Saturday, November 20, 2010

Home after Hospitalization

This week I was mulling over several topics to post about, when I saw an article in the New York Times “Planning for Temporary Home Care After the Hospital Stay.” An interesting piece, it reminded me of how “going home” can be so different depending on the community you live in, the reason for the hospitalization and financial resources. A lot of the chronically ill people I work with can’t afford to pay $90 to $160 for a care or nurse manager, which is one of the article’s recommendations. However, depending on your diagnosis, where you live, and where you receive your care, you may be eligible for free case/care management services.

People with chronic conditions may have more experience with hospitalizations then most, but all the same it requires planning and attention when returning home.

If this is a planned hospitalization, such as an elective surgery, you have time to prepare for what you’ll need when you return home. Stock up on food, notify friends and family who can be counted on to help, lay in a supply of books, DVDs or whatever might be of interest to you. Depending on the admission, the hospital where you will be receiving care may have a website on discharge planning and/or offer tips on recovering at home from a particular procedure or surgery. The more information you can get up front, the better.

Unplanned admissions are a bit more difficult. As soon as possible, start meeting with the “disposition coordinator” or “ discharge planner.” The last thing you want to do is to be scrambling an hour before going home. If you do have a case/care manager, contact them as soon as you can after admission and have them work with the hospital team in planning your discharge.

If you don’t have a Lotsa Helping Hands page, this may be the time to start one. If you are not familiar with this free website, it allows you, or an appointed person, to coordinate what you need, when and by whom. A lot of the support services-cleaning, cooking, transportation, laundry, yard maintenance, child care-can be achieved by using trusted friends and relatives. People really do want to help.

When a hospital wants you out, they’ll do whatever they can to make that happen, no matter if the patient thinks they are ready or not to be discharged. Pleas to a supervisor can easily go unheeded. If you really don’t think you or the person you are caring for is ready to go home, speak to their doctor. Keep in mind, that even with the best advocacy, it’s a dollars and cents game and you may be forced to leave before you feel you are ready.

Be as clear as possible about what it is you’ll need when you get home. Check your insurance to see what type of coverage you have. If you know that you’ll need some assistive devices, like a wheel chair, walker, or commode, and your insurance wont cover it, ask about “loan closets.” There are a variety of organizations that loan such equipment for free. The social worker/discharge planner should know about them. However, if you get a blank stare, call 211, the state by state information and referral service, the local chapter of your condition specific organization, and/or a local community organization that helps in times of need.

Condition specific organizations, such as the local chapter of the American Diabetic Association, can be very helpful in seeing that you have resources and tools to help you at home.

During discharge, pay close attention to the information they are giving you. Be sure to determine if they are calling the home health agency that will provide nursing care or if you need to do that. Are they going to make appointments for follow up care, or is that your responsibility? Get written copies of instructions and that you do understand them. If you get home and are not sure about something, call.

In summary, if hospitalization is necessary, you can maximize the chances you’ll remain at home after discharge if you:

• Prepare in advance if it’s a scheduled admission

• If unscheduled
- Connect with the hospital’s discharge planner as soon as possible. If you have a care/case manager, have them coordinate with the discharge planner.
- Update your Lotsa Helping Hands website if you have one, or start one if appropriate.
- Determine what you will need when you go home
- Determine what insurance will or will not cover
- Identify gaps and work to close them using hospital and community resources.
- Understand discharge plan and don’t leave the hospital without a copy of it.

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