Coming Home From Hospital: Caring for an Elderly Parent in the First Two Weeks
The ward rings at eleven in the morning to say your father is being discharged that afternoon. You had assumed another two days. By four o'clock you are driving back from the hospital with him in the passenger seat, a paper bag of medicine on his lap, and the clear sense that nobody has explained what happens next.
That gap is normal and it is not a failing on anybody's part. A hospital is built to treat the thing that brought someone in. What happens in the fortnight after they leave is largely left to the family, and the fortnight after they leave is when most of it goes wrong.
Bringing an elderly parent home from hospital is a short and intense job with a small number of entirely predictable problems. Knowing what they are in advance is most of the work.
He will be weaker than you expect, and that is normal
The first shock is usually physical. Your mother went in walking to the bathroom unaided and comes out unable to get out of a low chair without help.
That is not the illness. It is the bed. Studies of older adults on bed rest have measured losses of muscle strength in the order of one to three per cent for every day lying down, which adds up to roughly ten per cent in a single week, and the legs go first. Around half of older people leave hospital less able to manage ordinary daily tasks than when they went in.
Two things follow from that, and the second one is counter-intuitive.
Plan for the person coming home, not the person who went in. A week in a hospital bed can turn somebody who was managing alone into somebody who needs help to wash and dress for a fortnight. If the house was already borderline, it is not borderline now. A grab rail in the bathroom and a higher chair in the living room matter far more this week than they did last week.
Rest is not the cure for it. This is where families go wrong out of pure kindness. Sitting in a chair all day is closer to the cause of the weakness than the treatment for it. Unless a doctor has specifically said otherwise, short and frequent movement is what rebuilds what the bed took away. Standing up every hour. Walking to the end of the verandah and back three or four times a day. Not one long effort, which exhausts somebody and puts them off, but small amounts, often, every day.
A week in a hospital bed can cost around ten per cent of muscle strength, and the legs go first. Plan for the person coming home, not the person who went in.
Medication is where it actually goes wrong
A hospital stay changes medication. Doses get adjusted, something is stopped, something new is added, and a familiar drug may come home in an unfamiliar box under a different name.
What arrives home is a paper bag. What is already in the house is the cupboard from before. Nobody reconciles the two, so for the next week your father takes the new tablet from the bag and the old one from the cupboard, which are the same drug wearing two names.
Do this on the first evening, before everybody is tired.
Put everything from the house on the table next to everything from the hospital. The cupboard, the bedside drawer, the handbag, the kitchen shelf. All of it, in one place.
Work through the discharge list one line at a time.
Anything that appears on the discharge list, keep, together, in one container.
Anything that does not appear on the discharge list, take out of the house. Not onto a different shelf. Out.
Write down what he takes now, with the times of day, and put a copy where everybody can see it.
If there is a single item you are unsure about, ring the pharmacy or the doctor before the next dose is due. This is a completely ordinary question and nobody will mind being asked it.
Then keep the list up to date, because it will change again at the follow-up appointment. A written medication record is worth more than anybody's memory, particularly when two or three people in the family are helping and each of them thinks somebody else gave the morning tablets.
Put the hospital bag and the house cupboard on the same table. Anything not on the discharge list comes out of the house. Not onto another shelf. Out.
Ten questions to ask before you leave the ward
Discharge happens quickly, usually in a corridor, and usually while somebody is looking for a wheelchair. Ask these while there is still a clinician standing in front of you. Finding the answers afterwards takes days.
1. What exactly was wrong, in words I can repeat to another doctor?
2. Which medicines have changed, and which of the old ones must now stop completely?
3. What is he allowed to do, and what must he not do?
4. How much should he be walking, and starting when?
5. Is there anything he should not eat or drink?
6. Are there wounds, stitches, a catheter or dressings, and who looks after them?
7. What would tell me something is going wrong, and at what point should I not wait until morning?
8. Who do I ring out of hours, and what is the number?
9. When is the follow-up, who arranges it, and with whom?
10. Is there a written discharge summary, and may I have a copy?
Ask for the answers in writing wherever you can, and photograph the discharge summary on your phone before you leave the building. Paper gets lost between the car park and the house more often than anybody admits.
The first week at home
Four things carry most of the risk, and none of them are complicated.
Drinking. This is the quiet one. Older people feel thirst less reliably, someone recovering in bed drinks less than they think, and in a Mauritian summer that adds up quickly. Dehydration in an older person shows up as confusion, weakness and a fall rather than as thirst. Put a glass where he can reach it without standing, and top it up on a schedule rather than when somebody remembers.
Eating. Appetite comes back slowly and hospital food has usually put him off the idea entirely. Small amounts often, things he actually likes, and no anxiety about a proper plate for the first week.
Moving. A little, often, every day, as above. This is the single most useful thing anybody in the house can do, and it is easy to organise around ordinary life rather than treating it as exercise.
Sleeping. A hospital week wrecks a sleep pattern, because the lights never go off and somebody checks on you at three in the morning. The way back is daylight and routine. Up and dressed in the morning even when he would rather not, curtains open, and no long afternoons in bed if it can be avoided.
And one thing that is particular to Mauritius. Word travels, and by the second day the yard is full. That is a real asset, and it needs managing rather than discouraging. Spread the visitors across the fortnight instead of the first weekend, keep the early ones short, and give one cousin or sister the job of saying so on the family WhatsApp, so that it does not have to come from you and nobody takes offence.
When to ring somebody, and when not to wait
Some deterioration after a hospital stay is ordinary tiredness. Some is not, and the difference is worth knowing before you are standing in a bedroom at two in the morning deciding whether you are overreacting.
Ring the doctor the same day if any of these appear.
He is more confused than usual, or confused at all when he was not before
A fever
He is not drinking, or has passed no urine in a day
Breathlessness that is new, or worse than it was
A wound that is hot, swollen, spreading red, smelly or leaking
Pain that is new, severe, or not helped by what was prescribed
Vomiting that stops him keeping his medicine down
A fall, even one that appears to have done no damage at all
Do not wait until morning for any of them, and do not wait to see whether it settles. If he is very unwell, cannot be roused properly, is struggling to breathe or has had a serious fall, call an ambulance. SAMU is 114.
New confusion deserves singling out, because families almost always put it down to the shock of the hospital. In an older person it is frequently the first sign of an infection rather than a problem with the mind, and it often arrives before a fever does. It is worth a phone call on the day it appears.
New confusion in an older person is more often the first sign of an infection than a problem with the mind. It usually arrives before a fever. Ring on the day, not in the morning.
Chase the follow-up yourself
Assume nothing has been booked until you have seen a date. Appointments get arranged, and they also get lost between a ward, a clinic and a family that assumed somebody else was handling it.
Put the date in a diary the day you get home, and ring to confirm it a week beforehand. Then take three things with you: the current medication list, a note of what has happened since discharge, and any questions the family has accumulated. A doctor with that in front of them makes a better decision in ten minutes than one starting from scratch.
It is also worth keeping a short daily note for the first fortnight. Not a diary, just a line a day. What he ate, whether he slept, how far he walked, anything that seemed different. A fortnight of those lines answers questions at the follow-up that nobody can answer from memory, and it shows a slow decline that is invisible day to day.
If the first fortnight is more than the family can cover
The awkward thing about this fortnight is that it is exactly when help is most needed and least available. Somebody has to be there in the morning and the evening, the week he comes home is rarely a week anyone has free, and the person who takes the time off is usually the daughter who lives nearest and has already used her leave on the hospital stay.
It is worth saying plainly that this is often a short job rather than a permanent arrangement. Two or three weeks of help with washing, dressing and getting steady on his feet, while the strength comes back, then a review. Families tend to think of home care as a decision about the rest of a parent's life, and in this particular situation it frequently is not.
It takes longer than anyone tells you
Recovery from a week in hospital at eighty is measured in weeks and sometimes months, not days. Progress is quick at first and then flattens out, and the flat part is where families start to worry that this is as far as it goes. Usually it is not. A plateau at ten days is ordinary.
What is not ordinary is no change at all. If week three looks like week one, that is worth a conversation with the doctor rather than more patience.
Get the medicines right on the first evening, keep him drinking and moving, and know which changes are not to be slept on. The rest of it is time, and time works better at home than anywhere else.
This article is part of The Mauritius Guide to Caring for an Elderly Parent at Home, our free guide for families across the island. See the full guide.
Talk to Homebird
Homebird is a professional in-home care agency serving families across Northern Mauritius. If a parent is coming home from hospital and the first few weeks are more than the family can cover, that is exactly the sort of short arrangement we can help with. No obligation, no pressure.
WhatsApp or call: +230 5811 8335
Email: hello@homebird.mu
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This article is for general information and is not a substitute for professional medical advice. Always follow the instructions given by the treating doctor or hospital, and speak to a doctor or pharmacist before changing any medication. In an emergency in Mauritius, call SAMU on 114.