Hospital Discharge: Helping Your Elderly Loved One Transition to the Home

When your loved one comes home from the hospital, it's important to have things ready and waiting. They will be tired, overwhelmed, and in pain. The more you can do to ease the transition, the faster their recovery will be.

#1. What Equipment Will They Need? Talk to the hospital discharge nurse a week ahead of time so that you know what special equipment might be needed. Examples could be an oxygen tank, hospital bed, portable potty, or wheelchair. Once you have that information, then set up an appointment with the medical supply company to deliver it. Price check the services you will need, to get the best price and service. Check to see if the doctor can write a prescription for the medical equipment so insurance will pay for it.

#2. Special Instructions: Talk to the main doctor in charge, head nurse, and discharge nurse to know their release condition, their restrictions, special diet requirements and special instructions for bathing or wound dressings.

#3. Will They Need Help? Find out if they will be able to take care of themselves or will need home health care. If so, get the nurse to give you some guidelines. Will they be able to walk without help? Will they be able to take care of themselves in the bathroom? Will they need help in the shower? Will they be able to take care of their bandages? Will they be a significant fall risk? Do they suggest that 24 hour care will be needed?
Get as much information as possible, so you can make decisions on the next step.

Who Will Act As Care Giver? You then need to ask yourself whether you will take care of them, another family member or friend, or does someone need to be hired. You really need to be honest with yourself and the situation. You may know that certain family members may not be responsible enough or experienced enough to do the job, even though they volunteer. You need to examine yourself to see if you can honestly perform some of the tasks mentally and physically required. It takes a certain personality to perform tasks such as bed baths, help in the shower, or help in the bathroom. The cleaning of wounds, breathing devices, or catheters may be required. If you cannot do this for whatever reason, make sure the family member you have elected can and will do these tasks. Personal hygiene is important to the health, recovery and morale of your loved one. Get their care lined up before they are discharged. If you need to hire someone, get on the phone right away.

Hiring Private Caregivers: The advantage is they usually charge less money. You need to know if you will need a care giver or CNA (certified nursing assistant). It depends on the nature of the care required. CNA's will cost you more and they are not necessarily better than many of your caregivers. CNA's often come from working in a nursing care background. Caregivers often have worked mostly private cases.

Perform a background check: This is extremely important. When someone is in your home taking care of your loved one, they have access to jewelry, checkbooks, cash, papers that can be used for identity theft. Put those papers, checkbooks, and jewelry in a locked safe or file. Do not leave paperwork lying around. If possible, it is important for the person to have agency referrals not just private referrals. Private referrals can be falsified.

Evaluate the Care Giver: Ask them questions to evaluate how much real experience they have and if they have experience with the condition of your loved one. If your loved one has a cat or dog, make sure they will do those kinds of jobs. Some girls will not perform housework or take care of pets. Find out the kind of foods they cook. If your loved one needs a special diet, make sure they have experience in special diets. Make sure if your loved one is overweight or needs to be lifted, that the agency is aware of that. Not all health aids can lift heavy patients. There are some great home health aids and there are some terrible ones. Do not assume they know things.Give the aide full instructions on every level. Have a note book there with emergency protocols, phone numbers, and all necessary information. Have the aide take notes each day on meals, and other activities.

Private Care Problems: When hiring a girl privately, you have no agency to back you up if there are problems. Frequent problems include childcare problems, car problems, job injury, getting sick, personality issues, and just not showing up. You need to be prepared with a back up plan. Can you fill in if there are problems? Can someone else fill in? If you don't have a back up, sooner or later you will have to fill in for the caregiver.

Home Health Care Agencies: If you have no back up plan, you are better off hiring someone from a health care agency. They will cost much more and require a set amount of hours or days to provide service. They do provide background checks on the girls and are liable for any broken items or theft problems. They do have the personnel to supply you with backup help if your aid is unavailable one morning. They also offer help to solve any problems between your loved one and the care giving staff. You still need to keep papers and jewelry locked up. You still need to ask the agency questions. There are great agencies and there are some poor ones. Call the better business bureau. Check to see if there are consumer complaints and lawsuits against the health care agency. Do not sign a contract with that agency until you have performed the checks above. If you are not getting good service from the agency you contracted with, dismiss them and find one that will give you good service. You will be paying a high cost per hour or day so demand good caregivers and good service. Keep your eye on the help and show up at unexpected times to check the quality of their care.

#4. House Preparation and Supplies: Once you have all the rest in place, this is a good time to clean your loved ones house and render it free of clutter and falling hazards. You many need to install grab bars in the bathroom and shower. If your loved one needs a hospital bed to replace their regular bed, you may have to rearrange their bedroom or living room. Get the refrigerator cleaned out and stocked with any special foods they will need. Make sure you have a supply of depends, gloves, wipes, bandage supplies, and any other needed requirements. Call the caregiver or agency the night before discharge to make sure they will have a caregiver available for their arrival home.

#5. Discharge Day Advice: The day you bring them home from the hospital, expect them to be irritable and critical. If you had to rearrange the house to get the bed in, they are not going to be happy. You must dismiss all of this, keep a smile, bolster up your patience, and take one step at a time. They may need you to handle the discharge paperwork for them. Expect new details to emerge on their health condition the morning of discharge. Bring a set of clothes, socks, and shoes to wear home from the hospital. You might bring them flowers to put them in a cheerier frame of mind. Pick up any pain prescriptions or medications before you take them from the hospital. Make sure you understand when they must come back for a checkup or more tests. Just get as much information as you can. If they will be coming home in a wheel chair, and you have physical problems lifting, have hospital staff help you get them into the car. Try to have someone waiting back at the house that can help you with the patient and the wheelchair. Often the first few days, they may be weaker and more unstable than you are expecting. Make sure you can handle them physically if that is the case.

#6. If you are going to be your loved ones full time caregiver, you need to join a group for support. Being a caregiver is hard emotionally and physically and it gets hard after days and weeks without a break. If you don't get support, you will get burnt out eventually, so be aware.

References:

www.caregiving.org/pubs/brochures/familydischargeplanning.pdf

www.emedicinehealth.com/hospital_admissions/page9_em.htm#Discharge

www.medicare.gov/Publications/Pubs/pdf/11376.pdf