If you are like most, a hospital is the last place you want to call home. We can't wait to get home to our own beds, our own space, and back to normal.
Many times, transitioning home from an inpatient rehab or hospital setting can bring its own set of challenges; not just for the patient but also the family involved in care. It can be scary and overwhelming to transition home and that's completely understandable.
1 in 5 seniors are readmitted to the hospital within 30 days of discharge according to the Centers for Medicare and Medicaid Services (CMS). Most readmission happens within the first 16 days, making the case that proper transitional care and planning is essential for the patient's recovery.
Planning....that's what transitional care is truly all about. Yes, there are other factors involved but the core of transitioning from inpatient care to home, starts with a plan.
We all know the basic components of a well laid plan; answer the questions who, what, when, where, and how. But answering these questions can sometimes leave us scratching our heads. So, let’s go through each of these items together to help create clarity while you create your own transition plan:
WHO is going to provide care when your loved one transitions home? Is it you, part of your family, maybe even a hired caregiver? Or are you putting together a team of people to help you provide care? (hint, hint) This is not the time to claim super hero strength. No one person can provide 24/7 care for an individual who needs round the clock care. Be honest with yourself and call in reinforcements, whether they are hired or volunteers. You also don't want to assume the individual can handle caring for themselves when they really cannot. Speak to the case manager at the hospital to help guide you in how much care is needed. My tip, more in the beginning is better! After a few days you will have a better idea of how much care is needed. It’s better to be prepared than to assume...you know what they say about assuming:)
WHAT kind of care/equipment/supplies will be needed once they get home? Will they need Physical Therapy, maybe even Occupational Therapy? Will they need a walker or bedside commode? Will they need help walking, getting a bath, getting dressed, preparing food, etc. Based on the answers to your questions, you may need to seek Home Care assistance for both the medical and non medical needs of the person. Again, your patient advocate or case manager should be able to help guide you.
WHEN should I start planning for the transition? The answer to this question seems to shock many people, but honestly the answer is day 1. The first day of inpatient treatment is when you start thinking about and planning for the transition home. Obviously, you cannot lay concrete plans with dates attached until you know when discharge will occur, but this is the time to learn what options are available in your area. Reach out to the Case Manager or Patient Advocate to learn all you can about resources in your area. Ask friends who have been through a transition with their family members or friends. I cannot tell you how many families call me on their way home from rehab to see if we can provide a caregiver that day. Of course, we do our best to accommodate the situation, but a clear plan helps all parties involved understand expectations and goals for better outcomes for the patient.
HOW will the transition occur? Based on the individual's insurance they may qualify for a rehab stay to create a smooth transition out of the hospital and build up strength to go home. However, there are times when the transition may be straight from hospital to home. In these instances, work with home care providers to aid in smooth transitions. Both Home Health (PT/OT, wound care, nurse visits, etc.) and Home Care (personal care, meal prep, laundry, light housekeeping, errands, etc.) can assist you in the transition process.
Whatever your needs may be in transitional care, remember, it all starts with a plan. We've put together a free transitional care checklist to help guide your thoughts and actions as you prepare a transitional care plan of your own. Click the link below to sign up for our email and receive this free guide!
We'd love to hear your thoughts and advice on transitional care! Comment below to share with our community or email us at firstname.lastname@example.org. What has helped you in creating a transitional care plan? What tips or tricks were valuable in the process?
If you are located in or around Tallapoosa County, we would love to help with your transition plan! Call Beyond Home Care to schedule a free assessment today! 256.414.6090
...Where do I even begin?
Most family caregivers never expect to become caregivers. It's typically a surprise…or a complete shock! You may be more than happy to help or find it necessary to step in, either way, the question I am asked more than any other is: Where do I even begin?
It can be overwhelming and stressful to take on the care of anther person. They may be completely reliant on you for day to day care or you may be stepping in to manage finances from across the country. Either way, there is a shift in priority and responsibility. You now must manage not only your own life, but that of another person. There are a thousand things to consider when becoming a caregiver but I find its best to start broad and simple. To help you wade through the initial paralysis of where to begin, I have compiled theses 5 helpful steps.
Organization looks different for everyone and what works best for me, may not work best for you. But the focus needs to be getting everything together that you need, in one place. Find an old notebook or binder and collect insurance papers, advance directives, doctors’ numbers, medication lists, etc. Keep it all together so you can easily access what you need whenever you need it. If you prefer a digital approach, try an app like Evernote or Trello to keep everything you need easily accessible in your smart device. You can use Google Calendars to keep up with appointments or tasks that need to be completed by a specific date. Although organizing can take a little time, it will save you so much time and mental energy in the long run.
(more to come on this topic in the coming weeks so be sure to check back)
Write it down.
As much as we want to rely on our memory, when things get busy and you are out of your normal routine, it's easy to forget. In your handy binder or app, make sure there is a place to make notes. This will come in handy when you are accompanying your senior to a doctor’s appointment, paying bills, or picking up a few items at the grocery store. Keeping these notes together and well organized will help you stay focus and keep your tasks straight for your senior.
We can’t be everything to everyone all the time. When becoming a caregiver its important to reach out and ask for help when needed. Support can come in the form of emotional, physical and even mental help. Becoming a caregiver can be full of emotions, positive and negative. Your feelings are valid, no matter what they are, and you need to be kind to yourself if you are going to care for your senior.
Find a support group, online Facebook group, friend, neighbor, etc. to lean on for emotional support. Sometimes simply having a friend to listen to you when stress creeps in, can help more than anything else. It's easy to think we can handle things alone but asking for help or even receiving help when offered is so very important to ward off caregiver burnout.
If you don’t have family or friends who can provide respite care, consider hiring a caregiver to come into the home and provide a few hours of relief for you. You must take care of yourself if you are to care for another person. I always tell my family caregivers, “You cannot pour from an empty cup.” Allow others to help you!
Today’s world is amazing in that anything you want to learn is simply a click away on the internet. If you have become a family caregiver it's likely due to your senior being diagnosed with an illness, recovering from an injury or natural aging. Regardless, there are resources galore and the opportunity to learn as much as possible about their circumstances is endless.
You can also reach out to professionals in the aging community who can help educate you on what your senior needs and who to contact. As a Certified Senior Advisor, my job is to help guide family caregivers to valuable resources and experts who can support them in the journey of caregiving. It's important to surround yourself with others who can lend their expertise in their field whether it’s an Elder Attorney, Financial Advisor, physician or the leader of your local Alzheimer’s Association. You don’t have to walk this path alone.
It may sound trite but stop and breathe. You can do this! Take it one step at a time and try not to get overwhelmed with what could happen in the future. Focus on today, and the present. It's easy to get overwhelmed when we let ourselves think too far ahead and all that needs to be done. Take it one day at a time, the rest will start to fall into place.