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It’s time for your loved one to be discharged from the hospital. Oh! You don’t feel ready? You say he is still too sick to come home? Those are all common feelings for the families of those who are told they are ready for discharge.

Saying someone is ready for discharge has a totally new meaning than it once did. In hospital/ insurance parlance. Being ready for discharge means that the days that you are qualified for with your diagnosis and any complications, are up. You have to leave. It is rare that you will be told that bluntly, but when money runs out, you leave. Your willingness to pay out of your own pocket doesn’t work. When insurance and medicare requirements say it is time for you to be discharged, that is it.

The time for the next level of healthcare is now. It well may be that you aren’t ready to go home yet. So your case worker will talk with you about what your options are. Depending on insurance coverage, and I’ll go into more details on another day, you will be told what your options are. This is when you will say to yourself, “I’m glad I paid a little extra for that coverage I had.” or “I guess the saving I took on this coverage didn’t save me anything after all.”

You may qualify for Rehab next…either in a rehab hospital or in a nursing home

For some health diagnoses, rehab is an option, a very good one. After a stroke, it is a great option. If you have access to a rehab hospital as we did, it is great to have all that care in one place all day and have it reinforced during the evenings and nights.

But if a rehab hospital is not an option, then a nursing home rehab will work for a week or two until you and your loved one get your strength back/your house is ready for him to come home.

You will find those early days in rehab to be extremely helpful for both of you. For him, his strength will return, he will have less of that hospital confusion about him where he isn’t sure about the days and nights. He will dress in street clothes in the daytime for rehab and his day will be full of therapy…with some rest breaks.

For you, it will be a time when you can catch you breath a bit. You won’t be needed as much at the hospital like you were. You will be able to catch up on your rest a bit, on things at the house that got behind when he was in the hospital and after lunch, you will be able to catch up with him to see how he is doing. After the first couple of days in rehab, you will have an opportunity to observe how he is doing, but they usually want to know if you are coming ahead of time. Some days are better for observation than others.

I observed Ron on one of the early days of rehab, then close to discharge, I observed him again and met with each therapist. It was another time for the notebook! It was encouraging to see the improvement as well as understand what I was going home with. Yes, he had improved significantly. But he still had a long way to go.

Learning how to help your loved one get out of bed so you don’t injure yourself or him, safety precautions, given his limitations, and many other helps are what will help you at the rehab segment of the process.

At times, with certain severe head injuries, there will be further, more specialized rehabs to help with behavior, but these are unusual, not the norm. I do know that the earlier this rehab is done, the better it is for the patient. You may fit into this, I just don’t know enough to even write about it except to say that type of rehab will be even more regimented so the patient will be able to get into a strict schedule that will allow them to get as much of a routine as possible. This will allow them to get more of their memory back and get back into a good routine.

Another option after either hospital or rehab discharge, is home health care…but there is one caveat!

Another option after hospital or rehab discharge is home health care. However, there is a common misunderstanding that you will be able to have them come when you want them to come…at the convenience of your schedule. That is not the case.

Get used to the magic word “qualify.” You will hear it often! In order to qualify for home health care, your loved one needs to be homebound.

homebound: 1. You need the help of another person or medical equipment such as crutches, a walker or a wheelchair to leave your home. 2.Your doctor believes that your health or illness could get worse if you leave your home.   ~according to Medicare guidelines who set the standard for the insurance companies…does not just refer to those over 65.

According to this definition, you will be home when the nurse arrives in whatever order she chooses to for the day, at whatever time she comes! So you have to decide if you are “homebound” enough to want therapy to come to you and the nurse to come to you.

We don’t fit the definition of homebound at this point. I told you I’m not a full expert on this topic from personal experience. We haven’t reached the homebound stage. It is wonderful if you are homebound, to have this help. They will draw blood if needed. They will check vital signs, medications, call your doctor if needed, etc. You can also receive therapy here. Medicare covers it to the degree medicare covers anything. If you have a supplement, it covers the rest according to your plan.

Home health rehab
I almost forgot to mention home health rehabs that are available after discharge from the hospital or rehab. This often continues for weeks or months after your hospitalization(s). When you leave your hospital or rehab, you will have at least your first appointment for your home health rehab. Of course, in order to qualify for home health rehab, you must qualify for home health nursing care. That will include being homebound. They can fudge a little, but not much. Sometimes they can do the home health rehab for a short time, then move you over to outpatient rehab.

Outpatient rehab
I almost forgot to mention outpatient rehabs that are available after discharge from the hospital or rehab. This often continues for weeks or months after your hospitalization. When you leave your hospital or rehab, you will have at least your first appointment at your new outpatient rehab. Then they will set you up for a regular schedule of rehab.

Preparing for discharge sometimes requires getting your home ready

Depending on the nature of disability, your home may need modifications. The most common are ramps to the house and bars in the bathroom, but others might be needed as well. If you can’t afford to do them, there are volunteer groups in some communities that will do ramps.

Often, putting out the word in your church will get some volunteers together to help and you will only have to pay for the supplies. It all depends on the skill set you have available to help you. At least you can ask. If they say “No, we can’t do it.” the world will not end. It may hurt a bit, but life will go on. Don’t allow one person to speak for everyone. Ask more than one. Ask women and men. Some people tend to say, “No.” easier than others. Some of those people tend toward administrative gifts. Give them time to hunt for you before committing. If  “No.” ends up being the final word, move on without holding a grudge and find another solution. GOD will provide. He just won’t use them. You don’t need to carry the burden of a grudge.

Another way you may need to prepare your home is to eliminate clutter. If you have piles of newspapers, clutter lying around the floors, lots of scatter rugs, blocked hallways, etc. these need to be eliminated. If you aren’t sure, ask a younger friend to look around your house and be honest. If you tend to collect too much, you might need to get help clearing out your house before your loved one comes home.

This would be a great time to have your kids come and gather their things and help you clear out the clutter. You are rattled enough. Ask for their help. If they feel sentimental about their things, ask them to take them home to their places rather than leave them with you. If they don’t feel sentimental about their things, ask them to come and throw them away along with some other stuff you are having a hard time tossing. You can ask for the donation of a weekend, maybe even a long weekend. Maybe you have let some things go, you can still ask for their help.

Another source for help is your church. There are people there that you have known for awhile that might be able to help. Ask for it. Yes, they may see a mess. I’m sure they have seen messy houses before. If they haven’t, they will survive.

You may have other friends in the community or neighborhood who have offered to help. Ask if any of them could help you in this way. You will be surprised at the people who are glad to help! Not only that, but it often deepens friendships when you ask for help. Go figure!

I think I have covered most of the important information you need regarding discharges, rehab and home health care.

There are a variety of other helps available that your caseworker can tell you about that you may be uniquely qualified for. Sometimes, you may need the help of a social worker to help you with resources. This is especially true if you have limited financial resources. It is easy to get a social worker consult in the hospital and I think in a rehab hospital. It is not as easy in a nursing home or when you are in your home. The time to ask for it is when you are in the hospital if you think you might need it. The person to ask if you will need one is the case worker or your doctor.

I’m sure I have overwhelmed you by now. I hope you will be able to refer back to this in your time of need. I am remembering that this series is for the caretaker, but for the caretaker, your learning starts at the very beginning. It starts with the very first hospitalization or diagnosis. There may be many hospitalizations or only a few. But telling you how to navigate your hospitalizations will save you a lot of angst along the way. With each hospitalization, you have the opportunity to learn more about his condition and improve ways of caring for him. Watch how the good caregivers treat him and move him. Learn from them. Add your special loving touches and he will be well cared for and loved!

Ask, and it will be given to you;
seek, and you will find;
knock, and it will be opened to you.
  For everyone who asks receives,
and the one who seeks finds,
and to the one who knocks it will be opened. 
Or which one of you, if his son asks him for bread, will give him a stone? 
Or if he asks for a fish, will give him a serpent? 
If you then, who are evil, know how to give good gifts to your children,
how much more will your Father who is in heaven give good things to those who ask him!

Matthew 7:7-11