Rehearsing for recovery

It may have happened in your extended family. Someone ends up in a hospital or rehabilitation facility after a fall, surgery or illness and then must transition home to continue mending. And what if it’s you who needs to recuperate at home?

Without round-the-clock care, the ways home life may change, even temporarily, warrant some serious consideration. When a person is preparing to leave the hospital or facility, a key to successful recovery is knowing even simple things such as how to fold and unfold a wheelchair.

Mark Toles

To help you prepare for such situations, Carolina Nursing’s Mark Toles offers some context on what skilled nursing facilities do and some tips on what you can do ahead of time. A registered nurse, associate professor in the UNC School of Nursing and Beerstecher-Blackwell Distinguished Term Scholar, Toles is an expert on nursing care of adults, quality of care in nursing homes and care of adults as they transfer between settings and health care providers. He conducts research to improve care in nursing homes.

Toles and his colleagues assess and aid skilled nursing facilities and rehabilitation centers throughout the United States, including 11 in North Carolina. “We try to help them do some of what they’re already doing in better ways,” he says. “People who work in nursing homes are genuinely interested in improving quality.”

He comes in with training and tools for health care workers to try. His expertise translates into better care for someone temporarily in a center and after they return home. He has designed tools that health care workers can use to make electronic health records more useful. With them, the nursing home can provide a detailed checklist to patients of what they should do when they return home.

“A lot of times, we see family members preparing to bring a person recovering from an injury like a hip fracture back home. They need to help that person continue to get well, stay safe at home and avoid returning to the hospital,” he says.

Along with the digital tools and assessment, Toles and his colleagues offer training and technical assistance so that staff can provide high-quality transitional care that enables the family and patient to succeed at home.

In the midst of the pandemic’s fluctuations, serious health events, surgeries and injuries continue to change lives. What can you do to help yourself or a family member be ready for such situations? Toles advises five things:

• Prepare advance directives. “What are my preferences if I get in a situation where I can’t speak for myself? Who do I want to speak for me? What do I want them to say? Those are serious conversations that happen with family members, and then they need to talk to a doctor and get it written down,” Toles says. Doctors’ offices will have forms such as health care power of attorney and medical orders for scope of treatment.
• Identify changes in cognitive ability. If there are changes, are they short term or expected to continue? Ask a doctor. “It’s important to determine whether a family member has any cognitive impairment,” Toles says. If they do, meet with the health care team and learn what kind of help the person needs.
• Record and understand all medications. Toles says that it’s common for medications to change during transitions in care. “You want to be really careful,” he says. “Know what the medications and doses will be when you get home because it may be different.”
• Prevent falls. The risk of falling after returning home is high, Toles says. “It’s hard for folks to understand how often this happens. They may have had a fall before and had no serious injury. But, after coming home, some people will fall and break their hip or break a wrist. Bring in an in-home physical and occupational therapist to identify safety risks and teach skills for mobility and self-care, Toles advises.
• Involve a loving family member in documenting plans for care. “Even younger people, if deprived of sleep for two or three days and given pain medication after surgery in the hospital, won’t remember things like they normally do.” Hospitals can be a stressful environment, so Toles advises family members to pay attention, to ask questions about care at home and to write down instructions. Ask a nurse to help you understand medications and other important elements of care at home.