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How Seniors Can Avoid Hospital Readmissions

November 3, 2020

Did you know that one out of five Seniors will be readmitted to the hospital within 30 days from initial discharge? That’s a scary statistic! Usually the culprit is lack of care and support once they return home. Here are some ways you can help your loved one stay on track and avoid readmissions:

1. Before you are discharged, make sure to have the doctor or specialist request an order for Home Health. Secondary falls are a top reason for hospital readmissions. Medicare will pay for skilled nursing care to come to your home and provide services to make sure your loved one’s health is improving. This includes Physical Therapy to focus on strength and mobility, as well as Occupational Therapy which can aid with daily tasks, as well as making safety recommendations around the home.

2. Have an In-Home Caregiver so your loved one isn’t overextended when they return home. Once home, it’s natural for Seniors to “push it” too far and this leads to exhaustion, them hurting themselves, falling and overall decline. An in-home Caregiver can fill in the gaps when Medicare Home Health is maxed out. Even having someone checking in to help with food prep and socialization 2-3 times a week can make a huge difference in recovery.

3. Have an advocate with you at discharge to make sure details of care, medications and protocols are understood. When leaving the hospital, there are a lot of information and directions that are critical to continue healing and avoiding readmission. This “advocate” could be a family member, friend or care manager. If visitation rules don’t allow them to accompany your loved one, a phone call or zoom can be set up with a Case Manager or Nurse.

4. Proactively have a follow-up appointment set with General Practitioner or specialist. Failure to keep follow up appointments is the #1 reason for hospital readmissions. According to the Dartmouth Atlas Project, more than half of Medicare patients don’t see their primary care physician within 2 weeks of leaving the hospital. This is so important to make sure progress is being made, and also to check on changes that may need to be made to medications or therapy.

5. Have a meal preparation gameplan in place. Inadequate nutrition will not just delay healing, but it can even reverse it. Seniors are typically low on the energy and mobility needed to keep up with daily meal preparation and weekly shopping. Have a plan in place. Ideas include: setting up a meal train with family & friends; get them signed up for a food assistance service like Meals on Wheels; have an in-home Caregiver help with weekly meal prep; help with food shopping by using a grocery delivery service like Shipt or Instacart.

​It’s also a great idea to be connecting with us at Sunways Assisted Living Concierge when your loved one is getting discharged from the hospital to have us be part of your “team” moving forward. We’ll be able to give insights to care options such as Home Health agencies and Caregiver services, as well as senior communities that can provide higher levels of care when it’s needed. Beyond that, having a shoulder to lean on to provide insight and resources is invaluable. Make sure we’re in your corner!

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