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Before Hospital Discharge -- Evaluating Your Homecare Needs
Ernest H. Rosenbaum, MD, Isadora R. Rosenbaum, MA, Diane Craig, RN, ONC, BSHS, and Carol S. Viele, RN, MS

It is natural for some anxiety to accompany anticipation of discharge from the hospital to the home; there are significant differences in the two environments. You will be leaving the security of the hospital support team -- the nurses and physicians who provide physical care and support; the physical therapist who began an exercise program and whose firm assurance enabled progressive ambulation; the occupational therapist; the nutritionist who provided diet instruction; and the medical social worker who helped you and your family deal with practical problems relating to your illness, as well as fear and anxieties. However with proper discharge planning, you can be assured of a continuing support system at home, and your rehabilitation will be enhanced by all the additional advantages that being at home offers, both physically and psychologically.

Discharge from the hospital represents a crucial move and a progressive step in your rehabilitation. Many patients become more alert and better oriented after returning home. You will need to participate in planning your home care by providing information regarding the physical setup at your home (stairs, bathroom facilities, etc.), the availability of people to help you and whether special equipment can be accommodated.

If you are confined to bed, your hospital team (nurse or discharge planner) will assess your ability to move about and position yourself for maximum comfort and to prevent skin breakdown. They will decide whether you need a trapeze to help raise yourself in bed and will examine your ability to transfer in and out of bed, either to a wheelchair or to an ordinary chair.

If you are able to be up, your hospital team will evaluate your ability to ambulate (walk) to the bathroom, and to other parts of the house. If you need help to move about, your hospital support team will show your family how to support your weight while you are walking and getting out of bed, so as to avoid injury to either of you. Perhaps you can walk independently with the use of a walker, a three-pointed or ordinary cane, braces, or other specialized equipment.

It is very important that this equipment be the right size and configuration, and that it be adjusted specially for your needs. You must be sure to speak up at any time if your equipment is no longer satisfactory. When using braces, pay particular attention to your skin in the areas where braces fit. Point out any blisters or areas of redness. If you find that your shoulders, arms or legs get very tired during walking, it may be that your appliances, cane or crutches are not in proper adjustment, or that you may need some additional strengthening exercises.

Bowel and bladder elimination should be re-evaluated in light of your home set-up. Are you able to walk to the bathroom independently or with the use of aids? Is the toilet situated so that you can safely and easily use it? Equipment may be needed to adapt the height or accessibility of your toilet. A raised toilet seat, arm rests or grab bars can be easily added if needed. If you cannot get to the bathroom, a bedside commode can be provided. Arrangements can be made for privacy and cleanliness.

Urinary incontinence is sometimes a problem after certain kinds of strokes or surgical procedures. If your situation requires the use of a catheter of any type, your nurse will show you how to use and care for it. If incontinence products are needed, purchasing those ahead of time is important.

An assessment of your ability to shower or bathe and what safety equipment you may need is important. If sponge baths are preferred, decide whether the bed or bathroom would be more practical and energy-saving. Have the nurse show your family how to bathe you most efficiently, simply, and with the least discomfort. Bed and sponge baths should be comfortable and relaxing.

Transportation may be a concern, particularly if you will have therapy or doctor appointments. If you have private insurance, check to see whether it covers ambulance or alternative transportation. Ask your hospital discharge planner if there are local transportation resources available. Some free transportation is available through the American Cancer Society and other organizations.

Home Health
Licensed home health agencies are available in most communities and will provide skilled services on an intermittent basis. The services of professionals who make up your home health team (e.g., registered nurses, social workers, and physical, occupational, and speech therapists) are prescribed by your physician. Your hospital discharge planner will help arrange for home health services if needed. You can also search for one on your own.

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