By Arun Rao, MD, AGSF, FACP
If you’ve been hospitalized with a serious illness or injury, the decision of where to continue recovery once you have been discharged is an important one.
This is particularly true for patients aged 65 and over, who are more likely to feel the effects of a hospital stay than younger patients.
For many patients, returning to their home after a hospital stay offers recovery in a familiar environment, where getting back to the activities of daily living can offer a faster return to strength and peace of mind.
The key to a successful return to home, however, is planning.
At Penn Medicine Princeton Health, physicians, nurses, and experts in physical, occupational, and speech therapy work closely with case managers and discharge planners to ensure the best plan of care after a hospital stay.
Hospital Stays Impact Overall Health
Even a short hospital stay can have a significant impact on many aspects of an older patient’s health.
In fact, older adults can experience a variety of effects when they’re in the hospital, including:
• A sudden change in mental health, especially delirium. Signs of delirium often include inattention, restlessness, disorientation, and incoherent thoughts and speech. These can be caused by the acute illness itself, new medications, or recovery from anesthesia. The anxiety some patients experience because they’re in an unfamiliar environment and out of their daily routine can also contribute to changes in mental health.
• A decline in physical strength from immobilization. The decline in physical strength during a hospital stay can be the result of not being involved in daily activities of living such as bathing, cooking, and household chores. Consider that one day spent in a hospital bed is equivalent to seven days of strength lost.
Recognizing these situations can have a lasting effect, the multidisciplinary team at Penn Medicine Princeton Health begins evaluating each patient the moment that they’re admitted to Princeton Medical Center.
The evaluation includes a comprehensive health assessment that considers the patient’s nursing needs, functional status, available and able support network, and goals for care.
The team also speaks with the patient and their loved ones to learn more about the patient’s life outside the hospital, so the team can recommend the best plan of care after a hospital stay.
Concerns in any of these areas that might make discharge to home difficult might result in the option of transfer to a skilled nursing facility — perhaps even on a temporary basis.
When Discharge to Home is Best
The period of recovery after an older patient is discharged from the hospital can be a difficult, emotional time.
Patients and their loved ones are faced with the often challenging decision of whether to return to home after a hospital stay, or to go to a skilled nursing or other type of care facility.
For many patients, discharge to home offers the best opportunity for a more comfortable recovery and a faster return to normalcy.
While at home, patients who experienced physical deconditioning in the hospital can regain strength sooner as they get back to a daily routine of cooking, bathing, household chores, and other activities that require them to be mobile and active.
Additionally, their nutrition also tends to be better, as more of the foods they like are available.
For patients who have experienced psychological changes, returning home can offer immediate relief from the fear and anxiety that they faced during their hospital stay.
Sometimes, when a patient has complex medical needs, discharge to a skilled nursing or long-term care facility may be the best option. A skilled nursing facility offers various levels of care, from a period of recovery and rehabilitation until the patient is ready to go home, to long-term and hospice care for patients who aren’t able to return home.
Some patients may also face concerns with health insurance coverage, or the lack of a support system that can help ensure that they are safe in their home, able to take their medication as directed, and follow up with their physician.
Factors to Consider
When exploring the return-to-home option after a hospitalization, there are many factors to consider.
Even after discharge from the hospital, the patient may require physical or occupational therapy, speech therapy, or medical equipment such as a bed, wheelchair, shower seat, or walker.
An older adult who is returning home after a hospital stay will require a safe environment that’s free from tripping hazards and matches any reduced physical abilities. The patient and their family must also evaluate whether help with cooking, cleaning, bathing, wound care, medications, and the like, are needed.
Support from family, friends, and others in the community is also important.
If recovering at home is determined to be the best option, the team at Princeton Health —working closely with the experts at Penn Medicine at Home, or another homecare agency of the patient’s choice — will provide guidance about the equipment and services that will be needed in the home, what may be covered by insurance, and what local resources may be available to help fill in the gaps.
Take A Proactive Approach
Conversations about your wishes for medical care can be difficult, but it’s best to have them before a medical crisis happens.
For the patient, it’s important to voice your desires and concerns, so your needs are regarded by your family and care team.
For family members, ask your loved one what matters most to them to better understand the environment in which they’d be most comfortable recovering.
No matter your role, be proactive. Work with family members to prepare and review your Power of Attorney for medical and financial matters, Living Will or Advanced Directive, and insurance information so everyone understands how to proceed.
Talk to your primary care physician about completing a Physician Orders for Life Sustaining Treatment (POLST) form. If you are in the hospital and aren’t able to communicate, the POLST form informs providers about the treatments you want and your goals of care.
Also, take steps now to protect your health and build resiliency so that if illness or injury occurs, you are better equipped to handle it.
• Stay active. Engaging in some physical activity every day, such as swimming, gardening, or even simple chair exercises, can help you stay strong and healthy.
• Stay social. Maintaining social connections helps support your mental health and can help keep your mind sharp. If you do need to be hospitalized at some point, you will have a network that you can depend on.
• Stay on top of existing medical conditions. Taking medications as prescribed, staying up-to-date on vaccinations and getting regular check-ups can help you manage existing medical conditions and avoid future illness.
To find a physician affiliated with Penn Medicine Princeton Health, call 1-888-742-7496, or visit www.princetonhcs.org.
Arun Rao, MD, AGSF, FACP is board certified in internal medicine and geriatric medicine. He is the medical director of care coordination for Penn Medicine Princeton Health.