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By Rebekah Levit
Milton – After a hospitalization for a serious health event, many seniors need additional care or rehabilitation services, such as physical or occupational therapy. Often they are discharged to a skilled nursing facility or rehabilitation center for a short visit to receive these services. If they do not need rehab or continued intensive medical care they are sent home where they may still require assistance with daily activities such as bathing and preparing meals, or nursing care such as wound dressing.
The burden of securing all of the necessary post-hospital services and assistance most often falls on the family. The discharge planning process can be overwhelming, leaving little time for families to digest their options and make the best informed decisions for their loved one.
Seven Things You Should Know
1.      If your loved one does not require 24-hour medical care, they may be sent home to recover. If they need to continue rehab started at the hospital, you can bring in therapy services. However, successful recovery often requires adherence to an exercise, diet or medication regimen when the therapist is not around. An assisted living community might be the better environment to recuperate with staff reminders and peer support, along with 24-hour oversight. Just like at home, seniors can contract for therapies paid for by Medicare.

Assisted living can provide an option for short term recovery for the patient and some time for the caregiver to prepare for their return to the family home.

2.      When recovering at home there may be extra responsibilities for family members, or you may need to bring in services. Is your family equipped and/or available to help provide personal care, medication assistance and household care? If you need professional help, you can contract for non-medical “home care” services such as bathing, dressing, meal preparation, housekeeping, shopping, assistance with medications, exercises and transportation to medical appointments. These may not always be covered by insurance. You can also bring in skilled medical “home health care” services, such as nursing care, physical, occupational, speech and respiratory therapies and hospice care.
3.      If your loved one needs rehab they may be discharged to a skilled nursing facility (SNF) or rehabilitation center. The environment at these types of facilities often feel like a hospital; keep this in mind if you think your loved one would do better socially in a more home-like environment. Although SNFs are appropriate for patients who require intensive 24-hour medical care, rehab can be completed in assisted living. Families can also choose to have their loved one complete their initial post-hospital rehab in a SNF and then transition to assisted living for additional rehab and care before returning home.
4.      Post hospitalization, short-term rehabilitation stays at a SNF may be covered by Medicare for up to 100 days. Not all post-hospitalization care is covered by Medicare or insurance. Check directly with the hospital, your insurer and/or Medicare.
5.      An interim respite in assisted living can provide the extra care and support one needs to recuperate, and can give families extra time to organize post-hospital care. You may also consider a respite stay even if medical care or therapy is not necessary, but your loved one is not strong enough to be home alone. Just like at home, you can bring in services, generally paid for by Medicare, in order to provide the specific therapies and nursing services medically required.
6.      At an assisted living community, seniors who are regaining their strength can receive personal care services, proper nutrition and help managing medications, along with other benefits like camaraderie, a daily calendar of activities and a private fully furnished apartment. Personal care is provided discreetly in the privacy of their own apartment.
7.      A respite stay can provide an opportunity to test out life at a senior living community to see if it is a good fit. This can make a transition to permanent residency, if necessary, much easier.
When making a decision, it will be important to consider not just the recommendation of the hospital, but what your loved one would want and how they actually feel. For example, the hospital may recommend your loved one be released to their home and yet you know that they do not feel confident or strong enough to handle being on their own. Be sure to discuss all options and preferences with the hospital’s discharge planning team.
About The Author
Rebekah Levit is Executive Director at Standish Village, an assisted living and Alzheimer’s care community located on the Dorchester / Milton line in the heart of the Lower Mills. If you are interested in assisted living or memory support and would like to learn more, or if you are beginning the research process and have questions, you are invited to call Rebekah directly at (617) 298-5656.

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