About a million Americans will have knee replacement surgery this year, and roughly 600,000 will have their hip joints replaced. For years the consensus in the medical community has been that the best place to undergo post-surgical rehabilitation is in a rehab center, typically a short-stay skilled nursing facility. But new research suggests otherwise: there’s a growing belief that the best place for complication-free recovery from joint surgery is the patient’s own home.
More and More Patients are Recuperating at Home
We just read about this new report in this article written by Judith Graham for Kaiser Health News. We think it’s important information for seniors and their spouses and families to have before surgery even takes place. As Graham writes, “Older adults and their families often wonder: Where’s the best place to recover after a hip or knee replacement — at home or in a rehabilitation facility? Increasingly, the answer appears to be home” – assuming, Graham adds, that the procedure is elective and that friends and family are available to help. The findings also presume that the patient doesn’t have some underlying medical condition that might trigger unusual complications. What’s more, says Graham, “This trend is likely to accelerate as evidence mounts that recuperating at home is a safe alternative and as hospitals alter medical practices in response to changing Medicare policies.”
The Kaiser article is based on a new, comprehensive study published in JAMA Internal Medicine. The study analyzed a total of 17 million Medicare hospitalizations of older adults between 2010 and 2016. These patients had been hospitalized for surgeries or illnesses, but hip and knee replacement were the most common reasons. Following surgery, all the seniors were either sent home to recuperate or sent to a rehab facility. According to the Kaiser report, “People who were sent home with home health care services demonstrated the same level of functional improvement as those who went to a skilled nursing facility.” Their post-surgery death rate was no worse than those hospitalized. And while the rate of hospital readmission appeared slightly higher among the “home group,” the costs of recovery were dramatically less. “What this study tells us is it’s certainly safe to send people home under many circumstances,” said one health care expert in response to the data.
Recuperating at Home is Ideal for Healthier Patients
According to the Kaiser article, the new research confirmed what previous smaller studies had shown. An increasing number of seniors are being sent home to recover from surgery, and the outcomes appear to be the same or better as they are for patients sent to institutional rehab facilities. “As a result of these findings, we are encouraging all of our patients to consider home discharge after [total knee replacement],” the authors wrote.
In the Kaiser article, Judith Graham asks, “How do physicians decide where to send patients?” One study co-author, a doctor from New York University, responded that the patients most likely to be sent to skilled nursing facilities are “older, sicker, [and] more deconditioned after surgery.” They also tend to be those who have no spouse or caregiver, who have fewer resources, and who lack social support. However, while many physicians believe that people who live alone might not do well recovering at home, other research shows that isn’t necessarily the case. At one medical institution in Philadelphia, says Graham, “patients are assigned a nurse navigator who provides assistance before and after hip or knee replacements. Patients who lived alone stayed in the hospital longer and received more home health care services than those who lived with others.” Nevertheless, they were no more likely than non-singles to suffer medical complications, and about 90 percent of people who lived alone said they’d again choose a home discharge.
Recuperating at Home Places a Burden on Caregivers
Amid all this good news about home-based recovery from surgery, the Kaiser article sounds a note of caution. “People shouldn’t underestimate how much help they may require at home, especially in the first few weeks after surgery,” said one health care professional who herself has had two hip replacements. Recovering at home places a greater burden on caregivers and raises the danger that complications might go undetected. If friends and family become unavailable, basic needs might go unmet and rehab protocols can be ignored. Medical facilities also have to be ready to provide support to the in-home caregivers when needed.
In one large Utah institution that operates 23 hospitals, “every joint-replacement patient going home after surgery now gets a thorough assessment to determine the resources that are needed. A care plan is created and a case manager, usually a registered nurse, makes sure that physical therapy, durable medical equipment and home health care are supplied. The case manager also coordinates postoperative care with orthopedic surgeons and makes sure that patients reconnect post-surgery with their primary care physicians. And a team of providers is available 24/7.” As a result, during the past few years, discharges to rehabilitation facilities have declined by half with no notable increase in complications. Last year, 85 percent of this group’s knee replacement patients and 88 percent of hip replacement patients went home after surgery.
Recuperating at Home: Part of Making the Right Choices
Whenever the discussion turns to seniors and their medical needs, our recommendation here at AgingOptions is that senior adults ought to place themselves under the care of a board-certified geriatrician who is trained to understand the unique medical needs of older patients. He or she can advise you about all aspects of getting healthy and staying that way – and if joint surgery or any other kind of procedure requiring a period of rehabilitation is called for, your geriatrician will help you plan and prepare wisely.
So much for surgical rehab – now, what’s our prescription for a healthier retirement? Here at AgingOptions we prescribe a uniquely powerful and comprehensive solution to the challenge of retirement planning: a LifePlan. An AgingOptions LifePlan takes all the vital elements of your future planning and weaves them together into an interdependent whole: your finances, your legal protection, your health care needs, your housing choices, even communication with your family. With a LifePlan in place, you have the blueprint you need to build the retirement you’ve always longed for, one that’s rewarding, fruitful and secure.
There’s a simple way to find out more: join Rajiv Nagaich at a free LifePlanning Seminar. We offer these popular seminars at locations throughout the region, so click here for details, including online registration. You can also contact us during the week. We guarantee that you’ll come away with a fresh outlook on the process of planning for your retirement years. It will be a pleasure to meet you soon at an AgingOptions LifePlanning Seminar. Age on!
(originally reported at www.khn.org)
