What To Know When Your Loved One Is Leaving Rehab

From Rehab to Home

When your loved one has resumed some level of baseline mobility and independence, a discharge plan will be made to return home. Here are some thoughts to consider:

1.  Do they need special equipment at home? A walker? A shower chair? A bedside commode? A wheelchair? A supportive cushion to sit on? If there is equipment needed in order to go home, the discharge planner or social worker at the facility will help you understand what is needed and covered by medical insurance and what your person's out-of-pocket expenses will be. One tip for you here is to look for a LOAN closet in your area. A Google search for DME equipment at local loan closets should bring up several options.

2.  Understand the nutrition needs of your loved one. If a low sodium or low fat, low glycemic diet is called for, see if your person can speak with a nutritionist about this before leaving rehab.

3.  If Oxygen is needed, it comes from a private company. There will be a monthly copay to rent the equipment. I strongly suggest you find out ahead of time when it will be delivered to the home so that a second person will learn how it works as well. These companies may send a 'delivery technician' to set up the machine(s) and show you how to start the oxygen flow. A Respiratory Therapist might be the person who answers a phone call with issues that come up later. Always make sure you get the phone number for their 24/7/365 off-hours! Remember Murphy's law because it could be Christmas Day or 3am when you need them. Keep the phone number handy; tape it to the Oxygen machine!

4.  If your loved one has COPD or heart failure and needs oxygen around-the-clock, there are different kinds of machines you can rent. The Oxygen "Concentrator" is a large machine that sits on the floor (a folded towel under it decreases the noise) and can provide oxygen 24hrs - 7 days/week. Twenty-five feet of tubing which is included in the delivery allows your person to walk from room to room without disconnecting from oxygen. The delivery should provide extra tubing as well as extra 'nasal cannulas' or face masks. I suggest making sure there is humidification with the oxygen so the nasal passages don't dry out. Some people experience nose bleeds without this. Oxygen "tanks" are often delivered at the same time, but they only provide oxygen for 2-3 hours and it's a bit complicated for first-timer users to figure out how to hook up to a tank. Ask for help by phone if needed. If it's affordable, renting a "portable" oxygen tank is much less bulky than those big tanks and easy to use when going outside the home. It comes with a battery pack to plug into an ordinary outlet and might even include a charger for the cigarette lighter of your car if it has one of those.

5.  Is there an updated list of medications? Will the rehab facility give you what is left of the meds given in rehab? Those meds are held in what's called "blister packs" and they're thrown away if you don't request them. Make sure your person understands how and why they're taking each medication and any side effects to watch for.

6.  If dressing changes, IV flushes or heart conditions require a visiting nurse, have you picked a homecare agency to use? Do you know what your person's insurance will cover? Is there a copay for home visits? Homecare agencies will be responsible for ordering supplies needed for those specific tasks, but you can ask for some supplies at the rehab facility so that initial dressings or flushes can be taken care of.

7.  Just so you know, your loved one may still qualify for PT at home after rehab, especially if their hospitalization followed a fall or surgery, such as hip or knee replacement. The physical therapist would need to attest to the need for continued therapy in their notes. Find out if there are any exercises or activities that your person should avoid until they can perform them well or have assistance. Also ask about whether your person should be driving.

8.  Are there wounds that need healing? If the homecare nurse has been changing dressings, they are good teachers for you or your person to learn how to do them independently. If there is swelling, redness, drainage coming from the wound and/or a fever, these could be signs of infection, and a nurse will give you instructions about what to do. If the wound is healing, a nurse will tell you when a dressing can be discontinued. If there is no visiting nurse you should call the primary doctor's office or the specialist who took care of your loved one for updated instructions over time.

9.  It's recommended to have someone help your loved one full-time for the first two to three days after discharge and then part-time for a week or two after that. I plan to write more about finding private help in the home soon. "Seniors Helping Seniors" comes to mind. I can recommend some private aides as well.

10.  Make sure a next appointment is scheduled with the primary doctor covering your loved one's current medical problems. It might be the PCP (primary care physician), but it could also be a specialist.

From the Hospital to Home

If your loved one is able to go directly home from their hospital stay, the guidelines shown above ("From Rehab to Home") all apply except for #5 regarding medications. There are no "blister packs" in the hospital to take home. You might be able to get prescriptions filled in a hospital pharmacy before leaving. Otherwise, they should be picked up at your chosen pharmacy on the same day of discharge.

In the case of leaving the hospital, it's important again to understand what each medication is for, how often to take it and why they're taking it. And yes, DO FINISH the entire antibiotic if you're prescribed one! (The Health Coach in me would still remind your person that they can take "Saccharomyces boulardii" - a probiotic, also known as "Florastor" - alongside the antibiotic to support your gut).

To get more support from me in these complex comings and goings, let's chat.

This was Part 3 in the series “How to Advocate for Your Loved One when they need Hospitalization.” To see Part 1 and 2, email Jean for a copy at CompassionateConsulting@gmail.com 

About Jean Oswald: Jean’s nursing career spans more than three decades in the hospital and community settings, but it is end-of-life work that is most aligned with her Soul’s purpose. Jean offers practical, real-time advice to clients with a serious illness who are nearing end-of-life. Jean is a valuable resource for our aging population, recently publishing a book titled Guiding Lights: Navigating the End-of-Life Journey which can be purchased at Amazon.
 

Jean's Website: https://compassionateconsulting.com/