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A Visiting Angels caregiver comforting an elderly woman with Alzheimer's, highlighting compassionate support in a peaceful home setting. A Visiting Angels caregiver comforting an elderly woman with Alzheimer's, highlighting compassionate support in a peaceful home setting. A Visiting Angels caregiver comforting an elderly woman with Alzheimer's, highlighting compassionate support in a peaceful home setting.

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If you or your loved one has ever been admitted to the hospital, the one thing you probably longed for most was to return to the safety and comfort of your own home. A study from the University of Alberta found that older adults who had been discharged from the hospital were 40 percent more likely to be readmitted within 30 days of discharge.

Senior Home Care by Angels is committed to helping seniors stay at home where they are most comfortable. Through our Ready-Set-Go Home program, we help seniors recover in familiar surroundings and lower the likelihood of re-admission by providing quality, personalized transitional care at home.

Why Do Re-admissions Among Seniors Occur?

To address the high rate of hospital re-admissions, we must first understand why re-admissions occur. The reasons for re-admission are varied, but often include:

  • Difficulty managing a disease or illness at home
  • Exhaustion due to disrupted sleep and eating schedules while in the hospital
  • Lack of follow-through with discharge instructions
  • Medication issues - not taking appropriately, missing doses, etc.
  • Lack of timely follow-up with medical appointments or lack of follow-through with medical instructions

Regardless of the reason, what's most important is that quality transitional care at home can help reduce the likelihood of being re-admitted.

How Our Ready-Set-Go Home Program Provides Quality Transitional Care at Home

At Senior Home Care by Angels, we address these issues and others by using a three-prong approach to transitional care at home for our clients returning home after a hospital stay:

  1. The hospital – with Senior Home Care by Angels, we offer peace of mind. If one of our clients is hospitalized, we visit him or her at the hospital upon request. We believe collaboration with the hospital discharge planner is necessary to help ensure success at home. During the hospital visit, we provide our client with a copy of ‘Ready-Set-Go Home’, a discharge planning guide. Specific items in the guide prompt the client to ask pertinent questions about issues that impact readmissions, such as symptoms to report, times and dates of follow-up appointments, medications, special dietary needs, home equipment needs, etc. For maximum benefit, this guide should be initiated prior to discharge and used across the care continuum from the hospital to the home and brought to subsequent medical appointments.

  2. At the client’s home – Our caregivers are the ‘eyes and ears’ in the home. Our franchised location Owners/Directors and Caregivers have unique insight into why clients don’t follow up with appointments, why they miss medication doses and other actions that can lead to re-admission. We can share this information with the case manager or supervisor, so any issues can be addressed. Additionally, many of our caregivers are trained to provide Holistic care at home. This training enables our caregivers to understand the importance of reporting changes in condition promptly, so any problems can be addressed in a timely manner. Our approach also helps alleviate caregiver burnout for family members by providing reliable support and ensuring that loved ones receive the necessary care and attention they need.

  3. At the Senior Home Care by Angels office – Behind the scenes, office staff utilize tools and resources to identify and track clients who are at high risk for re-admission. Staff can help facilitate medication delivery, equipment, and food delivery services, offer medication and appointment reminders, and accompany clients to appointments.
 
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Find A Senior Home Care by Angels Office Near You!

You can quickly locate a Senior Home Care by Angels office nearby by entering your postal code in our office locator. We look forward to meeting you and your family and being able to provide the transitional care at home your loved one needs!

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Frequently Asked Questions

What Causes Hospital Readmission?

Many seniors lose function after hospitalization, which impairs their independence and quality of life. They may feel overwhelmed and exhausted by daily tasks at home, especially if they have a chronic condition along with a serious health event or surgery.

Some seniors develop post-hospitalization syndrome, which can occur for several weeks after hospital discharge. Signs of post-hospitalization syndrome may include:

  • Bowel or bladder concerns
  • Disruptions to sleep patterns, diet, routines, and activity level
  • Foggy thinking
  • Increased disorientation
  • Increased stress and anxiety
  • Lingering fatigue
  • Medication-related side effects
  • Weakness

Seniors are vulnerable to infections, falls, or symptoms that can result in re-hospitalization or death. They may struggle to care for themselves, complete household tasks, manage their medications, attend medical appointments, or contact their medical team about symptoms.
How Does “Ready, Set, Go Home” Work?

Our “Ready, Set, Go Home” program prepares for your senior loved one’s successful transition home from a hospital or rehabilitation facility.

Our helpful program will also provide you with a checklist/guide where you can:

  • Keep a comprehensive record of instructions
  • Record vital information, such as where they need assistance and who can help coordinate care at home
  • Reference information and notes from healthcare providers
  • Store questions for follow-up visits
How Can Family Members Support a Loved One's Recovery?

Families play a critical role in a loved one’s recovery by staying actively involved in their care and ensuring they have the necessary support at home. It’s important to communicate regularly with healthcare providers, attend follow-up appointments, and monitor any changes in their condition. Helping with household tasks can also make daily life easier during the recovery period.

For additional peace of mind, families can enlist the help of professional caregivers, like Visiting Angels, to provide daily assistance and supervision. We offer personalized care services to supplement family support, allowing seniors to recover safely while easing the burden on loved ones.

What Are Signs a Loved One's Recovery Needs Additional Assistance at Home?

After returning home, a senior may struggle with daily activities. Signs include difficulty managing medications, changes in mobility, increased forgetfulness, poor personal hygiene, unintentional weight loss, or trouble keeping up with household tasks. If they seem fatigued, disoriented, or are at risk of falling, additional assistance can help ensure their safety and well-being.

How Can Visiting Angels Help After Hospitalization?

Visiting Angels can visit your loved one in the hospital or rehab facility and create a plan before discharge. With input from you and the healthcare team, we can customize senior home care services to meet specific needs at home.

Contact a Visiting Angels office near you to learn more about the Ready, Set, Go Home program. Request a free home care consultation today.

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