By:  ComForcare Home Care

Last week reminded me how even the best hospital care can be undone if patient's don't get the right help after discharge.

One of our 87-year-old clients, Mrs. T, was inspired by warm weather to do some ambitious spring cleaning - overambitious, in fact.  She managed to drag the furniture away from the walls and move some heavy lamps.  She was taking down curtains when she fell hard and fractured her shoulder.  When our home care aide arrived to prepare dinner for Mr. and Mrs. T the ambulance was just pulling away.

The hospital took fine care of Mrs. T for three days, and the plan was to transfer her to a rehab center for a couple of weeks of physical therapy.  So Mrs. T's husband was shocked to get a call telling him she was coming straight home instead - an in less than two hours!

Medicare wouldn't pay for a longer hospital stay or for rehab, so back home was the only option.  Regulations didn't take into account that there was no family nearby to help or that the patient's spouse was 90 years old.

Mr. T wanted to take great care of his wife, but trekking up and down stairs with her meals was really hard, and he wasn't much of a cook anyway.  Poor eyesight and some memory loss made deciphering the hospital paperwork challenging.

When my RN and I visited them the next morning they were both exhausted after a bad night's sleep.  It was clear we needed to get them extra hours of home care, but just as important was coordinating the follow-up care.

There were no instructions in the discharge papers about how to care for the bruised, swollen shoulder.  Ice?  Heat?  More it or keep it immobilized?  The paperwork said a visiting nurse and therapist would come, but when we called the service they had not received the information about Mrs. T and nothing was lined up.

Fortunately, we were able to make calls, get the needed information and set up the proper follow-up appointments.  We are happy to do this kind of care coordination not only for our regular clients but also for anyone who needs a hand making a successful transition from hospital to home.

Our home health aides transport patients home, pick up prescriptions and groceries and help people settle in.  Our RN reviews discharge instructions and educates patients about maintaining their health in the home environment.  She makes sure needed equipment is delivered and coordinates follow-up care with doctors, nurses and therapists.

Hospital do an amazing job healing injury and illness.  Our job is to help patients continue the path toward health and independence once they are home.  If you would like to learn more about our Hospital-to-Home Transition program or about ongoing home care services, please call us at 908-927-0500 or see our website.

Whether your loved one needs assistance only a few hours a week or around-the-clock, our team is happy to help! Call (732) 499-0182 to learn more about the transition care services offered through ComForCare Home Care (Middlesex North, NJ).