When a person needs help at home to manage their medical conditions, a home health nurse can be a lifesaver. Our home health nurses are licensed professionals who provide great care for seniors with a variety of health concerns and conditions.
Returning home from the hospital or inpatient rehab doesn’t have to be a solitary journey. Our nurses can help you manage your conditions, make sure you are taking all the right medications they way your doctor has prescribed, and answer questions you may have about how to get better and stay healthy.
Our nurses develop individual care plans to treat health problems that may be new or may be longstanding. Our services include medical assessment, wound care, pain management, patient education, cardiac care, medication management, IV therapy, and monitoring your health status. We follow your doctor’s orders and provide care that’s based on the best research that’s available today.
By working closely with you, your family members (if you choose), and your physicians, our nurses help ensure that you get the right help at the right time.
Sometimes things happen that can cause a person to have trouble getting around safely. It may be a hospitalization due to illness, a joint replacement, a decline in strength, dizziness or a fall. When those sorts of things happen, our physical therapists can help you regain and/or improve your mobility so you can be safe and as independent as possible.
Our physical therapists can help you get around better. For some people that may mean getting in or out of bed, in or out of a chair, or walking around the house. Our PT’s can teach you how to use a walker or a cane if your doctor recommends it, and we can make sure you’re safe getting to and from the bathroom, or walking safely down the stairs and out to your car. They can also make sure that your home is arranged so getting around is safer and easier for you.
One of the most important things our therapists can do is help with pain. Many people go to outpatient physical therapy when they are in pain, but we are able to use many of the same devices and techniques in home health. We have ultrasound, electrical stimulation, Anodyne therapy, microcurrent and cold laser treatments. Depending on what your doctor orders, there’s a lot we can do to help with different kinds of pain.
In order to help you be as independent as possible, we want to make sure you are able to perform activities of daily living. Those are things such as personal grooming, bathing, dressing and preparing meals. If you’re having difficulty with any of your activities of daily living, or if you’re having problems with your neck, shoulders, arms or hands, you might benefit from occupational therapy.
Occupational therapists evaluate your ability to perform activities of daily living, determine what is keeping you from being independent, and develop programs that help restore function. The evaluation includes identifying hindrances such as loss of muscle strength, decreased coordination, increased pain or the inability to bend or reach without losing balance. Our OT’s then develop a program to address these issues to help you get better and, when necessary, adapt to the environment.
Patients who have had a stroke or heart trouble, orthopedic surgery, arthritis or trouble breathing because of COPD may all benefit from occupational therapy.
There are lots of reasons why someone would benefit from Speech Language Pathology (what we sometimes call speech therapy). The main two reasons are problems communicating and problems swallowing.
Sometimes problems communicating come from a speech problem, which may be caused by a stroke, Parkinson’s disease, or an accident. Sometimes problems communicating come from problems with cognition, understanding or comprehension. Swallowing problems are often caused by stroke or another type of neurological disorder such as Parkinson’s disease or multiple sclerosis.
Our speech language pathologists can teach you (and your family or caregivers if you wish) eating and swallowing strategies. Our SLP’s help improve swallowing skills and teach compensatory strategies that help reduce the risk of aspiration pneumonia while helping you maintain adequate nutrition and hydration. They can also teach you communication options, alternatives and strategies if that’s what you need. In addition to helping you, they can work with your family members and other caregivers to provide strategies to make it as easy as possible for you to communicate effectively.
Not everyone who needs home health needs a social work visit, but you might be surprised at how a social worker can help you. Social workers identify and address social and emotional problems impacting your medical condition, treatment plan, or your rate of recovery.
For many people, a change in health status can cause lots of other changes, too. You might experience changes in your financial status, changes in your living arrangements, etc. You might need more help than you’ve needed in the past. You might need some help paying for medications, help finding support or connecting with community resources. Those are all things a social worker may be able to help with.
Social workers can help you with long-term planning. They can help you with information about advanced directives such as Power of Attorney for Health Care, and they can provide resources and discuss potential living arrangements and support systems for your future. Social workers can also help your family/caregivers if they need more support in caring for you or planning for your future. In addition, social workers are able to provide short-term therapy and crisis intervention.
Why do care transitions matter? Without a structured care transitions plan, about 1 out of every 5 people who transition home after a hospital stay have to go back to the hospital unexpectedly. Studies show that people who follow a structured care transitions plan are much more likely to get better and stay home without having to go back into the hospital.
When a person is being discharged from a hospital or rehab facility to their home, it is called a “care transition.” The term “care transitions” refers to the movement patients make between health care practitioners and settings as their condition and care needs change during the course of a chronic or acute illness.
For example, a person might see their primary care doctor and then be admitted to a hospital where a hospital physician and nurses take care of them. From the hospital they might go to a skilled nursing facility or an acute rehab facility where different doctors, nurses and therapists take care of them. From there, they might go back home and be seen by a home health nurses and therapists and follow up with their primary care doctor again. Each time they go from one health care setting or provider to another, it is a care transition.
Because going back to the hospital unexpectedly is a big problem, our government has been supporting a lot of research to figure out what are the best things to do to be able to stay home after being in the hospital. That’s good because we now know some specific things to do to help. Also, a lot of people are talking about care transitions, which can be helpful. Unfortunately, some home health agencies are talking a lot about it but not implementing the recommended steps.
We have a care transitions plan that we follow that will give you the best chance of staying home once you get home. We understand how important the hospital is, and we deeply appreciate the amazing care that hospitals provide, but why go back to the hospital unexpectedly if you don’t need to? When you are discharged from the hospital and receive home health services from Advanced RehabTrust, you will have the confidence and peace of mind that comes from knowing that everything that can be done is being done to keep you safe and healthy in your home.