It's a happy day when a senior citizen is discharged back home from a stint in skilled rehab. Despite the attempts of the social workers to ensure safety and schedule follow-up, there are a few things that are often overlooked if this is your first rodeo. If you are advocating for an aging loved one, or if you have found yourself in this situation, you may want to consider a few key things.
Durable Medical Equipment
Medicare doesn't offer a lot of assistance with paying for durable medical equipment, but it's always worth asking the social worker ahead of discharge. If your loved one needs several assistive devices, you may be out of pocket. You have the option to order these things yourself on Amazon or through a local pharmacy, but I always suggest that you discuss any need for DME with the therapy department before your loved one returns home. Items may include a hospital bed, wheelchair, walker, cane or shower chair, among other things. If you have an idea of what your loved one will need, you can have the items delivered before they go home. Just keep in mind that not all rehabs are pro-active with ensuring that items are ordered, so you may have to do some homework on your own.
Medication Review
It's advisable to review the medication list prior to discharge. Often times skilled nursing and rehab facilities will change long-standing medications for any variety of reasons. It's important to know what these changes are and why they occurred. Ask for a medication list and notes prior to the discharge so that you can review it with your loved one. You may want to ask the medical director to discontinue any medications that don't need to be on there such as over the counter medications for pain or laxatives.
If your loved one is going home alone and intends to self-med, find out what medications they still have at home and compare the medication list with the new one from the rehab. Any expired medications at home should be disposed of properly. If they intend to self med again, just remember that they haven't had to do this for several weeks to months and they may need some help getting back into the routine. Pill organizers and timers might be helpful. You may also want to review the new medications with them to ensure they know what they are taking, when, and what it's for.
Upon discharge, you should receive all the paperwork, including prescriptions, which can be filled at their pharmacy or you may ask the social worker to call them in ahead of time. You may need to fill several new prescriptions for your loved one and if they are using a mail order pharmacy with auto-renewal, you may need to help them adjust or cancel orders.
There will often be standing orders for laxatives and enemas on their medication list as mentioned above. These are often not needed upon discharge but it's good practice to go through item by item with your loved one before they leave the rehab to see if they need it when they get home to ensure you have everything prepared.
Transportation Home:
Work out how you are going to get your loved one home. If they have difficulty transferring into a vehicle, you may want to consider hiring a medical transport or a wheelchair transport. This is something you should discuss with the therapy department and the social worker ahead of discharge day. If you are arranging the wheelchair transport, you will need to purchase your wheelchair before they are discharged and bring it to the rehab because they do not give wheelchairs away. Keep in mind that medical transport will be out of pocket as it typically isn't covered by insurance.
Home Safety Inspection:
Seniors that spend several weeks to months in a rehab tend to have physical changes including muscle loss, weight loss, changes in appetite, general deconditioning of balance and ability to accomplish activities of daily living such as dressing and bathing themselves. When they get home, it's a good idea to walk through the living space with them to watch how they navigate. Remove any trip hazards such as small area rugs or furniture that stands in the general path of movement from space to space.
Ask them to go into the bathroom and show you how they will get on and off the toilet. If you need to, you may want to install grab bars or a raised toilet seat. Ask them to step in the shower to see if they have any difficulty. You may want to consider getting a new shower head if they don't have one that is removable. You may also need a shower chair to allow them to rest while they are bathing.
Ask them to walk through the kitchen and go through the motions of making a meal. Ask them to reach and take out a pot or a dish to see if they are able to perform the tasks. If they are still weak, which they most likely will be, ensure that you have a back-up plan for meal preparation.
Ask them to sit in their favorite chair and watch them when they get up. Take note of any balance issues or weakness when they perform this task.
Emergency Call Button:
If you don't have an emergency call button or system already, it might be time after a long stay in rehab. Encourage your loved one, especially if they live alone, to wear it or keep it close in the case that they need help or have a fall.
Post Rehab follow up
Most seniors that end up in rehab will need to schedule several follow ups, depending on why they ended up in the rehab in the first place. Ensure that they have follow up appointments scheduled with their specialists, but don't forget the primary care physician. PCs need to be updated on the changes that occurred and they can assist with any questions about medications.
Skilled Home Care:
Skilled home care is often approved by insurance following a discharge from rehab. This is organized by the discharging social worker. If you do not have a preferred provider, you will be assigned one. Skilled home care is a nurse who will visit the home regularly for a chosen period of time to ensure that your loved one is safe and healthy and continuing to heal. They may follow up on wound care, medication adjustment, and education for the patient and the family on continued rehabilitation at home. They do not provide companion care in that they don't sit with your loved one for hours at a time. They usually visit for an hour or less and go through the skilled nursing needs. Skilled home care will also include visiting outpatient therapy which is covered by Medicare Part B. It's important to have the therapists come to the home to help with activities of daily living and ensure that the patient is able to maintain independence at home. You should try to be present during the first few visits so you can get an idea of how well your loved one is doing from a therapy stand point. The therapist might make suggestions about how to re-arrange the living space for a safer environment.
Non-Skilled Home Care:
Many seniors are discharged with the request that they will hire a home care aid to help them with the transition. Be open minded to this option because despite the feeling of intrusion in the home and the cost, it's more than a suggestion. If the rehab is requiring it, they feel that your loved one should not be left unsupervised and you should consider that despite your feelings on the matter. Insurance does not pay for non-skilled home care as of now. If your loved one is low income, they may be eligible for Medicaid non-skilled home care, so this may be worth looking into if you feel that they cannot afford to hire help. Long term care insurance (if they have it) may pay for a portion of the non-skilled home care but it may not be worth it to file a claim if your loved one intends to re-gain independence and just needs a little time. Many policies require the patient to private pay for 60-90 days before they will re-imburse.
Many seniors who return home after rehab have several weeks to months of adjustment to go through before they can return to their full functioning independence and many never regain full strength. Just because someone was independent before they had their skilled rehab stay does not mean that they will bounce back immediately. Some people may heal faster than others, but understand that patience on the part of the senior and the family is key to ensuring a safe and healthy recovery. At the end of the day, whether it was an elective surgery, an accident, or an illness that cause the skilled rehab stay, the likelihood of a repeat incident is higher now. Continuing to advocate and learn about the system for our aging loved ones will ensure that we have the tools to do our best for them.
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