Advice on Discharges from a Caregiver Who’s Been There

Although my mother passed away last year, as a primary caregiver of an elderly frail parent, I  learned valuable lessons about the pitfalls seniors face when they are discharged from a hospital or nursing home.  They can experience functional decline, weakness and atrophy from being confined to hospital bed rest.  Cognitive functions can be negatively impacted by medications, a chronic illness or the additional anxiety of how they will manage their impaired health condition after discharge.  Further, seniors can be overwhelmed when the hospital discharge planner drills them with multiple instructions, necessary follow-up appointments and medication schedules they must arrange.

Important discharge strategies, if communicated and completed well, can result in a successful discharge. Unfortunately, if there is a breakdown of the medical orders or follow-up care, the loved one will be readmitted to the ER or hospital. Statistically, nearly one in five  seniors discharged from the hospital will be readmitted within the first 30 days due to preventable factors like premature discharge or being discharged without a viable discharge plan.  As a caregiver, you can help your loved one avoid readmissions by assessing their home environment for safety factors and ensure they have necessary supports in place.

First, it is very important for someone knowledgeable of the patient’s home and health situation to be at the hospital during the discharge planning meeting to act as the senior’s advocate. As a caregiver, you need to listen, ask questions, take notes and assure your love one that they will have the supports in place to assist with their recovery.  The patient might be disoriented, in pain, have hearing or vision problems, or possibly all of the above and it will be difficult for them to retain the information themselves.  When a senior goes home after a hospitalization, he or she may temporarily require an intense level of care.  They will need to regain their strength in order to walk safely, transfer in and out of bed, use the bathroom independently, perform some chores, personal hygiene activities, eat nutritiously, adhere to proper medication schedules and obtain follow up outpatient medical care.

Secondly, seniors who live alone may lack the support they need to recuperate safely. A family member or friend may need to stay with the senior until the love one is reoriented and strong enough to care for themselves on their own.  If you do not have an informal caregiver arrangement available, you might consider obtaining a professional in home care services to assist the senior that has been recently discharged. The hospital might prescribe a licensed home health nurse to make home visits to obtain vitals, provide wound care, change dressings and other activities that require skilled nursing care.  These hours prescribed are very limited and do not cover meal prep, house-keeping, laundry services or personal care such as grooming and showers.

A third thing to consider; seniors often get discharged from the hospital with a stack of prescriptions. Some of these medications are in addition to the medications they have been taking routinely. The hospital has probably checked if there are any adverse drug interactions between the medications they received as a result of the hospitalization and their routine prescriptions.  In addition, their doctor might have also eliminated some routine meds or changed the dosage.

It is very important to review their current medication list (new, routine, over the counter and supplements) to identify possible counter interactions or redundancies in meds.  It is a good idea for the caregiver to observe how the senior reacts to all the new meds when the routine meds are reintroduced into the loved ones medication regime when at home.

Another confusing issue to be aware of regarding medications is the prescriptions given at the hospital might not look the same as the ones you receive at the pharmacy depending on the medication’s manufacturer.  Medications can not only look different but they can have different names depending on if they are brand names or generic medications.

As well as making sure the meds are taken at their proper dosage it is equally important to make sure the medications are taken at the proper times, and whether with or without meals.  Prepacking med-i-sets for the senior is essential for easier medication management. You can purchase med-i-sets at your pharmacy.  Some pharmacies also offer bubble wrapped medications, where the required medications are encapsulated in individual plastic bubbles with the times and date indicated. Our office has a list of pharmacies that provide this service at no or nominal additional charge. Please check with the patient’s pharmacist or physician if you have any medication questions.  It is better to be safe than sorry.

A fourth consideration, is the loved one’s diet.  Proper nutrition is a vital part of regaining strength and healing. Eating poorly or not taking in adequate fluids after discharge can put a senior at risk for physical weakness or dehydration.  Failure to do either can lead to low blood sugar, dizziness and increase likeliness for falls.

Make sure that there is someone available to prepare healthy meals or that there are meals available for the senior to eat if they can safely manage to get around. It would be helpful for someone to be assigned to do the grocery shopping.  Another option is to request home delivered meals if the loved one is alone during meal time.  This provides another set of eyes to make sure your loved one is safe if they are alone.

Fifth and equally important is having someone available to assist with transportation to follow-up medical appointments and to pick up medications at the pharmacy.  The primary care physician can often catch warning signs of trouble before the health condition deteriorates to the point of needing re-hospitalization.

The optimal goal is to have these post discharge strategies lined up prior to hospital discharge.  The hospital social worker/discharge planner will help the patient develop a viable discharge plan while the patient is in the hospital, however, as we all know, the majority of the responsibility will fall on the caregiver to carry it through.  It is better to have the plans made in advance.  Believe me, there will be enough to coordinate post discharge.

Lastly, make sure you take care of yourself, get proper nutrition, sleep and have a backup support so it doesn’t fall all on you.  I know this is easier said than done BUT it is vitally important in order to be a good caregiver, you need to stay healthy and have a support system for your own mental health.

If you need any assistance with making these plans, want resource information or are looking for service delivery options, please call our office and ask for our NY Connects worker at 315-946-5624.

Good Luck!

Penny Shockley, Director