Transitions: Planning your trip home

Transitions: Planning your trip home

Posted by AskNurseLinda on Oct 15, 2018 9:21 am

The most looked forward to event in the rehabilitation process just might be going home. It can also be the most frightening. Recovery from spinal cord injury begins in the acute care setting and extends to your stay in rehab. Your body and mind have been pushed to their limits to obtain all of the information and abilities to be able to care for yourself. The thought of being at home on your own can be quite daunting.

Of course, you might not be aware of the challenges of being at home. In the rehabilitation setting, the facility is set up for your success.  Someone brings a catheter kit at the appropriate time. Even more importantly, the staff will help you clean up and assist as needed. These things do not happen automatically at home. Equipment is different. You might not be able to use all of your newly acquired skills due to physical space restrictions. You will not have a 24/7 staff of rested people to help you.

Planning your transition to home is essential. If you can meet the anticipated challenges with an idea for success, you will be able to meet any unexpected difficulties. Planning can help transitions become more successful as well as less fearful. You might not have even worried about transitioning to home because you have not done this before. Knowing what to expect will ensure success.

If you have been in the hospital for some time and your family has been with you, especially if in an out of town location, your home might not be ready for your return. Make sure utilities are in service. Many people turn down the heat or air conditioning when gone. Be sure the temperature of the home is meets your needs. It takes a while to bring your home to a safe temperature for. Ensure the home been recently cleaned. Homes become stagnant when away. Check to see if there is fresh food so you do not have to order out for several meals.

Think about how you will get home. If not offered, ask for car transfer education. When at home, you will want to go out for activities and to be able to participate in outpatient therapy. Getting in and out of a car will be essential. Typically, driving skills are not offered as an inpatient, so you will need someone to provide this assistance until you can obtain driving skills in a vehicle that is adapted for your needs.

When you sit in a car, you will need to use your pressure dispersing cushion. Car seats are cushioned but not pressure dispersing. Sitting, even for a short time, on a car seat can lead to pressure injury because the seat cushion collapses under you rather than dispersing the pressure. When you sit on your pressure dispersing cushion, you might be too tall for the car roof. Tilt your seat back so you fit while sitting on your cushion.

There are companies that will provide transportation in wheelchair accessible vans. These are available in a wide variety of prices. This can be an expensive mode of transportation so shop around. There are many less costly and very safe companies. Public transportation is required to be accessible. Local government might run a service in your area but often it takes six weeks to get on their list. Your case manager or discharge planner will be able to provide a list of companies in your area. Often, the less expensive companies do not have a website making word of mouth very important.

In therapy, if you meet someone coming in as an outpatient, ask what company they have used in the past. A consumer review will help guide you to a service at a reasonable cost. Uber has recently introduced UberMedical. I am sure other like services will as well. This service is new so adaptive vehicles might not be available in your area. Just don’t forget to keep checking as these will appear as the need becomes better understood.

Once you get home, think about how you will get inside. Most homes have at least a step or two. You will need a ramp with handrails to keep you from slipping off. A safe incline for a ramp is 1 foot of ramp for every 1 inch of height. If you have a step that is the standard height of 5-6 inches, the length of a safe ramp would be 5-6 feet long. Two steps would equal 12 feet or ramp, etc. That is quite a distance per step. Ramps can be quite attractive but also may switch back and forth a couple of time due to the length needed. Many people have wooden ramps constructed but there are also companies that sell prefabricated aluminum type that can be installed.

The length of a ramp is a huge safety issue. You might be able to navigate a much shorter ramp but one little slip on a shorter ramp and disaster. The 1 inch per 1 foot rule provides safety for you to reach back and propel yourself, does not require overexertion to get up the ramp, protects your shoulders from over use and will not gain too much speed should you slip backwards. Following the 1 inch per 1 foot rule is for your safety and those who may push you. It also protects you from too much harm should there be a slip.

The door threshold can be a bump that is a challenge to your independence. You might need a short little ramp that fits over the threshold to make the roll in and out smoother. A threshold of an inch or less can stop your chair from rolling over it.

In the rehabilitation facility, just about any type of equipment is available for your use. All of these items might not be supplied in your home. For instance, many facilities now have ceiling lifts or other transfer devices which might not be covered by your payor. Be sure you and a caretaker know how to transfer you. If you can do this on your own, great. If you should get the flu or become temporarily unable to transfer, someone else needs to know how to move you.

If your bedroom is on a different floor, you will need a lift or elevator to get to it. You might need to move your bed to a room on the main floor, switch bedrooms with someone or some people find moving is the best option. This can take more time than you have in the rehab setting. Set up your personal living space on the main floor. If you have to use a public space in the house such as the living room, you will lose your privacy as this is the main gathering room for the family. If you can use a dining room or room that has some privacy, especially a door, this will give you the opportunity to do your personal activities, sleep and time for self.

Think about the equipment you use in the rehabilitation facility. Talk with your nurses and therapists about what you will actually need at home. Your payor may or may not pay for a lift. Few may pay for a ceiling lift system, but it will probably be only from the bed to bathroom, not throughout the house. You might also decide that you need equipment that you did not use in the rehab facility such as a commode. You might not be able to move the commode into the bathroom but using one is essential for bowel care as sitting greatly enhances the use of gravity for evacuation.

Many facilities perform the bowel program in bed. Transitioning to a commode is often done at home. If your bathroom will accommodate the floor space for a commode, a rolling commode is very beneficial as transfers can be accomplished outside of the bathroom where there is room for the commode and wheelchair. A secure set of breaks is needed for locking the commode. The commode can be wheeled to the toilet. If you, eventually, have a shower area that the commode can be wheeled in, you can accomplish bowel program and shower in one operation. In the meantime, you might need to have bed baths until a shower space is created in your home.

The catheter type you used in the rehabilitation facility will most likely be different from what you will use at home. In the hospital or rehabilitation facility, there are many, many bacteria due to the numbers of people present. Therefore, sterile catheter kits are used. These are expensive. At home, there is still bacteria, but it is what your body has become accustom to being in and around. Therefore, at home, clean technique for catheterization and some dressing changes is used. You will have sterile catheters, a tube of lubricant (as opposed to individual packets), and soap and water for cleaning hands and urethra. Create a catheterization space in your bathroom or other selected place where all your supplies can be located and easily discarded. This saves time in performing this activity as well as you will not be searching for your supplies.

Meal preparation can be accomplished with a little forethought. Your hands are needed for propelling yourself but also for moving food from one place to another.  Using a little cart in the kitchen can help you move items to different locations. Some people will use a cutting board or wooden tray to move items on their lap. It is important not to use metal trays to move food especially if it is hot or cold. The metal conducts the heat or cold which you might not feel on your legs but still will significantly burn or freeze your body. You might want to cut food at a table so you can roll under it rather than on the high countertops that will require you to sit at a side angle. Place frequently used items in the lower cabinets where you can reach them.

Oftentimes, microwaves and other ovens can be very high. Be sure to use oversized dishes and pans so hot food does not spill out and on to you. Do not overfill casserole dishes. Ovens with the knobs at the front are safer for turning the stove on and off than those with knobs in the back where you have to reach over the hot burners. 

Make sure you have the proper bed and pressure reducing bed surface for your needs. Very few individuals will use their home bed. You can use your home bed if you can get in and out of it and if you have a pressure dispersing bed overlay. Most find the elevation feature of the electric bed to assist with transfers. Rails can help you with turning. Notice how many pillows you use for positioning in the rehabilitation facility as this is the same number you will need at home.

Your success depends a lot on electricity to power a chair, work a bed or even a ventilator. Notify your local police and especially firefighters (which includes paramedics) of your status. They will flag your house for quick response should there be a power outage, healthcare or other incident where mobility issues could hamper your safety. This is a friendly reminder if you have been home for awhile and have not yet done this.

One of the key issues when returning home is to be prepared. Equipment is not delivered to your home until the day you are discharged. That means you are coming home and nothing has been set up. If you know where things should go and have had someone make space for your equipment, you will be a step ahead. Whomever is accepting the equipment absolutely must check to see if it works and how to work it. All too often, equipment is delivered but incorrectly assembled or does not fit or work in you home. The supplier could be out of something and may tell you they will deliver it tomorrow which will not work if you need it now. You might want to lie down or need to catheterize. You need your equipment present and working on discharge day.

Coming home is a big trip. It is physically and emotionally exhausting. Planning ahead can aid you in your success in transition to home. As with any big event, there are things that will pop up to complicate the day. Work toward a successful outcome so these snafus become manageable.

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Re: Transitions: Planning your trip home

Posted by Jenn on Oct 19, 2018 3:03 pm

Hi Linda
This was a great piece super informative it touches on a lot of important topics.
Good idea about using the wheelchair cushion in the car. 

Thanks 
-Jenn 

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