If your mom or dad is about to be discharged from a Minneapolis hospital, you probably have a lot of questions and concerns. Will he or she be able to stay home in Minnesota alone? If not, how much home care will be needed and for how long? Will insurance cover their care? A great place to start is our FREE Returning Home Guide developed by Home Instead Minneapolis to help make the transition from hospital to home a smooth one.

Next, talk to your loved one’s doctor or discharge coordinator to create a plan of care. Key issues to discuss with the discharge planner include:

• Expected date of discharge
• Type of aftercare required including the level of skilled care
• Staff recommendations for discharge options

Options for Services and Rehabilitation After a Hospital Stay

There are three primary transitional care or rehabilitation options available and each has its own rules, regulations, and entrance requirements.

1. Inpatient—Nursing facility/rehabilitation hospital – This option is typically necessary if your family member will benefit from specialist treatment following the hospital stay, such as intense physical therapy and requires a doctor’s order.
   Time spent in a Minneapolis skilled nursing facility or rehab center typically lasts for weeks not months, and if continued rehab is required beyond the inpatient stay it usually takes place at home or an outpatient center.
2. Home—Certified home health care agency or in-home health care services—If your family member only needs part-time rehab or skilled health care services such as wound care or monitoring of medications and equipment, then home health care may be the right option for them. Depending upon need, care can be provided by nurses, nurse practitioners and physician assistants or certified home health aides.
   If your loved one is suffering from Alzheimer’s or dementia care, there are a wealth of resources for you to consider. Often, a non-medical but trained home companion will be able to assist with mobility, medication reminders and special dietary issues.
3. Outpatient—Rehabilitation center or adult day health center—In order for your senior loved to utilize this care option, they must be able to travel to the center in order for his or her after care needs to be met. Typically outpatient rehabilitation centers provide physical, occupational and speech and language therapy.
   Often, a combination of in-home care services and outpatient rehabilitation services works well in this scenario. For example, caregivers provided by an in-home senior care agency like your local Home Instead Senior Care® office could assist with transportation to rehabilitation. Also it is common for top rehabilitation facilities to have waiting lists so start early to find a center that will accept your loved one when he or she is ready to be discharged.

Guidelines: Determining Service Options After Discharge

• What level of skilled nursing care or specialist rehabilitation services are required and for how long?
• Are these after care services covered by Medicare or other insurers and if so, for how long?
• Does your loved one need full-time/around the clock, daily or intermittent care?
• Will transportation be a factor for both inpatient and outpatient options?
• Does the Minnesota facility (outpatient or inpatient) have extended hours of operation, convenient visiting hours and are meals/snacks provided?

As the primary family caregiver there are also many personal factors for you to consider as well:

• How much time do you have to help out?
• Will you need to take time off from work?
• Do you have a back-up caregiver in the event of an emergency?
• Are you physically able to lift or move your family member?
• Can you handle additional tasks such as picking up medicine and taking care of your loved one’s home?

Once you have answered these questions your loved one’s medical providers and you can decide which post-discharge care option is best for your loved one. Knowing what options are available and weighing each against your loved one’s desires and needs can help you make a well-informed decision that will help to ensure a successful recovery.

What is a Health Care Power of Attorney?

A health care power of attorney, also called a health care proxy or a durable power of attorney for health care, helps protect your loved one’s end-of-life wishes. It is a document that appoints a trusted individual to make decisions regarding your loved one’s medical care, and it becomes effective when he or she can no longer communicate effectively or coherently with others.

The person designated as your loved one’s health care power of attorney, also known as an “agent,” should be a trusted individual who knows your senior loved one’s religious beliefs and has the ability and time to act on his or her behalf.

Your loved one can give a health care agent as much or as little power to oversee his or her health care wishes and make medical decisions as feels comfortable. However, many people give their health care agent comprehensive power to supervise their care.

Each state has unique health care power of attorney laws and due to potential conflicts of interest, most do not allow medical providers or their employees to be named as agents. Many states also have free health care power of attorney forms that you can download from their websites.

What Medical Wishes Does a Health Care Power of Attorney Cover?

Seniors and their health care power of attorney discuss the following items:

• Does your loved one want aggressive health care measures or life-prolonging treatments in the event of a chronic and debilitating illness?
• Does he or she want to be resuscitated in the event of heart failure or stopped breathing?
• Are there any medical treatments to which he or she has a religious objection?

How to Help Your Loved One Appoint a Health Care Power of Attorney

Most of us do not like to consider the possibility that we may become incapacitated and unable to make our own decisions anymore. When discussing the need for a health care power of attorney with your loved one it is important to be considerate, patient and not demanding.

Below are some issues to consider when helping your loved one legally appoint a health care power of attorney:

• Make sure your loved one understands that the health care power of attorney document is intended to ensure that his or her wishes will be respected.
• Be careful about adding restrictive language to a health care power of attorney document as it is important that the agent is able to respond to changing medical needs as they develop, even ones that cannot be foreseen.

How to Assess the Amount of Care Needed

Below is a checklist below to help family caregivers determine how much care they might need to provide.

1. Patient Restrictions and Activities: Will your family member be able take a bath or shower, lift heavy items or walk up stairs? Can they be left alone? Are you prepared to help your loved one with exercise instructions?
2. Equipment and Supplies: Make a list of items you will have to shop. They might include a hospital bed, shower chair, oxygen supply, disposable gloves or special skin care items.
3. Home Safety: Do you need to move out items that might cause a fall such as area rugs or electrical cords? Do you need to make room for a hospital bed and other large equipment? Download the Returning Home Guide which includes a Home Safety Assessment.
4. Health Care Tasks: What tasks will you have to perform and will you need any special training to accomplish them? Plan on receiving the training, such as wound care or taking and recording vital signs, while your family member is still in the hospital.
5. Special Diets: Will you need to purchase and prepare any special foods? For example, your loved one may be on a liquid diet for some period of time.
6. Medication Management: Will you be able to monitor your family member to ensure he or she takes the correct medication at the right time in the right amount? Will medications cause side effects?
7. Follow-Up Care: Will you or another family member arrange for follow-up care and appointments? How often and where will they need to take place?
8. Medical Expenses: As the primary caregiver you may have to manage your family member’s medical expenses including correspondence with the hospital, Medicare and insurance companies.
9. Other Financial Issues: Are you prepared to manage your loved one’s finances, deposit retirement payments, balance his or her checking account and pay bills? There may be additional financial issues including taxes and home maintenance and repairs as well.

In addition to managing your loved one’s care, be sure to factor in time for yourself. It is important for family caregivers to take care of themselves while taking care of others. Remember that you don’t have to do everything on your own; hiring professional in-home caregiver services for even just a few hours per week can give you the time you need to focus on your own needs.

Understanding What Health Insurance Covers

One of the most common ways to finance medical care and health services for seniors in the United States is through Medicare which covers almost all Americans over the age of 65 for a large share of their medical expenses including hospitalizations, doctors’ bills, x-rays and therapies. The following steps will help family caregivers obtain the information they need to better understand their senior loved one’s insurance policies and programs before they return home from the hospital.

Contact Insurance Representatives Before Bringing Your Loved One Home

Make sure the insurance provider understands all the services and equipment that your loved one needs and ask them to provide information on what they will approve, why and for how long.

Conduct Research and Build a Support Network

• Discuss your loved one’s insurance needs with a bank trust officer, financial planner or other investment adviser. While these individuals do not provide legal advice they can often help with insurance, retirement plans and many other issues on behalf of their clients.
• Get to know your local pharmacist, who may be an excellent and readily available resource for information about insurance as it relates to prescription coverage.
• Discuss insurance options and information with friends and acquaintances who have experienced similar health care situations.
• Have family members help with sorting bills, reviewing current and potential supplemental insurance policies and conducting research.

These tips and resources will provide you a positive start in your loved one’s journey home from the hospital but it only touches the surface. Download the Returning Home Guide, then check back in the coming months as we provide more advice on bringing a senior home from the hospital.