You've done everything you can to make sure someone you love gets the best possible care in the hospital. But once the doctor gives you the good news that your loved one is ready to be discharged, your duties aren't over. In fact, you may find they're just beginning.
Whether your loved one's care takes place at home or in a rehabilitation or skilled nursing facility, there are many, many decisions to make, both in the beginning and as time goes on. And how you handle post-hospital care can make an enormous difference in your loved one's long-term recovery -- and in whether or not he ends up having to return to the hospital. "A high percentage of people discharged are readmitted within 30 days," says geriatric care manager Kay Paggi. "Often it's because they don't read the discharge instructions, don't understand them, or can't comply with them." Here, the 5 most common pitfalls, and how to avoid them.
Mistake 1: Underestimating How Long Recovery Will Take
When it comes to health issues, we tend to be optimistic -- perhaps overly optimistic, experts say. As we get older, we don't recover from illness and injury as quickly. There also tends to be an assumption that recovery means getting back to exactly how we were before. But that's not necessarily the case, or at least not right away. For certain conditions, rehabilitation can take much longer than either patients or their caregivers may expect. Take stroke, for example. According to James Castle, MD, recovery from a stroke may take up to two years.
Mistake 2: Overestimating Your Ability to Care for Your Loved One Yourself
When you feel a strong sense of dedication to someone else's well-being, it's natural to feel called upon to care for her yourself. But what we want to do and what we realistically can do are two different things, and overestimating what you're capable of can actually hurt your loved one's chances of making a full recovery. Ask yourself these questions:
- Are you -- or is someone you trust -- available to be with your loved one all or most of the time for the first few weeks after recovery, and possibly longer? Even someone who seems fairly strong and independent will be safest with constant supervision, at least for a week or two.
- What are your other responsibilities (work, children, etc.)? Can you manage caregiving without neglecting other essential tasks?
- Can you manage all facets of caregiving, or will you need help with certain aspects of your loved one's care?
- If you're going to need to delegate some duties, do you have someone you trust -- who's truly available -- to take them on?
- How are your own health and strength? Can you manage caregiving without ending up in the doctor's office yourself?
"One of the major factors is how much time and energy you have, and how long that will last," says Paggi, owner of Aging Care Solutions. "If an illness lasts several months and the patient either recovers or dies, either way, the illness is over. That is one thing. If the illness is projected to last for years and get progressively worse, that is an entirely different matter."
Mistake #3: Choosing to Recover at Home When It's Not Safe
There are a host of issues to look at if you or your loved one hopes to return home to recover. Make sure to look at discharge instructions carefully to see if you need special equipment, such as oxygen or a bed that can be raised and lowered. If your house has more than one floor, you may need to reconfigure furniture so your recovering loved one can sleep and use the bathroom on the ground floor. Bathrooms may need rails and other safety equipment, and you may need to reorganize the kitchen so she can reach food and utensils. And that's just the beginning. If your loved one's illness has left her weak or vision impaired, you'll need to reconfigure the house to remove excess furniture and rugs to decrease falling risk.
Then there are the additional problems faced by someone with memory loss or dementia. "For people with Alzheimer's, structure is very important; their environment and the daily routine need to be consistent," says Paggi. "Change is confusing." This issue is particularly important to consider if you're planning to hire in-home help.
Mistake #4: Expecting Too Much Independence
After any type of physical injury or surgery, there may be a great many tasks someone can't do for themselves, from small things like buttoning clothes and opening cans to big things like getting in and out of bed safely. If an illness or injury has left your loved one weak, simply getting around can be a challenge. Many medications prescribed post-hospitalization may cause dizziness, increasing the risk of falling. And if driving and using public transportation are out, someone can become isolated, lonely, and depressed.
"One of the biggest mistakes I see post-hospitalization is not making plans for temporary care until an older adult is truly functionally independent," says Paggi. We lose body strength with every day of immobilization, so someone who's been hospitalized for more than a few days may need time to regain strength. And for older patients, this process may be very slow. "If an elder is in the hospital three days or more, they lose the majority of their ability to function," says Paggi. "This is why I recommend that elders go first to a rehab/nursing home. They hate the idea of this. However, I find that the vast majority haven't visited a skilled nursing facility lately and are unaware that they've improved greatly." Paggi also points out that Medicare will pay for rehab if you've been in the hospital for three nights or more, which is one more reason to make sure you or your loved one isn't discharged too early.
Mistake 5: Not Following Through on Rehabilitation
Think of it like this: Your goal is for your loved one's discharge to be permanent, and often that's contingent upon her getting all the care she needs, often including some type of rehabilitation. But not carefully heeding discharge instructions is more common than not, experts say. It can be hard to get to follow-up appointments and to keep track of required tests. And while physical therapy is absolutely essential for full recovery from many illnesses and injuries, the majority of patients fail to fully follow through. According to one study, more than 70 percent of patients fail to follow recovery plans if they're "complex or require lifestyle changes and the modification of existing habits." That means only 30 percent of patients actually fully comply with doctor's orders.
Then there's the question of expectations. Paggi says she hates to sound pessimistic, but it's all too common for patients and family members to focus on "getting back to normal" when that's not a realistic goal, or at least not for a long while. "People tend to assume the cause of the hospitalization is fixed or cured, meaning they can go back to the way things were before," she says. But in many cases there remains a chronic underlying health condition that has to be managed. And the older your loved one is, the more likely that long-term health problems will be worse after a hospitalization. "Frail elders rarely return from a long hospital stay or illness back to the same health they had before it," says Paggi.
Keeping track of medications also raises issues, Paggi says, using her own family situation as an example. "My husband has had multiple eye conditions recently and is now taking six different drops daily, each with its own schedule. The bottles are all the same size and shape, some have colored tops and some don't. He is alert cognitively and has one good eye, so he manages. But what if he couldn't see the differences in the bottles or read the schedule?"
So what to do? Take it slowly, be realistic in your planning and expectations, and get the best possible care you can get. If you're over 65, the good news is that Medicare covers inpatient rehabilitative care as prescribed by your doctor if it involves at least three hours of therapy a day. Medicare also covers rehabilitation on an outpatient basis, including physical therapy, speech, and occupational therapy.