Haims: Transitioning from hospital to home requires coordination and planning
The fragmentation of our health care system is prolific throughout the country. Exacerbating the situation is the complexity of people’s care needs, challenges with the coordination of available care providers and the availability of rehabilitation services provided both at facilities and within people’s homes. Transitioning from a hospital to a facility or home environment requires attention. A little planning and forethought can go a long way to making a transition easier.
It is important for patients, of any age, to understand what, if any, assistance they may need after a hospital visit. While not all procedures may require support after a discharge, patients in need of assistance should have a clear understanding of the options available.
Identifying and gaining a clear understanding of the appropriate rehabilitation specific for one’s needs is imperative. Rehabilitation options most often include outpatient rehab, inpatient rehab or at-home rehab. As each rehab type may or may not present challenges, it is important to understand and ask questions of discharge planners. As well, it is important to understand the financial and logistical impacts that each option may impose.
Outpatient rehabilitation often includes speech therapy, physical therapy or occupational therapy provided at a clinic. This option may be suited for persons who have the ability and ease to safely get themselves to a clinic where such services may be offered. Questions to consider for outpatient care include frequency and distance to appointments, transportation options, the ability and willingness to support in clinic therapies at home and any special equipment that may complicate getting to and from therapy such as the need for a walker, wheelchair or oxygen.
Inpatient rehabilitation may also include speech therapy, physical therapy or occupational therapy. Depending upon a person’s needs, inpatient rehabilitation may be provided in a facility environment or within a person’s home. A decision between the two may be determined by answering:
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- Are there chronic or severe health needs that need frequent collaboration and monitoring by specialists?
- Can the patient properly and consistently manage their care alone?
- Does the patient need the assistance of another individual?
- Does the patient have the ability to manage medications, appointments, meals, bathing and transportation?
- Will the patient require durable medical equipment such as a wheelchair, walker, hospital bed or oxygen concentrator?
A properly executed transition plan ensures an easy-to-follow and executable plan that considers variables specific to each person’s needs and abilities.
Although aging/rehabilitation within one’s home is most often preferred, it may not be the best option for everyone. Rehabilitation and/or aging at one’s home poses several challenges. In-home safety measures must be considered. Of utmost importance is if the home environment is safe. Considerations such as installing stair rails and wall handles where needed (near toilet and shower), tripping hazards and fall risks such as throw rugs and electrical extension cords, possible need for a medical alert systems, ease of access to bathtub/shower, ability to vacate the home in an emergency, and the biggie — often the deal breaker, transportation.
If a planned hospital visit is in your future, and you have time to plan for it, consider packing lightly. Most likely you may not need much clothing as you may be wearing a hospital gown. However, you may want to bring your own bathroom supplies, a pair of walking/athletic shoes in case rehabilitation offerings occur, favorite snack foods, and most importantly, any medications you may need. While hospitals can provide you with medications, they may not always be the same brand or generic medication you are used to. Make sure you check such medication with your nurse, and remember to get the unused medications back when you leave.
Because not all visits to the hospital may be planned, it’s not a bad idea to have a “to-go” bag packed and readily available. Within this bag, you may want to consider bathroom supplies, sweatpants/T-shirt, walking/athletic shoes, a list of your current medications, eyeglasses, a personal and medical contact phone list, charging cords for your electronic items and something to read.
Coordinating a transition to or from a hospital, and then to a rehabilitation facility or back to a home environment, can feel overwhelming. However, do not fret. Hospital discharge personnel are available to assist. Additional resources include the Northwest Colorado Council of Governments Regional Ombudsman, Eagle County Healthy Aging staff, Caregiver Connections, and Visiting Angels.
Judson Haims is the owner of Visiting Angels Home Care in Eagle County. He is an advocate for our elderly and is available to answer questions.
