Home Sweet Home: Engage in Discharge Planning to Keep Your Loved One Safe and Happy

        Aval-Na’Ree Sian Green, MD, a geriatric medicine specialist, shares some tips for getting and keeping your loved one safe at home once they are discharged from the nursing home or other long-term care facility.
        When a person is discharged from a medical facility to their home, this is a big change. They were receiving 24/7 care, meals, medication management, and help with things like getting dressed but now must handle all this themselves, often with little help. This also can be a stressful time for family members. However, you can work with your practitioner to help your loved one and yourself through this challenging time.
        You can start by helping your practitioners and the team at the facility understand what is on the other side of the discharge for your loved one. What kind of support will they have? What are their special needs, such as transportation, a dog walker, or help with shopping or meal preparation?
        Lack of adherence with medication instructions and adverse events or side effects related to drugs are common reasons that patients go back to the hospital; so it is important for a clinician to do what is called “medication reconciliation” before your loved one goes home. This involves making sure that all medications and dosages your loved one will take are appropriate and current. It also is important to talk with the pharmacist or nurse about why your family member is taking various medications and find out about any special instructions such as taking some drugs with meals or not cutting or crushing pills. It is useful to put all the medications your loved one has in their home in a paper bag and take this to the clinician performing the medication reconciliation. This will help ensure your loved one isn’t taking any duplicate or expired drugs or medications that are no longer necessary.
        It is important to be honest with your practitioner and the discharge planning team. Realize that they are there to help you, not to judge you or your loved one. For instance, they need to know if mom has a cluttered house or dad doesn’t like to shower or bathe. This information will help the team identify issues that could cause an accident or injury or make your loved one sick; then they can arrange support services to help. The team understands that you may work and have kids and/or other responsibilities that demand your time. They want to ease your stress and anxiety, enable you to spend quality time with your loved one, and be confident that they are safe and happy when you can’t be there for them.
        Remember that goal setting involves a combination of what is possible/practical and what your loved one wants. Realize that you might want to do everything possible to keep mom alive for her 95th birthday next year, but she just wants to stay home and be comfortable in the moment. It’s important not to impose your wishes, fears, guilt, and other feelings on your loved one.
        To identify what’s important to your loved one, it’s essential to find out what matters most to them. To help target this, it’s helpful to ask, Is there anything about going home that worries or concerns you? What are you excited about or looking forward to?
        Once your loved one is discharged home, you can help be the eyes and ears for your loved one’s primary care providers. You can identify functional decline — such as mom having trouble walking or getting winded easily or dad not eating his favorite foods and losing weight. If function starts to slide, it may be possible to turn the tide if you catch it early.
        The goal of discharge planning is to keep your loved one home safely for as long as possible. When you and your family member are actively engaged in discharge planning, you help mom or dad stay comfortable and enjoy the best possible quality of life.

        Questions to Ask Your Practitioner

        • How can I help keep my loved one safe after they go home from the facility, especially if I can’t be there 24/7?
        • How can I help identify what support/services might benefit my loved one?
        • What technology, such as an Alexa device or pill box that triggers alerts, might be helpful?

        What You Can Do

        • Be honest with the practitioner, discharge planning team, and pharmacist about your loved one’s needs, limitations, and disabilities.
        • Don’t be afraid to ask questions if you don’t understand something, such as why your loved one is taking a medication or what vital signs will need to be monitored.
        • Ask your loved one about their goals, concerns, and wishes and listen to them. Work with your practitioner and others to make sure the discharge plan addresses what matters most to your family member.

        For More Information

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        Dischange planning will help keep your loved one home safely for as long as possible