After the Hospital: Coming Home and Staying Home

Some hospitalizations are planned—perhaps for a joint replacement, coronary artery bypass surgery, or gall bladder removal. Other hospital admissions happen after a sudden illness or injury—a hip fracture, acute appendicitis, a stroke, or a heart attack. Whether a hospital stay is planned or unexpected, following your post-discharge instructions provides the best chance of a successful recovery, with the fewest complications.

The hospital "revolving door" has been named as a major (and costly) problem for our health care system. The rate of unplanned readmissions is considered a measure of quality care for hospitals, both for financial reasons and because it can have a negative impact on the well-being of patients.

Not all re-hospitalizations can be prevented. But there are steps physicians, patients and family caregivers can take to make it less likely that the patient will need to return.

Here are some things to know about hospital stays today:

Patients are discharged sooner than ever. You may have heard the term "quicker and sicker." Hospital stays are on the whole much shorter than they used to be. Some patients are discharged to a skilled nursing facility or other care setting. Many others return home while they still need help managing their recovery.

Successful recovery depends on compliance with discharge instructions. But the recovery regimen can be complex—a real challenge for senior patients who may be in pain, sleeping poorly, and perhaps taking medications that leave them groggy, all of which can lead to temporary memory loss. Northwestern University researcher Lee Lindquist says, "A helper on the day of discharge could make sure a senior understands discharge instructions…and follows instructions safely." Lindquist adds, "When the senior is no longer sick enough to be in the hospital, it doesn't mean they're 100% ready to be on their own. It's a critical time and they need extra support and understanding from healthcare professionals and family." This is why it is recommended—and in many cases required—that the patient be accompanied upon discharge, and have assistance at home.

It's important to have a plan. Patients should discuss aftercare with their healthcare provider or hospital discharge planner before they leave—before their treatment, if that's possible. They should take notes and bring a list of questions. How long is recovery expected to take? What is the best setting for recovery? What are the financial considerations? What kind of care will be needed?

Families may be unavailable or unable to provide the care their loved one needs. Many family members are called upon to serve as caregivers for recovering patients, but they often feel unprepared. They may lack the physical strength and training to perform unaccustomed care tasks. Changing a dressing and helping a loved one to the toilet are out of the comfort zone for many!

The role of in-home care

In some cases, patients are discharged to a nursing home or other care community for recovery and rehabilitation. But many patients who might have formerly required institutional care can now recover in the comfortable and familiar surroundings of their own home. Home health care and in-home companion care may be part of the solution. In-home caregivers support successful recovery by:

• Encouraging medication compliance with medication reminders, taking the patient to the pharmacy or picking up prescriptions, and reporting any side effects.
  
  
• Providing supervision and an extra measure of confidence as the patient resumes normal activities as advised by the doctor, and coordinating home visits from the physical therapist and other providers.
  
  
• Ensuring that the home is a good recovery environment by performing housekeeping tasks that the patient shouldn't, being watchful for hazards that might cause the patient to fall, and providing reassuring companionship.
  
  
• Assisting the patient with the activities of daily living with in-home personal care, such as dressing, bathing, eating, transferring from bed to chair, and toileting.
  
  
• Transporting the patient to outpatient follow-up appointments, physical therapy and other outside-the-home activities.
  
  
• Supporting family caregivers by providing respite care and peace of mind when family live at a distance, have time conflicts with jobs and other responsibilities, or have health needs of their own that make it difficult to provide care.

For more and more patients today, a variety of post-hospitalization in-home care services helps assure successful recovery in the comfort of their own homes.