After a hospital stay, returning to senior housing can be difficult and present new challenges for patients and caregivers alike.

“A visit to the hospital can change everything,” says Kelly Mazza, senior executive director of The Arbors at Shelburne, a senior living community in Shelburne, Vermont.

If a senior has become frailer or their needs increase, getting re-acclimated may require more services, such as physical therapy and help with activities of daily living (ADLs). This can significantly increase the cost of care and may even necessitate a move to a higher-level care facility. Of course, coping with all these changes in personal abilities and living arrangements can be emotionally trying as well.

Hospitalizations can crop up suddenly for medical problems ranging from heart attacks to something as simple as dehydration. Understanding some of the common issues surrounding post-hospital transitions can help you and your loved one avoid unnecessary stress in such scenarios and ensure the discharge process goes as smoothly as possible.

Maintaining Communication with the Senior Housing Community While Hospitalized

Keeping the lines of communication open with a loved one’s independent living community, assisted living facility or nursing home is a fundamental part of managing transitional care. A trip to the emergency room may only last a few hours or it could turn into an extended stay at the hospital, so all parties must be kept abreast of changing circumstances.

If you did not discuss the senior living community’s bed hold policy upon your loved one’s admission, it is crucial to get this information in writing as soon as possible. Depending on the length of and reason for their hospital stay, a privately paid bed hold fee may be required in order reserve their current space in the facility. If these arrangements are not handled properly, a loved one’s room may be lost. Even if they are able to return to the facility, they may be assigned a different room or be placed on a waiting list if space is no longer available.

Reassessing Physical and Cognitive Abilities Upon Discharge

Although stress levels may be high as discharge time approaches, it is a good idea for family members to learn how changes in their loved one’s condition will impact whether their needs can still be met by their current community and the cost of this residential care. A good starting point is to read up on the community’s eligibility guidelines for resident admission.

A functional assessment is typically conducted upon initial admission and following changes in a resident’s condition to evaulate their physical and mental abilities and determine their corresponding care needs. For example, most assisted living (AL) communities require that residents be able to walk unassisted. If, following a hospitalization, a senior is no longer ambulatory, then the community may terminate their residency based on being unable to meet their increased needs. In some cases, this change may be permanent, but in others an intensive therapy regimen provided in a short-term rehabilitative care facility may help seniors regain the ability to walk and enable them to return to AL. Again, the family and community must decide what happens to the senior’s room during their often weeks-long absence.

Staff at a loved one’s senior living community should be in contact with the family and hospital staff, including physicians, social workers and therapy departments, to assess the patient’s evolving needs and if/how the community can meet them. Caregivers should be proactive to ensure communication among the care team is happening.

“The most successful transition back from a hospital to any type of senior housing happens when family is engaged and openly communicating what they want, instead of staying on the sidelines,” Mazza says.

Navigating the Elder Care Spectrum

Hospitalization commonly precipitates an increase in seniors’ needs and results in a transition to a higher-level care facility. For example, someone who was residing in an independent living apartment may now require assistance with ADLs and have to hire a professional in-home caregiver or move into an assisted living setting to meet these needs. Or, an assisted living resident may now require around-the-clock supervision and/or skilled nursing care. As mentioned above, this move might be temporary to help them recuperate, or, if the elder has suffered a serious physical or mental setback and is less able to care for themselves, the move might be permanent. Elder care exists on a spectrum and seniors can move up and down the hierarchy of care as their conditions and needs change.

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Discuss Assistive Devices and Home Modifications

The family, medical professionals at the hospital, and staff at either the current or new senior housing community also need to discuss what assistive equipment and therapy will be needed. Most senior living communities have been specifically designed to facilitate elders’ daily activities and improve their safety. However, some pieces of equipment can be added to a loved one’s apartment following a hospitalization to help extend their independence. Physical and occupational therapists can recommend the right senior care products that will help a loved one resume their old routine as much as possible.

More assisted living facilities have on-site therapy departments these days, often by contracting with outside providers. Instead of an individual having to leave the community and go to a doctor’s office or stay in a rehabilitation facility for occupational or physical therapy sessions, they can receive PT and OT at their own community. Of course, these services come at an additional charge, so it’s important to inquire about all costs before deciding where a loved one receives necessary therapeutic treatment.

Recognizing Hospital-Induced Delirium

A recent study found that elderly individuals who are hospitalized have a higher risk of cognitive problems following their hospital stay. Researchers with Rush University Medical Center in Chicago found that the rate of cognitive decline more than doubled in older patients who were hospitalized.

The study’s author, neuropsychologist Robert Wilson, PhD, says that the decline can be “equivalent to being more than 10 years older.”

When individuals are in a hospital for a prolonged period, they may lose their sense of time. In some cases, this confusion can be a symptom of hospital-induced delirium. Seniors are admitted to the hospital to receive treatment and regain their health, but simply being in this overstimulating, disruptive and unfamiliar environment can wreak havoc on a person’s mental acuity. It’s difficult to get quality sleep and new medications can cause troublesome side effects. The entire scenario is a perfect recipe for disorienting a senior, especially if they already have some form of memory loss or cognitive impairment.

An older individual may leave the hospital in better physical shape than when they arrived, but it takes time for their brain to heal itself from the whole ordeal. The effects of anesthesia and some antibiotics can also contribute to this haziness for weeks or even months after a senior has been discharged. Disorientation should lessen once they get back into their structured routine and familiar surroundings, but for dementia patients there is a risk that hospitalization can cause cognitive decline to worsen permanently.

Keep an Eye Out for Changes in Mood and Behavior

A lot of times an individual doesn’t come back home with the same needs and abilities. “That can be a challenge for them to accept,” Mazza says. “They may have been rather independent before, but now they may have to rely on others to help.”

Emotions that may manifest when elderly individuals get re-acclimated to senior housing after a hospital stay include frustration, agitation, defiance, fear and disorientation. If these moods and behaviors are present, families must work with and trust the community and its staff to address the challenges. Some people may have to relearn how to perform basic activities, especially if their mobility is increasingly limited.

Special Considerations for Seniors with Alzheimer’s and Dementia

For seniors with Alzheimer’s disease or other forms of dementia, the transition can be harrowing. These individuals do not handle changes in their surroundings or routine well. Mazza says preserving as much continuity and structure as possible is vitally important throughout this process.

“When they leave one setting and come back, it is very difficult for them to get acclimated,” she says. The staff at the senior living home should work closely with both the resident and the family to get the senior re-acclimated. If their mental condition has deteriorated significantly, then it may be time to consider placement in a specialized memory care facility or skilled nursing facility.