It is not unusual for a child caregiver to communicate to our office their frustration that their parent has refused home health care or has discontinued home health care upon discharge from the hospital. This is an all too familiar refrain we hear from our client’s caregiver children.
According to a recent report from the United Hospital Fund and the Alliance for Home Health Quality and Innovation, https://www.uhfnyc.org/publications/881209, as many as 28 percent of patients offered home health care when they’re being discharged from a hospital — mostly older adults — say “no” to those services. Understanding why this happens and what can be done about it may help relive some of the child’s sense of frustration and help the older parent receive the care needed.
Refusing home health care after a hospitalization puts patients at risk of a difficult, incomplete or slower-than-anticipated recovery. Without these services, older adults’ odds of being readmitted to the hospital within 30 or 60 days double, according to one study. Why then, do many seniors resist getting this assistance? One reason, according to the report, is there are many misperceptions about what home health care is.
Under Medicare, home health care services are available to older adults who are homebound and need intermittent skilled care from a nurse, a physical therapist or a speech therapist, among other medical providers. Typically, these services last four to six weeks after a hospitalization, with a nurse visiting several times a week. Some patients receive them for much longer.
Many seniors and caregivers confuse home health care with “home care” delivered by aides who help people shower or get dressed or who cook, clean and serve as a companion. The two types of services are not the same. Home health care is delivered by medical professionals; home care is not. Nor is home care covered by Medicare, for the most part.
Older adults are quite concerned about their independence, and they worry that this might be the first step in someone trying to take that away. Other reasons for refusing home health care include perception of invasion of privacy, unrealistic expectations of what recovering from a hospitalization will entail, concerns about costs, and failure to understand needs due to decline in cognition. Also, there could be other circumstances at home, perhaps hoarding, perhaps physical neglect, that an older adult doesn’t want someone to see.
By understanding an older adult’s fears and concerns, a conversation may begin about how to bring caregivers into the process and how recommendations should be conveyed.