I've spent seven years working in various acute care and acute rehab settings. I've had the responsibility of saying to family members, patients, and case managers that I don't think the patient should leave our facility and go home. It sounds like a thumbs up/ thumbs down decision but it's more than that. This recommendation may mean that an individual doesn't go home, now or potentially in the future.
This may be the first in a series of facilities an individual transitions through during their rehabilitation process but the ultimate ending could be an assisted living facility. Not home. Not the comfort of their own pillow, coffee cup, breakfast table, favorite pet. Yikes.
What leads up to this decision?
There are a number of factors at play, the two most important are home set up and family support. Let's talk about the top 4 categories.
1. Home setup- This is the most important. First question- can you get into your house? For example, what if you have 5 stairs to get in with no railing and you are leaving the hospital in a wheelchair? How's that going to work.. Then, once inside, can you maneuver your wheelchair around? Get in and out of the bathroom? Cook? Get dressed?
2. Family support- I use the term "family" to categorize any support a patient will have once they leave. I've had patients that have lived in the same neighborhood for 50 years and now that their children have grown and moved away their neighbors have become the closest support system. Can your family stay in town for a few weeks? Do you need someone to check in everyday? If you are going to be set up with lifeline (or similar products), who will get your notification?
3. Impact of illness- Is the diagnosis acute (will get better), chronic (will get worse over time), or terminal? Acute illnesses or injuries may only require temporary changes, like renting a ramp to get into your one level home, whereas a chronic condition will continue to impact function. Chronic conditions necessitate planning for future issues, this is where a home assessment and renovation planning has the greatest potential to impact safety and accessibility. Discharge planning for patients with terminal illness, is generally a different category because the focus is not on rehabilitation. Whatever that person wants, 100%.
4. Personal factors- This is the "what are you made of" category. Some people strive for independence and will only see a home discharge as the end result. Some are happy to be in the hospital as long as they can. Most people fall somewhere in between. Where you go at the end of your rehab stay, is ultimately up to you. Put in the work, take in the information, learn new safety techniques. Do you want to go home? Is this hospitalization a tipping point?
No two people are alike and no two patients are alike. Each person is a mixed bag of these four categories. What may be a simple diagnosis to one may be an overwhelming roadblock to another. This is why home visits are a key component for these patients on the edge.
Why aren't they happening as often anymore?
When I started working as an OT, we had more flexibility with scheduling that allowed for more home visits to occur. Changes in healthcare reimbursement over the last few years has almost eliminated this as a possibility for patients prior to leaving. These home assessments were often the deciding factor for the therapy team (PT, OT, Speech) for discharge recommendation. Limiting access to this has created a gap for patients and their families, unsure about what types of modifications are available and what their family member may need to be safe at home.
What can you do?
My goal is to help as many people as possible stay in their home as long as they chose to. If you have recently been diagnosed with a progressive illness. If your family member has been hospitalized and you want to help prepare their home for their discharge. If you are living in your "dream home" and are thinking about renovating to make it the "forever home."
Whether you're planning for now or 10, 20, 40 years from now, it's never too early to start.