What to Expect When Coming Home After a Hospitalization

Our team is often called to assist older adults transitioning home from the hospital or skilled nursing care. Successfully caring for a senior transitioning home requires planning and coordination, depending on the level of care needed. For family caregivers, making a home care plan following a hospital discharge helps avoid rehospitalization. Taking a proactive approach and anticipating health changes may avoid a crisis and keep stress low for everyone. 

Facts about hospitalization

• Older adults are much more likely to be admitted to the hospital than middle aged adults. 
• Men are more likely to be hospitalized than women. 
• Adults over 85 are admitted at the highest rate – 26% were admitted at least once last year. 
• When an older adult is admitted to the hospital the research shows they may take weeks to months to return to their previous level of strength and independence. 
• It is difficult to avoid the physical and mental decline older adults suffer after a hospitalization. 
• Top diagnoses for hospitalizations – septicemia, heart failure, osteoarthritis, pneumonia, and diabetes mellitus. 
• Septicemia and pneumonia are acute illnesses that can be cured. 
• Heart failure, osteoarthritis and diabetes are chronic conditions requiring ongoing management to avoid rehospitalizations. 

As the old saying goes “an ounce of prevention is worth a pound of cure.” In this case, it is very true. It is preferable to prevent hospitalizations instead of allowing health to deteriorate to the point a hospitalization is necessary. We all agree hospitals provide life-saving treatments for those battling illness or injury. If someone is admitted to the hospital, they meet the criteria their insurance company requires to pay for the room, medications, and other costs associated with treatment of their diagnosis. This often means the person being admitted is very sick and is not stable or safe to return home to receive treatment at home or in a medical clinic. Their care requires 24 hour observation by nurses and monitoring machines. Life-saving treatment notwithstanding, it is the rare person that enjoys their hospital stay or wants to stay any longer than necessary. The 24 hour activity, noise and lights making sleep impossible makes the home seem like a relaxing oasis. 

What to expect upon discharge home from hospital or skilled nursing care

It can be an enormous relief to hear from the doctor “Your family member has recovered enough to go home.” The next feeling after relief is often panic when you need to figure out how to transition your family member back home. Talk with your hospital discharge planning team, they can connect you with resources in your area that can help support the transition to home. Here is some additional helpful information we share with our families: 

Do a Care Trial – Are you the primary caregiver? To do a Care Trial, spend a 24 hour period in the hospital providing the care for the hospitalized person. Try not to use the call-button unless necessary. The Care Trial is critical to understanding care needs and your care capabilities. If there is a care mismatch between the needs of the person and abilities of the caregiver, the gap can be mediated before discharging home and a crisis situation develops. I haven’t located any studies that discuss Care Trials. It is a strategy we used here at HelloCare to determine the readiness of the care team for discharge and reduce the risk of caregiver burnout, mismatch and readmissions. 

Routines might be different – The return home can be joyous, being in familiar surroundings can have a calming effect. Pets, home made foods and family are all appreciated with more joy and energy. Conversely, if a fall or accident precipitated the admission, there can be some anxiety around similar activities. Fear of showering is common after a fall. If your loved one is feeling extra vulnerable bathing, a shower chair may be helpful. Some shower chairs have a sliding bench that can make getting in and out of the shower more comfortable. 

Have as many tasks completed before the person arrives home – Can you pick up the medication or direct someone else to? There may be shortages in medication or supplies – better to know before leaving the hospital where a supply may be provided of missing items. Special food (like clear liquids or soft textures), hospital bed, or wheelchair can all be in the home before your loved one arrives home. Delivery times can be unpredictable. Try to minimize the variables that can cause stress by planning ahead. Try to have delivery of any needed equipment the day before discharge. This allows time to assemble items and get other last minute necessities. 

Prepare for confusion – Older adults with hospital stay longer than 2 days can suffer from a condition similar to jet-lag. The 24 nature of a hospital makes restful sleep difficult. Mixing up day and night, disorientation even in familiar surroundings are common. Research shows, people with cognitive impairment may have reduced brain functioning for weeks to months after returning home. Give your loved one time to readjust, and have a plan for other trusted caregivers to help to allow everyone to rest. 

Learn when to call the doctor to avoid readmission – while your loved-one is ready to discharge home, they may need close follow up care by their doctor. If you need to call for advice after hours or on weekends, have that number handy. 

Risk factors for readmission include:

• Older adults admitted to the hospital with multiple chronic conditions
• Admitted emergently rather than electively
• Taking 5 or more medications
• Non-compliant or unclear about their home treatment
• No follow up appointment with PCP
• Discharged on a Friday
• Male 

Readmissions can be demoralizing, but sometimes necessary. If you are managing a new diagnosis for yourself or a loved one, get familiar with the early signs of trouble. For example a person with heart failure may notice swelling in the ankles and weight gain as an early sign of worsening heart function. A speedy recognition of symptoms and a call to the doctor can avoid a hospitalization.  

Ready for weakness – during a hospitalization people are often in bed most of the day and may be discouraged from getting out of bed and moving around unless hospital staff is at their side. A recent study of college students instructed to stay in bed for 3 days, showed decreased physical strength for 3 months. These were college students! Deconditioning and muscle weakness is so common after a hospitalization medical billers have a code for it. 

Know when to expect the home health team – do you have home health, hospice or home care upon return home? Have the contact information of the office or scheduler. Know when to expect the initial visit, and know who to call if they don’t show up as expected. The visiting nurses, therapists and caregivers are crucial in the first days at home. Know who to call with questions and have the phone number handy. 

Get the PCP involved – if your loved one is lucky enough to have a solid, longstanding relationship with their primary care provider (PCP), make an appointment to be seen soon after returning home. The PCP will help stabilize health and medications, refer to specialists and order tests to monitor recovery. This is an important piece of the puzzle to avoid rehospitalization. 

Knowing what to expect when caring for a family member after a hospitalization can help you manage the transition with minimal stress. Learn your resources and don’t be afraid to ask for help.