In-Home Care Reduces Hospital Readmissions

Nurse holding handA poor transition from the hospital to home is often the reason for unplanned, expensive, and often traumatic readmissions, many of which could have been prevented. Quality in-home healthcare can help improve the transition and prevent readmissions during the vulnerable time after hospital discharge. Unfortunately, the majority of patients in the U.S. are sent home without any supportive services.

Repeated hospitalizations can be even more traumatic for the elderly, many of whom live alone. Incidents such as falls, unsupervised medication, pressure wounds, infections and a lack of other necessary follow-up care can send an elderly patient back to the hospital within days or weeks of discharge. Studies show that people who live alone have a 50 percent higher risk of unplanned readmission compared to those living with others. In-home care provides a cost-effective supplement to medical-based care transitions.

Hospitalization for Illnesses

Three of the most common illnesses that require hospitalization and are prone to readmission are Congestive Heart Failure (CHF), Pneumonia (PN), and Heart Attacks or Acute Myocardial Infarction (AMI). Trained in-home caregivers can act as the critical link with other care providers, report early detection, and give much of the care necessary to prevent additional hospitalization.

Dakota Home Care nurses and aides can monitor and report symptoms of these and many worsening or recurring illnesses:

  • Congestive heart failure: weight loss or weight gain challenges, nutritional needs and restrictions, blood pressure monitoring, exercise requirements, etc.
  • Pneumonia: oxygen requirements, medication reminders, good nutrition and the needed recuperation period for patients who have just been discharged.
  • Acute Myocardial Infarction: heart rate monitoring, blood pressure, diet and exercise restrictions or recommendations, medication reminders and adjustments.

Surgery that Requires Hospitalization

Recovery from an operation takes time, especially for seniors. Not only do older bodies take longer to heal, but there are other factors to consider, especially their possible inability to follow instructions for wound care, physical activity, weight-bearing and dietary restrictions, medications, and follow-up appointments, just to name a few. They may not recognize what is a normal recovery vs. complications.

These and other issues are why the transition home from the hospital is such a crucial time. Hiring professional in-home care during the transition from hospital to home can help to ensure a smooth recovery without any complications and dramatically cut down on hospital readmissions.

At Dakota Home Care, we’re here to help older individuals and other discharged patients with safe transitions home from the hospital. We coordinate with the hospital to identify the patient’s needs, ensuring coordinated efforts and continuity of care.

We work together with the hospital care team to create a recovery plan that includes:

  • Medical concerns and how to respond to potential side effects.
  • List of meds being taken, allergies and dietary restrictions.
  • Scheduled follow-up appointments and changes to the care plan.
  • Use of medical equipment.

Once back at home, we offer a full range of customized home healthcare services, such as:

  • Medication reminders to ensure prescriptions are taken as directed,
  • Errands such as  picking up prescriptions and groceries,
  • Meal planning and preparation.
  • Health condition monitoring and reporting of changes in condition,
  • Companionship, and more

Family Caregivers

Many family caregivers are helped by and relieved to have our professional in-home care services. A loved one’s care post-discharge can be overwhelming and worrisome. Our home care team is available to ensure that the medical team’s orders are followed, that meds are taken correctly and to notice and report any negative side effects. We keep the family advised on their loved one’s recovery and contact them immediately if there is any cause for concern. We continuously monitor the plan of care for progress toward objectives, and any adjustments in care that are necessary are brought to the physician’s attention.

Many older adults and even younger patients prefer to recover in the comfort of home. By partnering with you and following doctors’ instructions, our staff can design a plan that is best for the person you love. If you or a loved one are anticipating a hospital stay and desire to return directly home, we encourage you to learn more about the health and cost benefits of home care. DTN Home Care can provide services around-the-clock or as needed.

We offer a consult for a Registered Nurse to  evaluate and assess the person’s needs and work with the client, family and home care staff to draft and implement an individualized plan of care.

As the leading caregiver agency in Bismarck, Mandan, and Fargo, one of our top priorities is making the transition from hospital to home a smoother process and ensuring that discharged patients are on the quickest road to recovery. Reach out to us at (877) 691-0015 to request an in-home consultation and to learn more about how we can help.

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