01 Jul Post-Hospital Care: Should I Recover at Home or in a Retirement Community?

When older loved ones are done with a hospital stay for illness or injury, you and they have one thing in mind: home. But often, a patient is not discharged to home; they’re discharged to rehab. How exactly does this process work, and who has a say in an individual’s post-hospital care? Discharge planning, post-hospital care, and short-term rehabilitation are topics of interest for every family with older adults. Is in-home therapy an option? What about inpatient or outpatient care at a senior living community or senior rehabilitation center — both of which employ skilled nursing professionals?

Discharge: The Moment of Truth

On the day a patient is scheduled to be discharged from the hospital — sometimes just hours before — a nurse or a social worker will hand out a list of local rehabilitation facilities. The list generally lacks essential information about the scope or quality of care at these places, but family members are still expected to decide where Mom or Dad will be going.

Families scramble to make calls and, if possible, visit a few places. But they’re not sure what to look for, what to ask, what the care plan will entail, or how long therapy might take. If asked for a recommendation, hospital staff members typically refuse, citing government regulations that prohibit hospitals from steering patients to particular facilities and guarantee patients free choice of medical providers. Not a particularly comfortable situation for most family members.

The Ideal Model for Discharge Planning

Only a doctor can authorize a patientʼs release from the hospital, but the actual process of discharge planning can be completed by a social worker, nurse, or case manager. Ideally, and especially when medical complications are involved, discharge planning should involve a team of people providing input. The discussion should include the patient’s physical condition before and after hospitalization; details of the types of care that will be needed, and whether discharge will be to a facility or home. It also should include information on whether or not the patient’s condition is likely to improve; which activities he or she might need help with; information on diet and medications; what extra equipment might be needed, such as a wheelchair, commode, or oxygen; who will handle meal preparation, transportation, and chores; and many other details. Does this happen every time at every hospital? Sadly, it does not.

Rehab Therapy at Home?

Some short-term senior rehabilitation therapies can be carried out in the home, but there are limitations. Visiting clinicians from home health agencies can perform services such as administering injections, providing wound care, or developing a strength and physical therapy exercise program. Usually, this type of rehab therapy is offered a few times each week with seniors instructed to follow the program on their own on days the therapist doesn’t come. They rarely stick with the program 100%, which can result in somewhat fragmented progress in therapy. There are also home modifications families must consider, such as wheelchair access and safety precautions. Home therapies lack the peer support and socialization that can be provided at a rehab center or in a residential setting like a retirement community offering skilled nursing care. This support and socialization often give seniors the extra motivation they need as they recover.

Hospital Readmissions

Although both the American Medical Association and the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) offer recommendations for discharge planning, there is no universally utilized system in U.S. hospitals. It’s been reported that as many as 40% of patients over 65 had medication errors after leaving the hospital, and 18% of Medicare patients discharged from a hospital are readmitted within 30 days. When it comes to patients discharged to home vs. those discharged to a skilled nursing facility, researchers at the University of Pennsylvania’s Leonard Davis Institute of Health Economics found that for more than 17 million Medicare hospitalizations between 2010 and 2016, patients discharged to home health care had a 5.6% higher 30-day readmission rate than similar patients discharged to a skilled nursing facility.

The All-Inclusive Aspect

Who needs post-hospital care in a rehabilitation center, and what do older adults and family members need to know before selecting one? Just as with discharge planning, there are no definitive guidelines. But older adults who have difficulty walking or taking care of themselves, who have complex medical conditions and complicated medication regimens, who need close monitoring, or who don’t have reliable family caregiver support, are often considered candidates for post-acute rehabilitation therapies at a retirement community that offers these services or at a stand-alone rehab center.

In this setting, loved ones receive help with the activities of daily living if needed, as well as tailored physical, speech, or occupational therapies, medication management, assistance with ambulation, meals and medical care, and many other services. Families who choose an all-inclusive residential setting like a retirement community over in-home care know their loved ones are safe and their needs will be met 24/7. They also don’t have to stress about finding, hiring, scheduling, or managing an in-home team of caregivers.

A Word About Costs

If a recovering senior requires little assistance following an injury or illness, in-home care may be more cost-effective. But if 24/7 care and supervision are necessary, the costs of home care will quickly add up. There may be costs associated with home modifications. And though an all-inclusive residential skilled nursing facility may require an initial fee, they often end up being the more affordable option for those with substantial needs.

Medicare covers both in-home care and care at a skilled nursing facility, but coverage is more limited for in-home care. For instance, while Medicare will pay for prescription drugs for inpatients, it will not cover medications for individuals who receive care at home. Likewise, Medicare will not pay for meals to be delivered to the home, but it does cover meals at nursing home facilities.

Questions to Ask

Before leaving the hospital, be as prepared as possible to choose the right rehab option for your loved one’s recovery. Getting answers to these questions will help you make a more informed decision.

• What types of therapies will be required after leaving the hospital?
• How many medicines will be needed, how often, and in what dosage?
• What is the purpose of each medicine?
• Will the medication have any side effects?
• Will my loved one need help with bathing or dressing?
• What about help with housework and meal preparation?
• How much time should it take, on average, for recovery?
• Should I watch for specific symptoms or problems?
• Will professional assistance or medical care throughout the day be needed?
• Will special medical equipment be needed such as a walker?
• Will health insurance or Medicare pay for this form of rehab service?

Getting Back to Normal at The Woodlands

At The Woodlands at Furman senior rehabilitation center in Greenville, SC, each person receives an individualized treatment plan based on their situation, physician orders, and therapist recommendations. We provide the most appropriate services as recommended by your therapy team. You’ll soon see improvements in your functional capabilities and your quality of life. Regular, personal assessments along the way will get you back to the life you love. And because we accept direct admission into rehabilitation, you need not be a resident of The Woodlands to receive services. Find out how The Woodlands can help. Contact us today.