Visiting Nurses Help Avoid Re-admission to Hospital

by Nancy Shohet West. After my father underwent routine surgery last summer, he was discharged from the hospital within a few days—only to develop a life-threatening infection at home. Rushed back to the hospital just two days after discharge, his stay stretched into weeks.
The discouragement of waking day after day in his hospital room was overwhelming, but he also didn’t want to go home if he wasn’t truly well. He’d already done that once, and the panic that resulted when his condition dramatically worsened there had caused emotional trauma to both him and my mother. So the news after a full month of hospitalization that he was probably okay to be discharged came as a mixed blessing. Home at last—but how to ensure that he stayed well?
It turned out that the hospital had an answer to this. He would be assigned a visiting nurse rotation. Every day for as long as they deemed it beneficial, one member of a team of medical professionals would pay an old-fashioned house call. The visiting nurses would not only execute the hands-on tasks of changing his dressings and flushing out his portable IV tube but would also monitor his overall condition from day to day and answer any questions he had. Dad could (and did) recuperate in privacy and comfort, but the oversight of his recovery wouldn’t be left exclusively to his and mom’s watch.
What happened to my father wasn’t unusual. According to a story published recently in the New England Journal of Medicine, one in five Medicare patients who are discharged from the hospital is readmitted within one month. How can patients ensure that they are not part of this statistic? One way is to solicit professional help with their home care.
Visiting nurses can be the quintessential win-win situation for a patient who is recovering from a hospitalization or learning to cope with a chronic condition. It costs insurance companies as well as patients an infinitesimal fraction of what a hospitalization would. Moreover, recent changes in legislation are giving hospitals an additional incentive to take measures against readmission: as of October 2012, hospitals will be penalized for re-admissions that could have been prevented under certain circumstances.
Visiting nurses aren’t only for medical treatments, either. The range of services their specialists can provide include physical therapy, occupational therapy, speech-language services, resource counseling, personal hygiene assistance and even support with outside medical appointments. Some specialize in areas such as Alzheimer’s patient support or veteran care. Home health aides, who do not typically have the medical training of visiting nurses, provide company and personal support for patients who do not have critical medical concerns but can benefit from outside help.
The primary organization that certifies standards for visiting nurses is the Visiting Nurse Associations of America. A visit to their website will provide a host of useful information, including how to find a visiting nurse group in your region, what to expect from a visiting nurse, and how your insurance company might alleviate the expense, depending upon the type of care.
Would the health situation you are trying to manage benefit from the help of a visiting nurse? It’s quite possible. You can learn more about the visiting nurse associations (VNAs), including how their services and quality assurance compare to other local home care agencies, at the government website called Home Health Compare. This site provides detailed information about every medicare-certified health agency in the country. Click here to learn more.

©Circle of Life Partners™

Nursing Homes, Assisted Living, & Retirement Communities: When an Elder Must Move

by Jan Simpson

Recently I got a call from a friend in California.  He told me that he and his sisters were worried about their 88- and 86-year-old parents who live on the East Coast.  Concerned about their ability to remain safely in their own home, this circumstance is a familiar one: his parents are approaching a tipping point where a housing change  is necessary.  How each family makes this decision is unique, but it’s useful to evaluate alternatives before a crisis forces a hasty change.

What are those housing alternatives? Some adult children have their ill or widowed parents move in with them. Today, more than 3.6 million parents live with their adult children, according to David Horgan and Shira Block, authors of When Your Parent Moves In: Every Adult Child’s Guide to Living with an Aging Parent. While the book gives strategies for creating a harmonious living arrangement, it also cautions the reader about jumping into this arrangement without first considering the long-term implications.  They offer the reader a “Moving In Quiz,” a sample of which is below.

Guilt: Using a scale of 1-Never, 2-Almost Never, 3-Sometimes, 4-Almost Always, and 5-Always, how often do the following apply?

___  Why am I the only one who steps up to the plate? If I don’t take care of Mom, no one will.

___   Dad refuses to go into an assisted-living facility or even let us send a home health aide to see him. What choice do I have?

___   My spouse doesn’t say it, but I know he/she expects me to take care of his/her mother. I don’t want to upset anyone, so I’ll just go along and try to make the best of it.

___   I can’t abandon my parent. I couldn’t live with myself if I did.

___   I know my mother thinks I don’t care about her. That’s not true, but she is always trying to make me feel bad.

According to the authors, if you score an average of three or higher, you may be walking into “a minefield of guilt leading to resentment, frustration, and the potential breakdown of your own well-being.”

While housing elderly parents may be the right choice for some, assisted living facilities, elderly apartments, and continuous care communities are other housing choices to seriously consider. Who can you contact to get a quick list of available options and guidance?  Physicians, friends, social workers, and nurses are all helpful resources, as is www.eldercare.gov.  Here are three other sources of free information:

  • Area Council on Aging—In addition to offering activities for seniors, local Councils on Aging have a trove of information about local home care services, elder law attorneys, local assisted living, and skilled nursing homes (see www.ncoa.org). Arrange to speak or meet with the director and explain your parents’ situation. They will help you develop a short list of options and provide insight into how best to evaluate choices.
  • Social Worker affiliated with a local hospital or the Visiting Nurse Association—If your parent has had a recent hospital stay, schedule a telephone or face-to-face appointment with the hospital’s social worker. Ask about local facilities and other services that may be of help. A quick call to a social worker affiliated with the local Visiting Nurse Association (www.vnaa.org) may also be useful.
  • A Place for Mom—A social worker who advises families that are dispersed geographically recommended this organization, a free service for families who need to evaluate a range of housing choices. They do not charge the callers, but rather are compensated by the facility where your parent may move (see www.aplaceformom.com).  Skeptical at first, I contacted them recently about a complex family situation that included a loved one with dementia, and I was surprised to find how helpful and how quickly they were able to identify potential facilities that the family could evaluate. (A reminder, I do not have any financial arrangement with this service; they are simply another resource easily accessible.)

In the end, my friend and his sisters evaluated their options and decided, collaboratively with their parents, to move them into an assisted living facility.

Have your parents or older loved ones had to make a housing change? If so, share your thoughts about how best to make that transition.

©Circle of Life Partners™