Post-Hospital Care in the East Bay

Serving Seniors in Alameda and Contra Costa Counties


Meal Preparation


Physical Activity


Transport / Errands


Cognitive Therapy


Personal Care / Hygiene


Medication Reminders

Post-Hospital Care

If you have a family member or loved one who has been hospitalized or is preparing for a procedure, you’ll likely have many concerns about what will happen when he or she is discharged. Will he or she be able to go home? How will you meet his or her increased needs for care when you have your own responsibilities and obligations?

Aging in Place Home Care helps families in the East Bay coordinate a smooth transition from hospitalization to home by providing assistance where and when you need it. Our carefully trained caregivers can work with you to address concerns and provide the services that will be most helpful.

What Are My Loved One’s Options after a Hospitalization?

At Aging In Place Home Care, we’ve found that our customer’s needs vary depending upon the procedure.  Some of our customers need care for a very short period after being in the hospital and can go right home and get back to their normal routine within days. Our caregivers are available on a temporary basis to bridge that gap.

Other customers may need extra assistance and rehabilitation after they are healthy enough to be discharged from the hospital. Someone who has had a hip replaced, for instance, might need a few weeks of physical therapy to make a full recovery.

When patients are discharged from a hospital, they are generally offered the choice of going to a rehabilitation or skilled nursing facility or of going home. One factor to consider is that care in a rehabilitation or skilled nursing facility is usually covered by Medicare. If your loved one chooses this option, he or she will likely receive several hours of therapy each day.

There are some drawbacks to this option, though. Living in a skilled facility with other people who are also ill or recovering from injury or surgery might allow your loved one to pick up an infection, slowing his or her recuperation. Outside of therapy time, your loved one’s schedule will be interrupted and he or she may complain of boredom or even depression at having to spend extra time away from home.

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(925) 660-7090

“People are often happier in their own homes for a variety of reasons. They are surrounded by their familiar belongings and can more quickly return to usual routines. They may have pets who need attention and lift their spirits. Also, people who return home are likely to be surrounded by family, neighbors and friends who can assist with their recovery.”

Would My Loved One Be Better off at Home?

If your loved one returns home after hospitalization, he or she may be eligible for skilled home health care. Covered by Medicare, skilled home care provides a nurse and any kind of therapists needed to help your loved one recover from illness, surgery or injury.

Unfortunately, skilled home care doesn’t cover assistance with day to day activities like bathing, dressing, preparing meals and light housekeeping. It is because of this gap that some family member caregivers find themselves getting burned out trying to manage all of their loved one’s post-hospitalization needs at home.

That’s where our agency comes in.

How Can a Caregiver from Aging in Place Home Care Assist With Recovery?

Your loved one’s individual needs will depend on the reason he or she was hospitalized. Someone with pneumonia, for instance, may need oxygen and breathing treatments at home as well as therapy to regain his or her strength. A person who was in a car accident might need wound care and physical therapy.

Our caregivers can assist with a wide variety of tasks.

Reconciling medications. Your loved one may be discharged with a variety of new medications. We can help provide reminders to take these medications. We may also suggest that you call your loved one’s doctor if he or she appears to be taking more than one of the same type of medication.

Following through with follow-up care. Someone who has been discharged should follow up with his or her primary care physician within two weeks of coming home. Depending on what your loved one was hospitalized for, he or she may also need to consult with a specialist for testing or treatment.

Working with skilled therapies. If your loved one has physical, occupational and speech therapy at home, the therapists might suggest exercises that will help your loved one get his or her strength back more quickly. We can help with these exercises and also encourage your loved one to participate in activities he or she enjoys.

Assisting with mobility. Someone who has been hospitalized may feel very weak, especially if he or she was confined to bed. Our caregivers are trained to help people move between different places. For instance, we can help your loved one transfer from bed to wheelchair in the morning and from wheelchair to toilet as needed.

Helping with personal care. We can help your loved one with dressing, grooming, bathing and other physical tasks. We also provide pampering, such as scalp massage or helping your loved one paint her nails.

Providing homemaking. We can keep your loved one’s home tidy, prepare meals, and help your loved one with other organizational tasks.

Offering companionship and encouragement. Being hospitalized can be frightening and discouraging. Our caregivers will provide a friendly ear if your loved one wants to talk.

Fall Prevention Strategies

During an initial home visit, our caregivers will assess whether or not a senior recovering from a procedure might need additional support to avoid a fall.

  •                 Are they recovering from a surgery such as a knee replacement that can lead to instability?
  •                 Have they experienced declining vision?
  •                 Are they taking medications or pain-killers which can lead to dizziness or drowsiness as a side effect?

Since falls can happen quickly without warning, prevention is the best way to avoid falls.  Our caregivers may make recommendations that can help seniors better secure their homes to avoid falls.

  •                 Are there secure rails on both sides of the stairs?
  •                 Is the lighting sufficient?
  •                 Are pathways clear of clutter?

Many falls happen within the bathroom due to the slippery conditions. We may make some suggestions to make your home more secure such as installing grab rails in showers.

Is my Loved One at Risk for Readmission?

According to the United Health Foundation, approximately 16 percent of Medicare patients had to be re-hospitalized within 30 days of discharge. Some of these readmissions are sadly not avoidable, but others can be averted. For instance, a person might need to be re-hospitalized because he or she couldn’t get necessary prescriptions or because he or she didn’t know how to follow up with a specialist.

There are certain risk factors that predict higher rates of readmission. These include

  • Increased age
  • Male gender
  • Being African-American
  • Not having enough health insurance, such as having Medicare only with no supplemental insurance plan
  • Having several serious illnesses at once such as diabetes, cancer and heart disease.

All these factors may seem overwhelming, but you can successfully fight the odds. A 2017 study out of the University of Pittsburgh Medical Center found that one of the keys to avoiding being readmitted is active engagement and participation of the patient’s caregiver. When caregivers played an active role in discharge planning, the patient’s likelihood of being readmitted declined by nearly 25 percent.

If your loved one has been hospitalized, we can help you care for him or her at home. We work with caregivers in the East Bay area of San Francisco to provide the best possible outcome for you and your loved one.

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4695 Chabot 4695, Suite 200
Pleasanton, CA 94588

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