Hospitals are designed to provide complex medical care. They operate to stabilize and treat conditions and then transition people to the next level of care. The set-up and care in a hospital rarely translates to other care settings, let alone for people returning home. Going from 24/7 managed care to a lower-level care setting or home can be tricky.
As an experienced nurse working in home health and community settings, a large part of my work was focused on the transition from hospital to home. These are some things to consider to understand why what works in the hospital doesn’t always work at home.
Hospital Vs Home Environment
While in the hospital, you have support from medical professionals and other unlicensed support staff. This means everything from laundry and housekeeping to medical care is taken care of. When you return home, most of these supports do not go with you. When someone starts to recover or stabilize and is discharged home, it can be common not to think through how their care will change.
An example of a day in the hospital can look like:
- Morning vitals and blood work
- Medication administration
- Breakfast
- Rounds from the doctor
- Hourly checks by nursing or nursing staff
- Lunch
- Therapy
- Medication administration
- Dinner
Once back at home, you become responsible for all aspects of your care again and may not have a structured routine. This can be overwhelming, as most people, when discharged, are not back to their baseline or normal level of functioning. Tasks that felt easy in the hospital, like self-care, toileting, and eating meals, now require a lot more effort. It is usually a fair assumption that the setup in a hospital room will be quite different from that at home. Differences in care environments can cause many issues if left unaddressed.
Mobility
For safety reasons, hospital staff may request that you notify them before getting in and out of bed. This is to help reduce the risk of falls. Nurses and other staff are constantly adjusting the environment to make mobility easier. You may not notice them moving IV poles, side tables, or cords to make sure they are not in your way.
Staff also use an adjustable hospital bed to better position patients for transfers. They can adjust the bed to make it easier to stand. They also use mobility aids such as gait belts (worn around the waist to support a patient and prevent falls), walkers, or wheelchairs. The extra set of eyes and hands may not be present when returning home, and basic mobility tasks can feel harder. Even though going to the bathroom, walking around the room, or getting dressed felt manageable at the hospital, they might not feel manageable anymore once home.
Falls post-hospitalization can also be a big risk. If someone lives alone, it might be a good idea to consider getting a product such as Life Alert or another monitoring system. These devices can automatically detect falls and offer an easy way to call for help if someone falls or experiences other medical events.
Nutritional Needs
While in the hospital, food is delivered to the patient’s room. There is no meal planning, prep, or clean-up. Often, family members staying or visiting with a loved one also have access to prepared food options. Once home, it is common to realize how much more effort it takes to maintain everyone’s nutrition (both the patient and the caregiver).
It can be a good idea to have easy email options available during the recovery period once returning home. This can look like quickly re-heated freezer meals prepared by others, or using a meal service that delivers ready-to-heat meals. Nutrition is a critical part of recovery from any illness or injury and should not be overlooked. This is why hospitals have an entire dietary staff focused on patient nutrition.
Hospital Vs Home Incontinence Care
Incontinence can be multifaceted; some people may enter the hospital already experiencing it, while others may develop it as a new condition. Inpatient incontinence is managed through catheters and products. Nursing staff and assistive personnel help with changes and trips to the bathroom. In a hospital room, the bathroom is usually only a few steps away, and bedpans, urinals, bedside commodes, and absorbent underpads for bed protection are available to make it easier. Depending on the setup at home, it may be a lot different to manage incontinence and bladder control than when in the hospital.
In the hospital, if someone needs to use the bathroom, they can push a call light to get help. Incontinence products, if needed, are available in the bathroom, and the staff can help change them, cleanse skin, and dispose of any soiled products. At home, help is not always available; it is important to think through the bathroom set-up and where supplies are stored. Using a higher-absorbency product might be necessary during the transition home. Using reliable protective underwear can reduce clothing and linen changes, which in turn reduces the need for extra laundry.
One commonly overlooked point is that patients have access to large inventories of supplies in the hospital. If one incontinence product doesn’t fit or doesn’t absorb well, they can just try something different. Once home, this trial-and-error takes time and resources. A good place to start is using an incontinence product guide through a manufacturer such as LivDry, where you can browse numerous products and sizes online to find something similar to what worked in the hospital. Always use the manufacturer’s sizing chart for accurate sizing.
Therapy
While in the hospital, physical, occupational, and speech therapy are often provided in the room; therapists come to the patient, and minimal organization is required on their part. If you need to continue rehab or therapy after being discharged from the hospital, it can be more complex. You will need to schedule appointments, arrange transportation (if unable to drive), and complete exercises independently at home. Outpatient therapy can be more taxing due to the extra effort required just to get to appointments.
Medication Management
When admitted to a hospital, all medications are managed by the medical staff. They store, administer, track, and document all medications taken. They follow up to make sure there were no side effects and that the medication is working. It is not unusual to leave the hospital with new medications, even if they will be temporary. Medications may have been working well to manage pain or other symptoms, but people may get home and feel out of control.
Once home, they become responsible for their medication, and the managed system in the hospital is no longer available. Having a printed list of the medication, dose, and time to give it is a good starting point. Other things to consider are:
- Can they open the bottles?
- Can they read the labels?
- Can they remember to take them on time?
- How will they order refills?
Using an easy-open mediset can be helpful for short- or long-term medication management. A family member or caregiver can fill it out and reduce missed doses. They have easy-open options and come in many sizes.
Self-Care
Self-care in the hospital is usually pretty basic. It can consist of oral hygiene (brushing teeth and flossing), bathing, and changing clothes or a gown. While hospitalized, people usually don’t wear their own clothes or complete full self-care routines, such as doing their hair, makeup, or shaving. When someone is in the hospital, they receive help from an aide or nurse with self-care tasks. Items can be set up near the bed, or a walker or wheelchair can be used to get them to the sink. People often don’t realize how much more taxing these activities can be at home.
I have seen patients where the hospital discharge notes do not refer to issues with self-care, but I will visit them a few days after a hospital discharge, and they’re still wearing the same clothes they left in. By the time they brushed their teeth and went to the bathroom, they had no energy left to bathe or change clothes.
Many older adults will need support from family, friends, or a caregiver, at least in the short term, after going home. This ensures they have ongoing support with self-care and other tasks that help them conserve energy to care for themselves.
Preparing to Go Home
Having a good plan for what will work at home starts with realistic discharge planning. Being honest about any concerns or challenges you were facing at home before the hospitalization can help the team provide you with support and resources for existing and any new challenges. An honest assessment of home capabilities will help address many of the common issues I see, such as mobility, self-care, incontinence, and meeting nutritional needs. Never be afraid to voice concerns to the social worker, discharge planner, or nursing staff to make sure all the bases are covered for a smooth transition home.
