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Family Caregivers and Transitions

As experts look at ways to improve health care outcomes, they’ve found one area where a few changes can make a significant improvement in outcomes and reduce costs.

Much of the responsibility for making a transition from hospital to home falls on family caregivers.That’s better handling transition from one care setting to another – usually from hospital to home.

Much of the responsibility for making a transition from hospital to home falls on family caregivers. Home health nursing may be provided by a home health agency, but they are in the home only intermittently. The family encourages and supports the patient, they provide all the supportive services such as meals and interaction.

What can you do to make the transition home as successful as possible?

  • Ask questions. Prior to discharge from the hospital, a hospital employee (nurse discharge planner or social worker) will meet with the patient/family to discuss discharge plans. Make sure you are there and that you understand the plan. Medicare and Medicaid and most all insurance plans cover home health services following hospitalization. You have the right to choose which home health agency or other post-acute provider you use. The choice makes a difference.
  • Get it in writing. The hospital will provide care instructions, including medications. There often are changes in medications from before the hospitalization.
  • Get Help. Home health services may be ordered. You might want to purchase a few hours of professional help from a home care agency to help with some tasks that you aren’t comfortable with or to give you some time off.
  • Take care of yourself. Caregiving is a taxing endeavor. You do it out of love, but you can’t be an effective caregiver if you run yourself down or let stress get the best of you.

The US health care system has many strengths. None of them are as strong as family caregiving. Your role in transitions can greatly improve the success of the health care system in keeping your loved one safely and independently at home.

Home care services can be an important part of transitions. It might be skilled services such as nursing or physical therapy or you might want supportive personal care services.


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