Seniors in Transition--Home Health to Hospital

Nationally, approximately 26 percent of all home health patients are readmitted to the hospital or emergency room during the first 60 days of homecare. This is usually due to a complication from an existing illness or surgery that is best managed in an inpatient setting. No matter the reason, if you are being admitted from a home health agency to the hospital, you have an advantage. Professionals who have been involved in your care can provide information to the admitting hospital and smooth the transition.
Be Prepared
All home health agencies are required to maintain a care plan and a list of your physician's orders. Ask your home health case manager for a copy of these things and place them in a handy folder for your use in case you must revisit the hospital. If you must go to the hospital unexpectedly, take all this information plus any disposable medical supplies you might need for the first day along with you. If there are delays in getting settled, you might need both the supplies and your medications until the hospital can reorder.
Ask questions of your home health provider right from the start. Here are some things you should know:
1. What signs and symptoms should you or your loved one look for that might mean a medical problem is developing?
2. Who should you call in case of a problem, the home health agency, the physician or the hospital?
3. What means will the home health agency use to communicate with your physician should a readmission be necessary?
4. What information will you be responsible to communicate or take with you if you must be readmitted?
5. How and when should you notify the home health agency if the physician sends you to the hospital?
6. How will the home health agency let the hospital know you are on service with them and wish to return to service upon discharge?
Tips for Going Home Again
Once your stay in the hospital is concluded, take all the information you had back home again. Be sure that if you wish to remain on service with the same home health agency as before, you request the hospital discharge planner make the contact for you. Once back home, make sure the home health provider is aware of any changes in your routine, diagnosis or medications so that your recovery is as smooth as possible.