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All too many times overwhelmed caregivers are physically and emotionally depleted and need to take time to rest and care for themselves. Believing in a holistic approach to caregiver stress and a strong commitment to helping our members find the right solutions, we created this blog to help you connect with others who, like you, may be facing the same eldercare issues and challenges. Feel free to comment, ask questions, and submit articles. Please forward the blog link to your family and friends. They'll be glad you did.

Warm regards,

Patricia Grace
founder & CEO
Aging with Grace

Wednesday, January 25, 2012

Stop the re-hospitalization revolving door

People are hospitalized with acute heart failure when congestion, or fluid build up worsens to the point that it causes severe leg or abdominal swelling and makes it difficult for them to breathe. Treatment is mostly focused to relieve symptons.

Because of inconsistent follow-up care and difficulty getting patients to take prescribed medication properly and to follow a good diet and exercise regimen, many of them relapse and wind up back in the hospital or in some cases die.

The following tips can reduce that risk:

Review medication upon discharge -medical errors often occur during the transition from the hospital to home. Make sure that you review your medications with a health care professional before leaving the hospital. If you are unsure about any aspects of the instructions ASK FOR CLARIFICATION...don not assume anything. If possible try and fill the prescriptions before you return home or within 24 hours.

Schedule a follow-up visit - schedule an appointment with your physician within a week or tow of discharge. Do not be surprised if your primary care doctor does not have all of the facts at your follow up appointment. Make sure to bring all of hospital discharge instructions with you!

Continue to treat symptons - even if your symptons improve enough for your to go home, you still need ongoing care monitoring and medication.

Treat other medical conditions - failure to control contributing conditions such as high blood pressure and kidney disease are just a few reasons why re-admissions are high.


  1. It is extremely important for an elder to be accompanied by a competent caregiver/family member upon discharge. Never leave the hospital without instructions in writing and a follow-up visit already scheduled. Make sure to understand how to take new meds and possible drug reactions. Elders are more sensitive to medications that younger folks.

  2. One very effective tool to help reduce a rehospitlization is to incorporate Skilled Home Care into the patient's discharge plan. There is also new technology, TeleHealth, available for the patient in their home that would, on a daily basis, monitor their(1) Heart Rate (2) Blood Pressure (3) Weight (4) oxygen level (5) blood sugar.
    Check with your home health provider to see if they provide TeleHealth services. Mercy Home Health in SE Pennsylvania, provides this service at no cost to the patient or the insurance company as long as a patient is on our service. This service is ordered by your physician.

  3. Pat You are right on with this. I teach individuals what they need to do when in the hospital to be their own advocate and be safe when they are discharged. Individuals need to become their own advocates when hospitalized and to let the staff know what it is that they need when they go home. Most people are programed to believe "the hospital staff are in charge" and until we make this shift we will continue to have preventable rehospitalizations.

  4. Great comments, all! Thank you for taking the time to share your perspective.


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