More ways to ways to help ensure a successful hospital-to-home transition
Plan to provide extra help and support to your loved one during the recovery period.
Why: Always assume that someone who's been hospitalized -- whether for a few days or much longer -- will need extra help and supervision during the weeks following hospital discharge. Even under a best-case scenario, it usually takes at least that long for an older adult to get back to his or her usual self. Caregivers often incorrectly assume that home health services will address most of their loved one's daily needs -- but they can't, since home health services come just a few times a week.
What you can do:
If your loved one usually lives alone, plan on having someone stay with him or her for at least the first few days, to make sure any dementia hasn't worsened and he or she has recovered enough function to live alone again.
Prepare to help with healthcare and personal care. Whether your loved one lives alone or not, after a hospitalization, most people with dementia will need to have the caregiver take on a certain number of added tasks. These may include healthcare tasks such as:
Monitoring symptoms, such as pain or shortness of breath.
Changing wound dressings.
Making sure discharge medications are taken as directed.
Administering as-needed medications, such as those for pain or for constipation.
Providing catheter or ostomy care.
Helping with injections.
Supervising physical therapy exercises
There may also be personal care tasks involved, such as helping your loved one to:
Get safely up out of bed.
Get to the bathroom.
Use a walker or wheelchair.
Bathe or shower.
Ask hospital staff for advice on how to manage unfamiliar tasks. If these are new tasks that you haven't previously been trained to do, be sure to mention this to the hospital nurses and to the discharge planner. Often families can learn a lot from hospital staff during the last day or two before hospital discharge.
Consider enlisting extra help, either from family or from a paid aide. Managing all the home care- and recovery-related tasks involved is both time consuming and emotionally and physically demanding.
Understand what symptoms and signs your loved one should be monitored for, and who to call if you have concerns.
Why: At discharge, your loved one will be on the mend but still recovering from whatever landed him or her in the hospital. Once home, you'll be the first line of monitoring and care for your loved one. It's essential to have a clear picture in your mind of what to expect in terms of a time frame for improving symptoms, what kinds of setbacks are common, and what are the signs that you need to reengage medical help.
What you can do:
Be sure you're present when discharge instructions are reviewed. The symptoms or signs your loved one should be monitored for are usually spelled out in written discharge instructions; most hospitals have a nurse or other provider review the instructions on the day of discharge. Be aware that hospital staff will sometimes review discharge paperwork only with the patient. But hospitalization is taxing even on someone who doesn't have dementia; your loved one will almost certainly be better off if you hear the information, too.
If by chance you miss being included in a discussion of discharge instructions, don't hesitate to ask for someone to review the instructions once again with you before your loved one leaves the hospital.
Realize that the exact symptoms to watch for will depend on the particulars of your loved one's case. For example, if your loved one was hospitalized for heart failure, you'll probably need to watch for worsening shortness of breath and for weight gain.
Ask about the best way(s) to communicate if there's a problem. Just as important as knowing what to watch for is knowing whom to call if a worrisome symptom pops up. Some hospitals employ dedicated nurses or other staff who check on patients post-discharge and are available in case you have concerns. Other hospitals direct patients to call their primary care doctor. If this is the case, make sure the hospital has sent a discharge summary to your love one's primary doctor, so he or she is best prepared to manage the new developments.
Make sure the discharge instructions are clear regarding medications.
Why: Most people with dementia need a caregiver's help with medications even before hospitalization. This reliance will increase after a hospitalization, when mental functioning may be even more confused and new drugs may have been introduced.
What you can do:
Be sure you leave with a discharge medication list. This is supposed to include all medications your loved one needs to take for his or her chronic conditions, plus any new medications related to the hospitalization.
Compare this list to your loved one's prehospitalization medications. If the hospital staff have discontinued any of your loved one's usual medications, ask for a brief explanation as to why. Be sure you understand the purpose of any new medications, as well as any side effects to watch out for.
Specifically ask if any medications your loved one is taking might make thinking or balance worse. It's better to know in advance if these are likely side effects.
Talk about instructions for medications that are to be given "as needed." Medications for pain and constipation are often prescribed this way, for example. In most cases, it falls to caregivers to figure out when the medication is needed, and to dole the pills out accordingly. Patients with dementia, in particular, may not think to report pain, and so they may not receive meds when needed.
Be sure to bring all post-hospitalization medications to the follow-up visit with the usual primary care doctor. You'll also want to let the usual doctor know how often the "as-needed" medications are being taken.