More ways to ways to help ensure a successful hospital-to-home transition
Prepare the home for your loved one's recovery.
Why: It's better to arrange necessary changes before your loved one heads home, because you'll feel better prepared and the house will seem calm, not stressed. Discharge planners can help you think through what will be needed.
What you can do:
Explain the home environment to the discharge planner. Does the person live alone or with others? With you? Where is the person's room? Are there stairs to negotiate? How are meals provided? This information will help you both think through what's needed in the weeks ahead.
Explain any limitations that you have. Do you work full- or part-time? Do you have health issues of your own that may limit your ability to provide care? Are you unable to drive? Together with the discharge planner, you may need to address transportation or meal services available in your area.
Consider making minor modifications. For example, if the person you care for has any additional physical limitations after the hospitalization, such as need for a walker, will you have to set up a bed on the ground floor? Can you install grab bars in the bathroom(s) to provide added support?
Figure out who's paying. Often insurance is able to provide certain equipment after a hospitalization, such as a hospital bed, bedside commode, or shower chair. You may also need supplies, such as gloves or dressings for wound care. The discharge planner should help you figure out exactly what will be needed and who will be expected to pay.
Get rid of obvious falling and tripping hazards. You should assume your loved one will be at higher risk for falls because of a weakened state after being in the hospital. If you haven't done it yet, now is a good time to clear area rugs off the floor, make sure the path to the bathroom is well lit, and get secure footwear with nonslip soles.
Understand what home health services will be provided.
Why: Home health services are usually ordered by doctors (who must attest to their medical necessity) after a hospitalization. These are "skilled" services and may include nursing visits, physical therapy, occupational therapy, and more. These services help facilitate your loved one's recovery.
What you can do:
Ask to have recommendations written out. The discharge planner should be able to tell you what services have been ordered and what to expect about the nature, timing, and purpose of each. Be aware that the prescribed quantity tends to come nowhere near the level of care that was provided in the hospital or that would be provided in a rehabilitation facility.
Ask how these services will be paid for. Most insurance companies (including Medicare) will pay for certain "skilled" services to be provided for a limited time in the home. Home healthcare may not be paid for, however, if the hospital stay was shorter than 72 hours.
Learn more about home healthcare after hospitalization.
Make sure follow-up has been arranged with a primary-care doctor and/or other outpatient health provider.
Why: It's usually a good idea to have a post-hospital visit within two weeks of discharge, to ensure that recovery is going as expected. Follow-up appointments are often listed in the discharge paperwork that your loved one will receive prior to discharge.
Depending on the hospital and the reason for hospitalization, follow-up appointments might be offered at a post-hospitalization follow-up clinic, a specialty clinic, or with your loved one's regular primary care doctor.
What you can do:
- Don't stop at one quick follow-up. Even if the hospital offers a post-hospitalization phone call or in-person visit, it's essential that your loved one see his or her usual primary care doctor for a post-hospital visit, usually within a few weeks. This will help ensure that any new health information uncovered by the hospitalization gets integrated into your loved one's overall care plan.