Your mother is coming home from the hospital after her knee surgery or other surgical procedure and you expect to be able to help her out as she recovers -- and still go to work, get the kids to school or day camp; maybe even see your significant other for dinner. It's time for a reality check -- and hospital discharge plan -- because caring for someone after a hospital stay can be a huge task. There is much (much) more to successful at-home recovery than ordering Netflix and stocking up on takeout food menus.
Remember all that planning you and your parent did before she went into the hospital? It should be the same thing in reverse for when she comes home, except there will be no staff of trained professionals there to greet and reassure you both when you arrive.
"Often we know that family caregivers are not fully prepared to take on the full amount of work that needs to be done when helping a family member recover from a hospital stay," said Paul Sauer, CEO and founder of Homewatch CareGivers, an in-home caregiving agency with locations in 35 states. "The family caregiver can become very frustrated with the realization that the recovery process is going to take more time than they had prepared for, especially when it means taking time off work."
What can make the difference, as well as lower hospital readmission rates and costs, is to have adequate home care lined up before leaving the hospital in the first place.
"Everyone's needs are unique, but we're here to help -- from running errands and preparing meals to medication assistance and personal hygiene," Mr. Sauer said. "Using a full-service home care agency will ensure that your loved one is cared for with all the services they need."
People are given explicit instructions upon leaving the hospital after having any kind of procedure -- from medication dosages to physical rehabilitation and much more -- with the expectation that they will follow these instructions and heal healthfully.
"What happens very frequently is that patients are given so much information over the course of their stay that they can't process all of it," said Deborah Tackett, an acute care manager at Denver Health Medical Center. "When they get home, they don't have that backup -- there isn't that nurse there to encourage them."
The result is panic, injury, medication mishaps, even malnutrition and dehydration -- all of which lead to readmission to the hospital for the patient.
"Then we have to start all over again," said Ms. Tackett.
A pilot program with the Colorado Foundation for Medical Care showed that 30-day readmission was reduced by nine percent after care transition was introduced. Noting that patient care transitions are increasingly problematic, and that older patients with chronic illnesses often need care from a variety of practitioners in different locations, the program sought to close the gaps in care.
"We found many specific root causes of readmissions and poor transitions," said Risa Hayes, project manager for Northwest Denver Medicare Care Transitions. These causes included an "unreliable information transfer and lack of support for activation of patients and their families."
The pilot program -- which highlights the use of care transition coaches -- is expected to become national this summer.
"The purpose of the coach is different from a caregiver," said Ms. Hayes. "Their primary mission is to work with the patient, their family members, neighbors or caregivers." With coaching, Ms. Hayes estimates that hospital readmissions can be lowered by 50 percent.
What experts often see is that people are focused on the big picture -- having surgery and follow-up medical care -- and not the daily routines.
"What they forget are the basic body functions," said Hilarea Amphauer, a nurse and transitions coach at Exempla Lutheran Center in Wheatridge, Colo. "Like getting up and out of a chair, getting in and out of their bathtub, and then pain management. If it's a new medication, knowing the side effects and how to take it." Ms. Amphauer's job also includes a home visit to best assess the patient's success and needs.
When planning for a hospital stay, plan for the homecoming at the same time. Think ahead to who can -- not only run a warm bath -- but help your mother in and out of the bathtub, who has time for a nice long chat in the middle of the day with her and other ways that your loved one can get back on his or her feet again as soon as possible. This requires anticipating the extra help needed when someone is discharged from the hospital.
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