hospitalization, as well as to ensure the ongoing well-being of senior loved ones.
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