Over the past few months, I have written several blogs describing my journey to provide care for my mother and her recent medical issues. Fast forward to today: Mom was in the hospital and couldn’t find an SNF with rehab that had a bed open…
I called her nurse every night and asked, “Should we should take her home?”
I felt like we could rehab her at home with home health. However, her nurse was a little apprehensive.
She was concerned that she would NOT get the rehab she needed. I reassured her with Home Health, PT, and OT that we could create a home exercise plan (HEP) that would ve “comparable” to an SNF rehab plan with less exposure to COVID since Mom is immune-compromised.
After “team” the next day, her Nurse Practitioner called me and said, “Can you support your Mom at home if we D/C her directly home?”
Of course, I said yes with my friends from Interim Home Health!
Yes, I can fly home and help, but here’s the catch you: want to D/C her on Monday, and I get out of COVID isolation on Tuesday. That way I can fly home on Wednesday.
I called my Mom to confirm this is what she wanted to do and was comfortable “going home” she said, “YES, I want to go home!”
So I called my brother who lives on the other side of Ohio and said, “Ryan could you get Mom and take her home on Monday? Set her up. I will organize home health and hire an in-home caregiver through the private duty side of Interim until I can get there on Wednesday.” He said yes!
Ryan has a HUGE truck. I had this vision of him “throwing” Mom up into the cab. Luckily for me, Mom already thought of that and told him to go to her house and get her car to bring her home – good idea!
By the time I called Interim later that day, they already had the order for Home Health, and I was fielding calls from the DME company to deliver equipment.
Mom made it home safe and sound on Monday – YEA! She had a friend stay with her Monday and Tuesday night until I could get there on Wednesday.
Interim professionals were doing the SOC on Tuesday. She is receiving Nursing OT and PT.
A private duty aide came on Wed afternoon to help her get settled. On Wednesday, I was out of isolation and flew home to 12 inches of SNOW! What a welcome! But, just like the mailman, the Home Health Clinicians came to see my Mom that week. I am happy to report Mom has graduated from her walker! She is still a little unsteady, but her OT and PT are working on that!
I am grateful that she was able to go home.
Moreover, she is THRILLED to be at home!
She said to me last night, “Mel, I think I just do better at home. Look at me; I am walking. I am climbing steps to the landing. I don’t think I would have done this well at skilled nursing with rehab.”
I believe her. In her own environment, which she loves, she is HIGHLY motivated to do her HEP and functional activities (last night, we made bread and the night before cookies to take to the kids).
Big shout out to Interim of Meadville, PA – Their customer service is off the charts, and their clinicians are super skilled!
What can we learn from this experience?
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- Hospitals automatically think “SNF with rehab” if they qualify- but it doesn’t have to be that way. In some cases, it shouldn’t be that way.
- Your clinicians, if the patient is medically stable and has a caregiver if they are not able to self-care, CAN receive Home Health.
- Home Health was the RIGHT answer for my Mom; I just needed to think about how to cover the 1st two days of her discharge since I couldn’t be there.
Tell the story of my Mom to your hospital D/C planners. Let them “visualize” how Home Health can be the answer – especially now that COIVD has so many of them without “beds.” We call these patient vignettes. This is how we get referral sources to connect the dots from a patient to a referral to you.
Need more patient vignettes to help them connect the dots to you? We got you covered!
The RoadMap to Referrals is FULL of patient vignettes you can use out in the field to get more referrals NOW.
Gaining referrals does not have to be complicated. Will you let us help you?
Pick a time convenient for you to have Mike show you the system!
Together we GROW!
Melanie
