By Christine Eggers, Appeal to Heaven
Have you ever heard: “His doctor says he can’t go home without 24-hour care,” or, “The facility won’t release him without 24-hour care”? Very often this causes families to scramble to find a facility with an open bed and they have to take the first one available rather than choosing the best option for them. The insistence of remaining under 24-hour care causes fear, anger, and agitation.
Let’s take this apart. First of all, a person cannot be held against his or her will except when under arrest or guardianship. Professionals recommend it, usually because of an injury resulting from a fall, because they have concern for the safety of the patient. The events leading to the fall may have included deconditioning and weight loss from poor nutrition and inactivity, poor management of prescriptions, and poor hygiene of self and/or environment. The evidence is that he or she is not eating enough or getting enough activity, leading to weakness. The obvious conclusion is that they can’t live alone anymore, because they might fall again. And, in our minds, falling equals dying.
So, what does our patient need?
• Meal preparation
• Housekeeping
• Medication management
• Bathing/grooming assistance
• Laundry help
• Health monitoring
• Toileting assistance
• Safety monitoring
The most common solution is an assisted living facility (ALF). However, it is also possible to receive all of these services at home. Studies have shown that, due to the familiarity of surroundings and muscle memory, a person is actually less likely to fall in their own home than the smaller units of an ALF, even with ADA accommodations.
For people who own their homes, it is also more affordable to pay for the services because there are no accommodation fees—you only pay for what is needed. If they own their own home, why would a person pay to live elsewhere?
In addition to all the personal and supportive services needed, private home health care provides the RN supervision necessary to manage medications and monitor health to prevent decline. It is the RN supervision in the ALF that allows for aides to administer medications. The same can be accomplished with RN supervision at home.
What about the safety checks? The fact is, no one in an ALF or a traditional nursing home is continuously monitored 24 hours per day. They are alone in their apartments for hours between safety checks. They can be discovered after a fall in either location. In an ALF, a resident pays for staff to check on him at regular intervals. The same service can be provided at home.
What if he needs to go to the bathroom between visits? No one needs to go to the toilet all the time. Assistance with toileting is provided at each safety check to prevent the need between visits.
It is important to think through why the professionals are recommending 24-hour care. Is the patient unable to bear weight to walk or transfer at all? Is he or she incapable of understanding the risk and might attempt an unsafe action? If so, then residential care is necessary. For most patients, however, an abundance of caution is usually enough. Regular safety checks to use the bathroom, get something to eat and drink, and attend to other needs are sufficient to prevent most hospitalizations.
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