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Had a joint replaced?

Plan for life after rehab

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May 19th, 2017
You will need support for everyday tasks when you come home after rehab following joint replacement surgery.
You will need support for everyday tasks when you come home after rehab following joint replacement surgery.

 

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, one million Americans have a knee or hip joint replaced every year, and that number is on the rise. If you are one of them, you may face a stay in a skilled nursing or rehabilitation facility for a few weeks before you go home.

Such facilities do not toss you out on the street. “In most situations, once you are admitted, there are interdisciplinary meetings conducted regularly to help patients plan for discharge,” says Vrinda Suneja, M.D., medical director at Fox Run, an Erickson Living community in Novi, Mich. “Team members can include doctors, nurses, therapists, social workers, and other specialists.”

These meetings are intended to ensure your needs will be met. But that doesn’t mean you should leave the planning entirely up to other people, as you are the best judge of what you will need when you arrive home.

Before you get to rehab

Sometimes preparing to go home from rehabilitation means making plans before you are admitted. That means getting information you need from hospital staff where you had your surgery. Experts recommend getting more details than what are on most hospital discharge printouts. “You should have more individualized information than what is listed on many standard discharge instructions,” says Donald Fry, M.D., executive vice president, clinical outcomes, for MPA Healthcare Solutions in Chicago, Ill. “You should receive explicit instruction on what signs indicate emerging problems, details of possible adverse events, and essential numbers to call if you have problems. You need to recognize potential problems and know what to do if anything occurs.”

Not all complications happen immediately after surgery, and once you are in rehab or at home, you aren’t out of the woods.  “Our research shows that over 50% of adverse outcomes occur after a patient is discharged from a hospital, and some may not be recognized until 30 days later,” Fry explains. 

Some signs of problems can be redness or drainage at the incision site; difficulty urinating; and abdominal pain, distention, nausea, vomiting, or severe constipation. “Any of these problems should be brought to your surgeon’s attention immediately,” Fry says. 

“All discharge instructions should include a complete list of your medications with instructions, and you should have follow-up appointments scheduled with your doctors before you leave,” Suneja says.

You will also receive a discharge summary when it is time to leave rehab, and it should include essentially the same elements as your hospital copy, but with updated information.

Points to remember

In most instances your main sources of aftercare when you leave rehab will be a home health care agency and a company that provides equipment and supplies. You may need followup nursing visits or physical or occupational therapies, and these will be provided by the home health care agency. Sometimes these agencies will coordinate equipment and supplies, but not always. It’s important to have everything set up and scheduled before you leave rehab. You need to have equipment delivered and waiting for you. Have a family member do some background research if you have a choice of companies.

You should plan to have your home modified beforehand. “With joint replacements it is hard to understand how your mobility will be affected in a real-world situation,” Fry says. 

Be prepared for anything by having someone make some simple changes, such as moving necessary items from high shelves and putting them in reachable places. Stock up on frozen foods and nonperishable, easy-to-prepare items like low-sodium soups. Have food and supplies stored at a height between your waist and shoulder level in order to avoid bending. Have a hand-held grabber ready to use wherever you need it in the house.  “Installing an elevated toilet seat and arranging for a bath chair may be necessary,” Suneja says. “Remove anything that increases your chances of falling such as clutter and loose rugs. Make sure you have sufficient light in the areas of the house you will be using. Check for electrical cords, footstools, or other obstacles.”

Make sure your phone is within reach. If you are using a walker or wheelchair, have a bag or lightweight basket available to carry necessities.

Don’t go it alone

“You need someone there to assist you in the first few weeks of arriving home,” Fry says. “This can help you become familiar with how to move and avoid falls.”

“Be aware of what constitutes your support system,” Suneja adds. “Many people don’t realize how hard they will have to work once they get home. When you are in rehab, you don’t have to take care of everyday tasks like cooking, cleaning, or laundry. You need to think carefully about how you will get these things done and how you are going to take care of errands that require transportation such as grocery shopping, going to the bank, and getting to doctors’ appointments.”

Your caregivers should be trained beforehand to do necessary tasks such as caring for wounds, helping you transfer, and properly using assistive equipment. 

Once you’ve planned the basics, adding some bells and whistles can make life easier. Community faith-based organizations or civic groups may have volunteers available to provide several types of assistance that can fill in the gaps not covered by Medicare or insurance.  Explore these options ahead of time.


Local assistance

To find help in your community, contact the Elder Care Locator at 1-800-677-1116.

 

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