Aging Options

Too Many Seniors Leaving the Hospital are Refusing this Vital Service

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One would think that a vulnerable senior adult being discharged from the hospital to recover at home from illness or surgery would welcome the offer of in-home medical help. Many do – but a surprisingly high number refuse the help they need, putting themselves at far greater danger of ending up right back in the hospital.

That’s just part of the findings in this very recent article on the website of Kaiser Health News. Kaiser author and aging expert Judith Graham reveals that as many as 28 percent of adults, most of them seniors, who are offered home health care upon discharge from the hospital refuse it, even though in most cases the cost is largely covered by Medicare, at least for a while. “Refusing home health care after a hospitalization,” Graham writes, “puts patients at risk of a difficult, incomplete or slower-than-anticipated recovery.” It also increases the likelihood that they’ll find themselves back in the hospital far sooner: a recent study shows that older adults who refuse home health care services are twice as likely to be readmitted to the hospital within 30 or 60 days.

One 84 year old man who was recovering from a mini-stroke was insistent that “he didn’t want anyone coming into his home, and he didn’t think he needed any help,” says the article. As a result the social worker cancelled the order for home health care services and sent the man home without a follow-up plan, completely disregarding the wishes of the man’s daughter who had spent weeks trying to convince her dad that the care was important and necessary. This kind of family miscommunication, writes Judith Graham, is all too common.

Why do so many seniors turn their back on services that can speed their recovery and even save their lives? There are many reasons, the Kaiser article suggests, starting with the idea that many older adults don’t understand what “home health care” services actually entail.  “Under Medicare,” writes Graham, “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.” These services typically last between four and six weeks after a hospitalization, with a nurse visiting several times a week. Occasionally home health care services can last even longer.

It’s important for seniors and their families to understand that “home health care” and “home care” are not the same. Home care “is delivered by aides who help people shower or get dressed or who cook, clean and serve as a companion,” the Kaiser article explains, while home health care is delivered by medical professionals. Also unlike home health care, home care is generally not covered by Medicare.

But apart from this misapprehension, families and caregivers need to understand some of the deep-seated psychological and emotional reasons for seniors to refuse home health care.  In the words of one San Francisco geriatrician, “Older adults are quite concerned about their independence, and they worry that (accepting care) might be the first step in someone trying to take that away.”  Many seniors are also intensely private and they are apprehensive about losing their privacy when a “stranger” comes into their home on a regular basis. Some may be afraid of becoming victim of fraud or abuse at the hands of a caregiver they don’t know. In some cases, a senior who is beginning to experience cognitive decline may not be able to make a rational decision, or they may be embarrassed if they’re having difficulty taking care of their own home.

But in some instances the older adult, like the 84 year old mentioned above, is just plain stubborn. They think they can get along just fine, and they really have little or no idea just how hard recovering from a hospitalization is likely to be.

Here at AgingOptions we definitely recommend the Kaiser Health News article because it spotlights a problem you might never have considered: what will you do five or ten or twenty years from now if your proud, independent parent is refusing the home health care you know they need? We do have two pieces of advice. First, if you’re a senior (or if you have a loved one who is) we strongly urge you to visit a geriatrician in your area and make him or her the most important individual on your health care team. Having a physician who specializes in issues facing older adults will be essential, not just today when things are relatively stable but tomorrow when a health emergency hits. The second recommendation is for you to contact us at AgingOptions and schedule a family conference. Our trained professional staff will guide you as you review many of these potentially troublesome issues, and you’ll find that by discussing and planning now you can avoid huge problems and conflicts later.

If you’re at the stage where you need more information about comprehensive retirement planning, why not do what thousands in the Pacific Northwest have done and attend one of our free AgingOptions LifePlanning Seminars?  Invest just a few hours in one of these information-packed sessions and you’ll come away with a fresh understanding of how all the elements of your retirement plan – legal, financial, medical, housing and family – need to mesh together in one seamless blueprint. That’s the genius of an AgingOptions LifePlan! If you’ll click on this link to our Upcoming Events page, you’ll see all the currently scheduled seminar dates, times and locations – then you can register online or contact us for assistance during the week. It will be our pleasure to meet you soon at an AgingOptions LifePlanning Seminar near you.

 (originally reported at

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