Home health care – How to make a smooth transition

Imagine that your 89- year- old father is being released from hospital today after a long and stressful stay. After a bit of scrambling, everything seems to be falling into place; the walker you’ve helped your mom arrange for has been delivered, the shower grab bars are in place and you’ve booked the follow up appointment with your dad’s doctor. So why, after all this has been put in place does your father end up back in hospital three weeks later, weak and dehydrated? And, how is it possible that your mother looks 20 years older, in the space of just three weeks?

The one element that is often overlooked in creating a successful and long lasting discharge is the family unit. Specifically, support for an elderly spouse. If a client, like the one above, is 89-years-old, then we know that a spouse is usually not too far behind in age.

When we assess a client’s home safety needs, of course we look for the needed assistive devices; grab bars; raised toilet seats and the like. We look for an appropriate exercise program to be in place and a nutritional plan that will put the client in the best position possible for attaining and maintaining good health. We ensure that medication prescriptions have been filled and that follow up appointments are made.

Very importantly, we also want to know that the client has companionship and a caregiver available, should they need one.

We know that if we are not careful to look after the health needs of both the client and the spouse, we will soon end up with two patients instead of one.

It is unrealistic and unfair to expect a frail elderly spouse to take on the care responsibilities, physical and otherwise, for their partner. Think about the hospital setting from where the client has recently been discharged; nurses, who have been looking after the client during the day shift leave the hospital for an evening and night off before returning the next day – not to mention that they are only expected to work a regular work week. The elderly spouse, by contrast, has a full-time plus job. They are present and responsible for caring for their partner 24/7.

It is not unusual for us to be referred to clients because the spouse of the client is becoming worn out or unwell.

I met a lovely, intelligent 85 year old woman who was neglecting her health and as a result suffering from painful gastric ulcers and out of control osteoarthritis. She was not making appointments to see the specialists recommended by her family doctor, she was spending most of her time at home and fast becoming isolated from her friends. Why? Because she was the full time and sole caregiver to her 100 year old husband. Her doctor advised her to get a relief caregiver in place in order to allow her to care for herself and to have a regular mental health break – or else!

We had a personal support worker relieve her of caregiving responsibilities each day for four to six hours. She had the opportunity to make medical appointments, see friends for lunch and even return to her quilting bee! Her health improved and when she arrived home from her outings, her husband had been assisted to shower, had been given a nutritious lunch and snacks, had been supervised in a light exercise program, had been out for a “walk” in his wheelchair in the fresh air and had had the benefit of discussions with the caregiver about current events and sharing of life stories. Additionally, the caregiver helped with the laundry and prepared dinner for the couple.

To support an older couple at home, think about how they will accomplish all of their activities of daily living each day. How will they get their laundry done, make their meals, shop for the food to make those meals, how they will get to doctors appointments, fill their prescriptions and organize the taking of their medicines. How they will bathe safely, have their hair cut and even how they will be able to have some “away” time from one another? For those living in a house, there are other more obvious home owner responsibilities like lawn care, snow shoveling, furnace or air conditioning repairs, plumbing emergencies, changing of lightbulbs, batteries for smoke detectorsÉ..

There are any number of ways to help with these activities. Talented and generous family members may be one option. Meals on wheels, private home health-care services, services from the community care access centre, visits to day care centres, friendly visiting services, are a sampling of some others.

Remember that when an older person who has care needs lives at home with a spouse, a successful plan should always consider both partners’ physical, mental and social care needs.