Hospital to Home: Supporting the Transition

When a loved one is hospitalized, it can be a stressful and emotional experience. In many cases, patients are discharged from the hospital with little notice and minimal instruction on what to expect and how to prepare.

If your loved one is going directly home from the hospital, it typically means they have not fulfilled the requirement to go to a skilled nursing facility for rehabilitation, or they chose to go home.

We have some general tips to help the transition home go more smoothly.

Tips for preparing for a hospital discharge

• Learn everything you can about the condition that hospitalized your loved one. Ask the rehabilitation and nursing staff for instructions on how to help with recovery. This might include caring for wounds, checking vital signs, and addressing specific precautions.
• Before returning home, ask about any adaptive equipment you may need, such as grab bars, a hospital bed, or a shower chair. Rehabilitation staff may have evaluated your loved one to identify the appropriate adaptive equipment or determine if ongoing therapy at home is warranted.
• Confirm any new medication prescriptions and how to get renewals if needed.
• Ensure that you understand the discharge summary and plan for any follow-up appointments.
• Prepare for additional help. Enlist the assistance of family and friends and be specific. If you need meals delivered, ask. Most people want to help and appreciate assigned tasks.

Services to consider

You do not have to go it alone. There are services that can support you and your loved one.

Personal care

Personal care involves the assistance of private caregivers who can help with bathing, dressing, shopping, cooking, and running errands. The cost of personal care will vary depending on the company and location, but you can expect to pay between $25 and $45 an hour.

Home health care

Home health care is a service that Medicare (and other insurance) may cover for people who need skilled nursing care and physical and occupational therapy for a limited time following a hospital stay. A doctor's order is required, so it's best to arrange these services before your loved one is discharged. Home health care is based on medical necessity; these needs are usually identified prior to leaving the hospital. If your loved one was not set up with home health care, it's OK to ask about it or call your primary care physician for reconsideration. Most insurance pays for home health care.

Local resources

There are often local resources to help provide financial assistance, respite, and more. 211 is a collaboration between United Way and AARP, and a call to them can help you find the caregiving support you need. More primary care practices have embedded care coordinators or social workers to help people connect to local resources.

Getting through the first three days

The first few days may be stressful until you find your footing and develop a routine. Here are some suggestions on how to make the first three days successful:

• Have meals delivered or prepare easy-to-cook items like frozen dinners so that you can focus on rest and recovery.
• Plan on having someone in the home as much as possible. If your loved one is not mobile, purchase an Emergency Response System in case they have an emergency, and you are not nearby.
• Ask for help when you need it.
• Talk with your loved one about their feelings and address any concerns.
• Reassure your loved one that you will help with household responsibilities such as paying bills, pet care, errands, and housekeeping.
• In the days following a hospitalization, it's best to schedule visits from loved ones to minimize fatigue. Always ask the patient beforehand if they would like to have visitors.