‘No’ to home health care for seniors leaving the hospital

A significant number Kernisan, a San Francisco of people, especially geriatrician and seniors, upon creator of the website leaving the hospital to “Better Health While go home, refuse skilled Aging,” says that accepting home health care services help at home according to a might be perceived as recent report from the first step in trying Kaiser Health News. to take that independence (http:// away. khn.org/ There may be more news/ circumstances at play some-seniorsjustwant-tobe-leftalonewhichcan-leadto-problems/). other than lack of sufficient information and communication. Seniors might not want strangers invading their privacy. They might feel that they are doing fine and are This unrealistic of how difficult refusal can lead to it might be to recover many problems for from a hospitalization. older adults, including There might doubling the odds be issues with the of being re-admitted to home, such as physical the hospital within 60 self-neglect or hoarding, to 90 days. The report that the older looks into why seniors adult might not want are so resistant to this anyone to see. Cost type of assistance. might be a concern.

Carol Levine, director Or if the patient’s cognition of the United is compromised, Hospital Fund’s Families he or she might not and Healthcare understand his or her Project, a sponsor of limitations. the new report, says The report emphasizes “There are a lot of that clear communication, misperceptions about in concrete what home care is.” terms might be The Medicare benefit more effective. Sometimes for home health care it is helpful to is available for beneficiaries have a physician directly who are homebound recommend the and require intermittent care. If an older adult skilled care says that “I don’t want from a nurse, physical assistance,” try to follow or occupational therapist, up by asking “Tell or speech therapist. me more. What are These services you concerned about?” may include an aide to A follow up with those help with bathing 1-3 who did agree to care days a week for about is also important. Involving one hour each time. families might Typically, the services help but sometimes the last for 4-6 weeks post patient and his family hospitalization although have different goals. some persons Working with hospital may need this assistance staff directly can be longer. This is helpful also. often confused with “home care,” which is generally “non-medical” and includes assistance with showering, dressing, cooking, cleaning, and serving as a companion. These services are generally not covered by Medicare.

Because of this confusion, older adults may refuse home health care because it seems like an affront to their independence. It can be seen as needing a babysitter, not as a road toward independence after an illness. According to the report, characterizing the “help” in the correct manner may be key. Instead of stating that “you really need the help” if the conversation began as “we want you to help you take care of yourself” it might make all of the difference. Most older adults are concerned about maintaining their independence. Dr. Leslie