Hospital care at home?

[agate]

I've been hearing about this arrangement where a patient can get hospital care at home. Then along came a flyer from one of the local hospitals, and here is the Website describing what it is offering. Maybe this is being offered in many other parts of the country. It sounds like a good idea to me.

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Looks as if the patient even gets meals...

[Virginia]

I have mixed emotions about this. As someone who just spent time in the hospital, while I didn't enjoy it obviously, I think as well as Eric and Fred that had I not been there the night I became so ill and my breathing so bad that I may well have died. I was where a highly trained person could spot a very quick and rapid decline in my breathing. It happened so fast that had I been at home and it was night like that, I doubt that I would have gotten treatment in time.

I can see where this would be a good thing if a person was very stable, but still needed some time to recuperate from something. But to stay at home and hope for the best just because there is access to a telephone, with possibly someone on the other end who might respond in the right way is not something I would feel.really comfortable about. However, if it was not so close to the experience I just had I am sure I would be more receptive to it.

[agate]

They list a few diagnoses that would qualify a person for at-home hospital care, and it sounds as if it's entirely up to the patient whether or not to set that up. Pneumonia is one of the diagnoses but there are cases of pneumonia that can get so bad so fast that a person might want to be closer to instant care instead of waiting for someone to come to the home. Some might feel comfortable enough with the daily monitoring to take that risk just for the sake of being at home--and away from the germy atmosphere of hospitals.

[Virginia]

Agate, I didn't feel the hospital was germy. It was very clean and I was in a private room with a private bath. In my case I would not have known that I had so little time, nor was I able to think about it that night. Hannah told me later the following day that I didn't say a word. She said I just looked at her. I remember hearing myself wheezing, I knew things had taken a turn for the worse and it did it so fast that I just wasn't able to take it in that I could die that night. There were "rails" which I later read about in my chart. I've got to look rails up to see what it is when a person has pneumonia and there are rails.

Again, I think to go home with the right kind of people and equipment there, could be a good tbing. I am just saying that I think they would need to be careful about who they sent home and know without a doubt that they were able to go.

[agate]

Absolutely they should be careful. It does seem as the insurance is structured in such a way as to encourage hospitals to keep patients out of them even when there is an urgent need for them to be there, and that is very unsettling.

[Earth Mother 2 Angels]

((((((Hugs to All)))))) ~

agate ~

Thank you for posting the link for this service. OHSU has an excellent reputation, so I would expect the program to be well managed.

Virginia ~

This program is for patients after being discharged from the hospital. It is an alternative to sending patients to rehab centers. From the description of the services provided, it seems that the patient may get more help with this home care than at a rehab center. Because the patient has 24 hour access to the care team, if an emergency occurs, the patient can contact the team for immediate help.

The services in this program exceed in home health care, which you received, when you came home from rehab. I imagine that once the patient is stable and doesn't require the same level of care provided by OHSU's program, a home health care plan would be developed.

Some patients may need a caregiver at home, while receiving this hospital home care, and the OHSU's team would consider that in placement of a patient in the program.

Here is a link, which describes what rales are:

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Our home health nurse always checked Jon's and Jim's lungs with every visit. I also checked them regularly, as I have a stethoscope. Michael, Jon, and Jim had pneumonia many times, and the most common indicator of fluid on the lungs is rales.

I think this program is a wonderful step forward in reducing the number of patients in rehab facilities. That should be the goal for all medical providers, because recovering at home is far more beneficial than being in a facility.

Love & Light,

❤️❤️❤️❤️

Rose

[Virginia]

I misunderstood. I thought they were saying that people in the hospital would be sent home sooner than they ordinarily would be.

I am glad I was in rehab because there is no way that the equipment they had in rehab could have been brought to my home. Also, I was fortunate enough to get a physical therapist who I liked very much and who liked me. I never got that connection at home. Even the best ones were anxious to do what they could in a short amount of time and get on with their day. In rehab my therapist quickly got to know my weaknesses and my few strengths and he became invested in my well-being. I didn't have that at home and I missed it. I realize I was different than a usual pt patient because I have MS. If I had not first had my therapist in rehab I would have had an even harder time adjusting to all the people who overwhelmed me when I got home. Working on a one on one basis in rehab is what got me going.

People's needs are so different. Healthcare is definitely not a one fits all thing.

[Earth Mother 2 Angels]

((((((Hugs to All)))))) ~

agate ~

I reread your post regarding people wanting to be closer to instant care in case their condition worsens. This is where a caregiver, or friend, or family member in the home would be helpful.

From what I can discern from the website, it seems that there is 24 hour contact available at the push of a button. Patients also have an assortment of professionals coming to the home daily, including nurses, aides, therapists. I am guessing that OHSU considers the potential for the patient's condition declining, as well as whether there is another person in the home to call 911 as qualifications to have this in home care.

In our hospital, we have a Step Down Unit for patients, who are leaving ICU. If patients aren't able to recover well enough to go home and receive in home health care, then rehab is the next stop.

During one of Jon's hospitalizations, our Intensivist, who also treated Michael and knows our family, suggested that Jon could go straight to rehab from ICU, skipping Step Down. I refused. I insisted that Jon go to Step Down, because if he had a setback and needed to be ventilated again, he would be right there in the hospital, with all of the experts to help him. If he went to rehab, he would have to be returned to the ER by ambulance, and time would be wasted.

I concluded my rebuttal with, "Jon stays here until he is ready to go home. No rehab. Ever. Do you honestly think that rehab would take better care of Jon than Jim and I at home? And, you do realize that Jim and I would be at his bedside caring for him in rehab, as we do here. So, if you're thinking it gives us a break, you're wrong."

Jon stayed in the hospital. He went to Step Down, had a horrid seizure, needed to be ventilated and returned to ICU. When the Intensivist and I met after intubation, he just shook his head. I gave him that look, which means, "I told you so."

Even if we had the OHSU program for home care, I knew that Jon wasn't ready to be discharged. He returned to ICU two more times in that 47 days' stay.

Virginia ~

You are so blessed to have had such a positive experience in your rehab center. In my lifetime, I have been in many rehab/nursing facilities with my elders, friends, and finally with Jim (for only a few hours, before I sprung him out of there). None of those facilities come close in comparison to the quality of care you received. Not even in the vicinity of the quality of care you received.

Think about the facilities, which Jeanie, Dar, and Renee are in currently. They certainly have not received the kind of care and attention you did in your rehab center.

So, if you had a choice between a subpar facility and in home hospital care, you might be more inclined to consider the OHSU program as your best option.

The OHSU program is focused on hospital care, not in home recuperative care. They probably have the best qualified and skilled nurses and therapists going into patients' homes. Because it is "hospital care at home," they likely have access to the latest equipment to allow for tests in the home setting. Therapists may have access to smaller equipment for in home use.

I think the OHSU program is a positive, progressive step forward in health care. I wish we had a program like it for Michael, Jon, and Jim. Our home health care agency was wonderful, but in the first few weeks home, it would have been so helpful for them and for me, if we had an OHSU "hospital care at home" program.

Did Hannah take care of you in the hospital or in rehab? You might try calling whichever place it is and ask for her full name, and the best way to send her a thank you gift. You can order flowers on line or over the phone from a local florist, or a plant, which would last longer, and have it delivered to the front desk of the facility.

Love & Light,

❤️❤️❤️❤️

Rose

[Virginia]

Rose, Hannah was my nurse in the hospital when I quickly went downhill. She was well trained enough to do something about it right away. I just posted in chit/chat about my conversation with my cardiologist yesterday regarding Hannah. His building is so close to the hospital that they share the driveway and parking building. They are all Duke facilities. He wrote to someone there, but I feel he will go a step further and say something when he is on the 4th floor of the hospital. One of the nurses told me after I asked him to be my cardiologist that he was not only a good Doctor but a good guy.

As far as my stay in rehab I didn't mean to mislead anyone. I have always told people that it was not a five star hotel with gourmet food, but I honestly felt I got five star therapy. The therapy was what I needed. I had the same therapist every day and for me that was the difference. He knew I was depending on him to help me and he did his best I believe. I would have been there longer, but Eric got so concerned about COVID. I wasn't watching the news so I was pretty unaware of how bad it had gotten here during my illness. My needs were different than Jon's and Jim's. Like everywhere they were short staffed when I was there and Jeanie has said that is part of the problem where she is. However Jeanie is so much more dependent than I was. There is a big difference in being in rehab and still being able to walk and not being able to. So I do expect that my experience was different. Believe me I still would not want to go back.