It is always encouraging for a patient and their family to know for certain that the patient will be returning home. But the transition can also be scary and stressful for them. There is always this uncertainty and fear of “I’m not quite ready. What if I fall again. I’m not going to have as many people around to help me at home as I do here.” Of course this is completely understandable but also a fear that we can help the patient to overcome.
As with my post about community re-integration, we need to ask the correct questions in order to make sure we are setting the patient up for success at home:
Do you live alone?
What does home look like? House? Apartment? Stairs to enter? Multi-level? Where is the washer and dryer? Are there grab bars in the bathroom?
What are your responsibilities at home?
Do you do your own grocery shopping?
Do you prep your own meals?
Do you use a cane or walker to get around inside the house? What about outside the house?
Do you drive?
Do you have any pets?
Do you have any friends or family living the area?
How often do you get out of the house each week?
We need a clear picture of home to ensure that we are addressing the correct performance areas.
There are also some critical questions we need to ask ourselves:
Will this patient be able to show appropriate safety within the home?
Will this patient be able to safely manage their medications?
How many body systems are affected by the incoming diagnosis?
How far away are we from the patient’s prior level of function?
Does the patient’s perception of their functional status match what I perceive? What the patient’s family perceives?
Then we get to work. We address strength, endurance, ROM, sequencing, problem solving, and safety all in the light of bathing, dressing, toileting, housework, meal-prep, medication management, community mobility, and functional ambulation.
Remember that the home health agency is our ally and friend.
The home health therapist will be the one who helps the patient to carryover everything they learned with us into the home setting. The home health therapist is also the one who has the opportunity to physically lay eyes on the home, which often results in an easier ability to identify strategies for safe functional performance within the home.
So we do our best as the SNF therapist to be openly communicative with the home health agency. We document thoroughly and clearly. We provide the patient with a home exercise program complete with visual handouts. We cross our ‘t’s’ and dot our ‘i’s’ so that the home health therapist has as much information to work with as possible.
Have you ever worked in home health? What ways to you assist with that transition back to the home routine?