Returning Home: Medication Management

Medication mismanagement is one of the leading problems that sidelines a senior’s successful recovery.

Nearly 120,000 patients each year need to be hospitalized for treatment after emergency visits for adverse drug events, reports the Centers for Disease Control. As more people take additional medications, the risk of adverse events may increase.

Why Seniors Are Vulnerable

Although many seniors take regular medications, a recent hospital stay could result in new and unfamiliar prescriptions. Taking the right medication at the proper time and in the correct dosage is important to keeping an older adult on the road to recovery.

Following are key tasks that older adults returning home often need assistance with to ensure they remain safe and on track:

• Picking up prescriptions from the pharmacy.
• Ensuring medication is taken.
• Refilling prescriptions. (It’s best to go to a senior’s regular pharmacy to avoid adverse reactions from a combination of drugs prescribed by different sources such as hospital and primary care physician.)
• Organizing pills to ensure that confusion doesn’t lead to a medication mishap. A pill box can help track whether a senior has taken his or her medications. Some pharmacies will fill a pill box and others offer a service that seals each day’s medications in a blister pack.
• Tracking medications to help older adults more easily manage their health.

Make sure your senior has the support he or she needs to manage the tasks above.

Senior Emergency Kit

Whether accompanying your loved one to a doctor’s appointment or in response to a medical crisis, it’s critical to have your loved one’s medical information easily and quickly accessible.

The Senior Emergency Kit features several worksheets that family caregivers can complete with the help of a senior loved one. This toolkit can be kept in an easy-to-reach location, such as a nightstand, to allow easy access to information.

Returning Home: Time to go Home

It’s the day you and your senior have undoubtedly waited for: time to go home! All hospitals and facilities have their own patient discharge procedures but, regardless of their policies, you can be better prepared by ensuring that you have all you and your senior need to be ready when you step out the door.

Following is a checklist adapted from the Centers for Medicare and Medicaid Services* that can help ensure that you and a loved on haven’t forgotten anything:

• Confirm where you loved one will be going – back home or to a rehabilitation facility or care community.
• Ask staff what your loved one can do to get better.
• Ask about problems to watch for and what to do about them. Write down a name and phone number to call if you have problems.
• Review with medical staff the list of drugs, vitamins and herbal supplements your senior loved one will be taking. Write down a name and number to call if you have problems.
• Confirm the medical equipment your senior will need. Write down a name and phone number to call if you have questions about the equipment.
• Ask if your senior will need help with the following:
  • Bathing, dressing, using the bathroom or climbing stairs.
  • Cooking, food shopping, house cleaning, laundry, and paying bills.
  • Getting to doctors’ appointments, picking up prescription drugs.
• Ask staff to show you and your senior any tasks that requires special skills such as changing a bandage or taking medication.
• Ask the social worker any final questions about what insurance will cover. If you need help with costs, ask about your options.
• Ask for written discharge instructions and a summary of current health status. Bring this information and list of medications for follow-up appointments.
• Write down any appointments in the coming weeks.
• Get prescriptions and any special diet instructions.

Being prepared will help make you a more confident caregiver and put your loved one at ease.

If you can’t be there when an older loved one goes home from the hospital, a CAREgiver from the Home Instead Senior Care network’s Returning Home program can assist.

Returning Home: Ask Questions

Even before you know how long a loved one might need to be in a hospital or facility, start working with medical professionals. Get the lay of the land, as they say. Early on, it’s important to ask questions – and lots of them – of key people caring for your older loved one.

The questions and the answers you receive will help determine what that older adult will need at home and the schedule he or she must follow for a smooth transition. Some of the questions can be difficult to ask such as, “Will my loved one ever be the same?” But it will be vital to know the answers if that senior can expect the best possible outcome.

The Right Questions

Ask your medical team – whether it’s doctors, nurses or rehabilitation professionals – these questions about your senior:

• What time of day does the doctor make rounds so I won’t miss him or her with my questions?
• What is the prognosis? What is the likely outcome? Will my loved one recover?
• How long will my senior be in the hospital or facility?
• What condition will my senior likely be in when released?
• Will my loved one go straight home or to another facility?
• How much will my loved one be able to do when he gets home?
• What are the warning signs that my loved one needs help?
• Can my loved one be home alone? If not, how much help will she need and for how long?
• If I am the primary family caregiver, how much help will I need?
• What type of equipment – and care – will my loved one need at home?
• Will I need a prescription for any of this equipment or care?
• How many follow-up appointments will be needed and how soon do you need to see my loved one?

Social workers and case managers can help put a discharge plan into action. A social worker is a professional who provides counseling, guidance and assistance, and can help a senior focus on his or her environment. Social workers often work hand-in-hand with case managers who assist in the planning, coordination, monitoring and evaluation of medical services for a patient with an emphasis on quality care.

You can ask these professionals:

• Where do I go to set up durable power of attorney for health care? (Your loved one should establish this legal instrument that allows patients to select the person they want to make health-care decisions for them if they are unable to do so)
• Who is assigned to my loved one’s care?
• What is the best facility for my senior if he can’t go directly home?
• What will my loved one’s insurance cover?
• Do I have options, and what are they?
• Will my loved one need home health care or palliative or hospice care and, if so, will I need a prescription?
• Will my senior need support for activities of daily living?
• What if my loved one is the one returning home and she’s been caring for her spouse with dementia? How do I get them both help?
• What are the best resources that can meet my loved one’s needs?
• Where do I go to find these resources?
• Where can I find the equipment that I need?
• If it’s not covered by insurance, how will it cost and are alternative funding resources available?
• If my loved on need in-home care, what are my options? (Hospitals won’t recommend, but they will provide options and background information.)

When you know the score, it’s time to begin planning just what your loved one needs to return safely home.

Returning home: Introduction

Start Planning Now

When a doctor admits your loved one to a hospital or facility it’s often a traumatic experience, whether you were expecting it or not.

And, as a family caregiver, it’s unlikely that you’re thinking too far ahead. Just get through one day at a time, right?

However, while a senior is still in the hospital or rehabilitation facility, it’s important to begin preparations for the time your loved one will return home. That’s because a smooth transition home is vital to a successful recovery. Consider this:

• Nearly 20 (19.6%) of Medicare patients discharge from the hospital are readmitted within 30 days of discharge, accounting for $17.4 billion of spending, according to the New England Journal of Medicine.*
• One chronic condition that often sends older adults back to the hospital is heart issues. In fact, approximately 30 to 40% of patients with heart failure are readmitted within six months of hospitalization.**

Many issues factor into why older adults are vulnerable to problems at home after they have been in a hospital or rehabilitation setting.

“The key issues that send seniors back to the hospital are medication problems, falls in the home and not following up with the doctor,” said Lanita Knote, President of the American Association of Managed Care Nurses.

Add to that list home safety issues, nutrition and hydration challenges, and overwhelming responsibilities for the primary family caregiver, seniors and their families can face a difficult road ahead.

Planning during a crisis is never as effective as being prepared in advance. Preparations is your best strategy for avoiding the many pitfalls that can sabotage your senior’s health and well-being when he or she goes home.

The 50-50 Rule: Real-Life Situations

These real-life family stories are followed by idea and resources for ways to handle the situations before they damage sibling relationships. Each is backed by research conducted for the Home Instead Senior Care network in the U.S. and Canada. Responses were developed in cooperation with Ingrid Connidis, Ph.D., sibling relationships expert from the University of Western Ontario.

Money Matters

The slow economy has taken a toll on many families, straining finances and relationships. Do you and your siblings disagree on how to approach money matters when it comes to family caregiving situations? If so, consider the following real-life family solutions. Research shows that the inability to work together in important areas such as money can lead to a deterioration of sibling relationships.

Payment Overdue

You and your brother have just discovered a pile of overdue bills, spoiled food in the refrigerator and magazines stacked ceiling high at your parents’ house. Your brother loses his cool and practically demands that they move to a nursing home. Your parents are visibly upset. You want the continued help and support of your brother. What do you do?

Approach your parents and brother with a sense of working together to find a solution rather than telling them what to do. Is the problem that your parents don’t have the money? Or are they just unable to manage the bill-paying anymore? Speak to your parents about the issues that are relevant to avoid family conflict.

After accessing the situation, talk with your brother and suggest what seems like a reasonable course of action to you. Be sure to ask his opinion as well. One solution is to set your parents up on automatic bill-paying through their bank or take over payment of their bills. If you and your brother disagree, try to find a compromise. Offer the help you deem appropriate to your parents. A united front is the ideal course of action, unless you and your brother feel it would be best if you spoke to Mom and Dad on your own. Both you and your parents will benefit by keeping your brother engaged in the process in a positive way.

Do what you can to maintain a relationship with your brother. Siblings are sometimes the only family relationships that endure. Friendships from our early lives often don’t last. So there is a depth of empathy we can tap into that goes back to that childhood relationship. That sibling relationship will continue after your parents are gone. Research suggests that siblings don’t want to harm their relationships with each other.

Recession Bust

The economy has taken its toll on your parents’ retirement nest egg, which they worked so hard to build. You and your four siblings are doing well financially, but no one is stepping up to the plate to help Mom and Dad. What’s the solution?

Initially, this calls for a conversation between yourself and your parents. Awareness of your parents’ financial situation is critical. Parents can feel like they are giving up their independence and privacy is they discuss that information. In terms of harmony among siblings, it’s better if everyone has the same information.

You could discuss an agreement where you will help your parents out financially now, on the understanding that they will pay you back through your inheritance. If they agree, you could share your agreement with your siblings so that they know in advance. They could be invited to be part of the agreement as well. Seek the advice of a professional like a lawyer or financial advisor about how best to make this financial arrangement.

Remind your siblings of the impact that the current economic situation has had on seniors like your parents. Older U.S. adults have lost almost one quarter of their buying power since 2000, according to the Annual Survey of Senior Costs released in 2010 by The Senior Citizens League (TSCL), a senior advocacy group.

In Canada, according to the Office of the Superintendent of Bankruptcy Canada, the share of insolvent consumers for people 55 and up has more than quadrupled in the past decade, hitting 20.6% last year. This was the steepest increase for all age groups. The office compiled the findings based on annual numbers between 1989 and 2009.

If your siblings understand, they may get a better grasp of what your family is facing and be more willing to pitch in to help.

Returning Home: A Support System

What happens when seniors returning home have no one there to help them recuperate? Seniors going home to an empty house can be in danger, both physically and emotionally, and represent a concern for many senior care professionals, such as case managers, who are managing their care.

It’s common for discharge planners to tell families that their loved one will require 24-hour care initially and then adjust the schedule according to the patient’s needs. If that’s the message you receive, it’s important to discern with the discharge planner what that really means. Sometimes all that’s needed for your senior in those first few hours and days is overnight assistance and a few additional hours during the day. On the other hand, you don’t want to leave your senior vulnerable if he or she could be at risk alone.

Ask the doctor to be specific about the kinds of support your senior will need during the day, whether he or she can be left alone during the day and night, and what the risks are during those first few hours and days at home.

Planing for whatever help you’ll need is an important step to take very early in this process. In talking with a senior about the amount of care needed at home, encourage your loved ones to be realistic.

As a family caregiver, don’t assume that caregiving will be easy or even possible if you’re living elsewhere or managing a demanding career and other obligations.

“We have a very mobile population of adult children who often don’t live near their parents.” LaNita Knoke, President of the American Association of Managed Care Nurses, said. I’ve worked with seniors who were adamant that they would be fine when they returned home. That older adult will say, ‘My daughter is coming for two weeks.’ But often that daughter cannot be there for the important discharge process not can she stay as long as her parent might need help.”

Returning Home: What You’ll Need

Hospital and facility staffs can direct you to the types of equipment you will need to get those important supplies, whether you must have a prescription and if the equipment is generally covered by insurance.

Depending on his or her condition, following are possible supplies that your loved one could need at home:

• Wheelchair
• Hospital Bed
• Walker or Cane
• Raise Toilet Seat
• Shower Chair or Bath Bench
• Bedside Commode
• Grab Bars
• Colostomy Care Supplies
• Oxygen
• I-V Equipment
• Lift Chair
• Hoyer Lift
• Disposable Gloves & Incontinence Briefs

You may hear the term “durable medical equipment,” which is medical equipment such as walkers, wheelchairs or hospital beds. Generally, anyone who has Medicare Part B can get durable medical equipment as long as the equipment is medically necessary.

Having everything ready in advance will help ensure that the discharge process runs more smoothly and efficiently.

Returning Home: Ask Questions

Even before you know low long a loved one might need to be in a hospital or facility, start working with medical professionals. Get the lay of the land, as they say. Early on, it’s important to ask questions – and lots of them – of key people caring for your older loved one.

The questions and the answers you receive will help determine what that older adult will need at home and the schedule he or she must follow for a smooth transition. Some of the questions can be difficult to ask such as, “Will my loved one ever be the same?” But it will be vital to know the answers if that senior can expect the best possible outcome.

The Right Questions

Ask your medical team – whether it’s doctors, nurses or rehabilitation professionals – these questions about your senior:

• What time of day does the doctor make rounds so I won’t miss him or her with my questions?
• What is the prognosis? What is the likely outcome? Will my loved one recover?
• How long will my senior be in the hospital or facility?
• What condition will my senior likely be in when released?
• Will my loved one go straight home or go to another facility?
• How much will my loved one be able to do when he gets home?
• What are the warning signs that my loved one needs help?
• Can my loved one be home alone? If not, how much help will she need and for how long?
• If I am the primary caregiver, how much help will I need?
• What type of equipment – and care – will my loved one need at home?
• Will I need a prescription for any of this equipment or care?
• How many follow-up appointments will be needed and how soon do you need to see my loved one?

Social workers and case managers can help put a discharge plan into action. A social worker is a professional who provides counseling, guidance and assistance, and can help a senior focus on his or her environment. Social workers often work hand-in-hand with case managers who assist in the planning, coordination, monitoring and evaluation of medical services for a patient with an emphasis on quality care.

You can ask these professionals:

• Where do I go to set up durable power of attorney for health care?
• Who is assigned to my loved one’s care?
• What is the best facility for my senior if he can’t go directly home?
• What will my loved one’s insurance cover?
• Do I have options, and what are they?
• Will my loved one need home health care or palliative or hospice care and, if so, will I need a prescription?
• Will my senior need support for activities of daily living?
• What if my loved one is the one returning home and she’s been caring for her spouse with dementia? How do I get them both help?
• What are the best resources that can meet my loved one’s needs?
• Where do I go to find these resources?
• Where can I find the equipment that I need?
• If it’s not covered by insurance, how much will it cost and are alternative funding sources available?
• If my loved one needs in-home care, what are my options?

When you know the score, it’s time to begin planning just what your loved one needs to return home safely.