Imagine this: Your elderly mother has just been discharged from the hospital after a four-day stay. She had fallen at home due to her diabetes. No bones were broken, and after a number of tests were done, and medication was regulated, she was sent home, where she lives alone. She can walk a few steps by slowly grabbing onto furniture, but she has a hard time getting off the sofa or standing to make a meal. Getting on and off the commode is difficult. What can you do to help?
In this common situation, a number of services stand ready to help you and your parent.
Because most hospital stays are brief and the patient turnover in many hospitals is high, inpatient services may not always be completed before the patient is discharged. Severe HMO and insurance constraints, plus budget cutbacks in many areas of allied healthcare, strand many people without the support they need.
If you find yourself involved in such a situation, become your own advocate or have someone help you understand how to get help. Here are some suggestions.
In the case of the elderly mother, it would be important to know whether the primary care physician ordered home health care services to evaluate the patient’s condition after she returned home. If the services were ordered, the discharge-planning nurse usually contacts a home health care service and relays the necessary information.
Medicare and other insurances may cover a short period for these services when the patient is truly homebound. Homebound means, for example, that the patient cannot get in and out of the house, or drive, or walk easily up and down steps without receiving significant assistance. Usually in these cases, either a nurse or physical therapist from the home care service visits the home and does an evaluation. A variety of services, including occupational therapy, physical therapy, speech therapy, nursing and home health aides, are available, depending on the doctor’s orders.
An occupational therapist typically provides instruction and evaluation of dressing techniques, cooking, bathing, general self care and suggestions for organizing the household to make it safer and easier, and may assess for and provide adaptive equipment to assist in these activities.
A physical therapist usually assists with mobility training. Safety is an important issue with homebound patients. A physical therapist can teach a homebound patient how to safely transfer from sitting on a chair or couch, navigate from room to room with a cane or walker and get on and off a commode and in and out of bed. These are difficult activities for someone in a weakened state. A physical therapist also provides a number of exercises to help the patient gain strength, and may assist with wheelchair skills and needs, in addition to educating the family in how to assist the patient.
A speech therapist often retrains a patient to speak as clearly as possible, with as little impediment as possible and with the widest vocal range possible in light of the underlying medical, psychological or mental conditions.
Nursing provides assistance with wound care, intravenous medicines, assessment of vital signs, monitoring for infection and family education, among other care.
If a patient is physically unable to perform self-hygiene activities such as bathing, a home health aide may be provided for a short period of time. The home health aide may also help with dressing and cooking; however, the main emphasis of all short-term home health care is to provide instruction and assistance so that the patient becomes as independent as possible.
If Medicare benefits become exhausted, and the homebound elderly person remains unable to do the basic activities of daily living, other services may be delivered, depending on the patient’s income and availability of assistance from family members.
The Massachusetts Executive Office of Elder Affairs as well as the federal government distribute funds to 27 organizations called Aging Services Access Points. In this area, Tri-Valley Elder Services, Inc., a non-profit corporation, provides services to 25 south central towns. Tri-Valley has paid staff members and 800 volunteers who provide a variety of services to homebound patients and their families. To contact Tri-Valley Elder Services directly call (508) 949-6640.