Coming home from the hospital should feel like a step in the right direction yet we want to keep you from ending up back in the hospital. But for many seniors, the transition from hospital to home is actually one of the most important parts of recovery.
At Seaside Home Health Care, we see firsthand how quickly a seemingly small problem at home can become a much bigger one.
A medication gets mixed up. Mom isn’t drinking as much as she should. Dad is a little weaker than everyone realized. A wound starts looking different. Someone notices a little more swelling or shortness of breath but isn’t sure whether it’s important.
These are exactly the kinds of changes we want to catch before they turn into another trip to the hospital.
Here are six common reasons seniors may end up back in the hospital—and how the Seaside team can help.
1. Medication Confusion After Coming Home
One of the first things our nurses look at when caring for a patient at home is medication management.
Hospital stays frequently result in medication changes. New medications may be prescribed, doses may change, and medications that were taken before the hospitalization may be discontinued.
Once everyone gets home, it can get confusing very quickly.
At Seaside, our skilled nurses can review medications as part of the patient’s plan of care, provide education, and help identify potential concerns that need to be communicated to the physician.
We want our patients and their families to understand what they are taking, why they are taking it, and what they should be watching for.
2. They’re Weaker Than They Realize
We hear it all the time:
“I was walking fine before I went into the hospital.”
But even a relatively short illness or hospitalization can affect strength, balance, endurance, and confidence.
The first indication may be something small. Getting out of the recliner is suddenly more difficult. Walking to the bathroom takes longer. The shower feels less safe. A patient starts holding onto furniture as they walk through the house.
This is where Seaside’s therapy team can make a tremendous difference.
Our Physical Therapists can work on strength, balance, walking and mobility, while our Occupational Therapists can focus on safely completing everyday activities such as bathing, dressing and other daily tasks.
And because therapy happens in the patient’s own home, we’re not just asking whether someone can walk.
We’re looking at how they actually function in the environment where they live every day which leads to long term success.
3. They Aren’t Eating or Drinking Enough
This one can be surprisingly easy to miss.
After an illness or hospitalization, a senior may have less appetite, feel tired, experience nausea, or simply not feel like preparing meals.
Sometimes patients purposely drink less because getting up to use the bathroom has become difficult.
At Seaside, we look at the whole patient—not just the diagnosis that sent them to the hospital.
Changes in appetite, hydration, weight, weakness and energy can all provide important information about how someone is recovering.
When we identify a concern, we can educate the patient and family and communicate with the physician when appropriate.
4. A Wound Starts to Change
Whether it’s a surgical incision, skin tear, pressure injury, or another type of wound, regular assessment can be an important part of keeping a patient safely at home.
Seaside’s skilled nurses provide physician-ordered wound care and monitor the wound for changes throughout the healing process.
We also educate patients and caregivers about what they should be watching for between visits.
If something changes, we don’t want the first person to notice it to be someone in the emergency room.
We want to identify concerns as early as possible.
5. The Little Changes Don’t Seem Important—Until They Are
This may be one of the biggest benefits of having a skilled clinician coming into the home.
A family member might notice that Mom seems a little more tired today.
A Seaside nurse may notice that she’s more tired and has increased swelling, a change in her vital signs, isn’t eating as well, and isn’t managing her medications the way she normally does.
Those pieces together can tell a very different story.
Our nurses are trained to assess changes in a patient’s condition, provide education, monitor chronic diseases, and communicate concerns with the patient’s physician.
Sometimes the most important part of a home health visit isn’t what we do.
It’s what we notice.
6. Families Are Trying to Manage Too Much on Their Own
Coming home from the hospital can be overwhelming for the entire family.
There may be medications to organize, follow-up appointments to schedule, new equipment in the home, dietary recommendations, wound care instructions, exercises, and symptoms to monitor.
Meanwhile, adult children may be trying to coordinate everything while also managing their own families, jobs, and responsibilities.
At Seaside, we believe families shouldn’t have to navigate all of this alone.
Our team works with patients, families, physicians, and other healthcare providers to create a plan of care based on the patient’s individual needs.
And for families who need additional support beyond traditional home health, Seaside also offers Concierge Care Management. Our experienced Care Managers can help coordinate appointments, attend physician visits, advocate for the patient, continually assess changing needs, and serve as local “eyes and ears” for families who may not always be nearby.
Our Goal Is Simple: Keep You Safe and Successful at Home
At Seaside Home Health Care, we don’t believe home health should be one-size-fits-all.
Every patient comes home with a different diagnosis, a different living situation, a different support system, and different goals.
That’s why our care starts by looking at the individual.
Depending on the patient’s needs and plan of care, Seaside can provide services including:
- Skilled Nursing
- Physical Therapy
- Occupational Therapy
- Case Management
- Concierge Care Management
Our goal is to work alongside the patient, family, and physician to identify problems early, support recovery, improve independence, and help our patients remain safely in the place they want to be most:
Home.
Don’t Wait for a Small Problem to Become a Big One
If someone you love has recently been hospitalized, you don’t have to wait until they’re struggling to ask whether additional support might help. Let’s not have them go back in the hospital!
Medication changes, increasing weakness, falls, wounds, difficulty managing a chronic condition, or simply feeling overwhelmed after coming home can all be reasons to ask about home health care.
At Seaside Home Health Care, we’re here to help make the road from hospital to home a safer one.
Call Seaside Home Health Care at (239) 202-2703 to learn more about how we can help you or someone you love recover safely at home or visit us on our website to learn more!
