Stroke is a leading contributor to hospital readmissions and excessive length of stay (LOS) in the hospital. Stroke is the leading cause of long term disability. 79,000 Americans have a stroke each year. 1 in 4 Strokes are recurrent. 130,000 Americans die from a stroke each year.
Creating a dual discharge to home care, utilizing both skilled home health nursing and a professionally trained and nursing supervised CNA caregiver can dramatically decrease the chances for complications due to stroke once the patient is released from the hospital.
Vetting the home care agency is of paramount importance, but using the following criteria, the proper selection of a properly trained and supervised caregiver can make a huge difference in readmissions and length of stay in the hospital. At the present time, there is no licensing requirement for Home Care agencies in California, although this will change in 2015 according to CAHSAH (California Association for Health Services at Home). Finding an accredited agency solves this problem. Agencies accredited by either CHAP (Community Health Accreditation Program), or the Joint Commission. Both of these organizations have broadly structured nationally recognized Standards of Excellence that provide standards into best practices for quality and performance.
With nursing supervision, a qualified caregiver is trained to check for the following if they suspect a reoccurrence of a stroke:
Face - ask the person to smile
Arm - ask the person to raise both arms
Speech - ask the person to repeat a simple sentence.
Time - Call 911 if the person is showing symptoms of slurred speech, droop in face, not able to complete sentence.
Here is a list of items a trained CNA or HHA caregiver will be providing for stroke victims after being discharged from the hospital:
• Monitor Blood Pressure
• Add Fiber to the diet
• Encourage healthy eating
• Encourage Exercise
• Ensure patient is compliant with Physician appointments
• Monitor Mental status for any sudden confusion, trouble speaking or understanding.
• Sudden trouble with walking, balance and coordination.
• Sudden severe headache with no known cause
Ideal patients for dual discharges with a Home Care Agency:
• Clearly need care longer than Medicare covers
• Do not have a solid support system in place
• You’re just not sure what to do with/for them
• See multiple physicians
• Are at high risk for readmission to the hospital
• Are frequent flyers to the ER
• Have multiple chronic conditions
• Take a lot of meds
• Need support transitioning to their home
Cost is always a concern as Medicare does not cover home care at this time. Here are some suggestions for families to help cover or supplement the cost of the additional home care:
1) Long term care insurance, usually covers most if not all of the cost for caregivers. Some will have a waiting period, which acts as a deductible
2) Veteran’s benefits: if the patient served in the armed services during a period of wartime, whether or not they were in combat, they may be eligible for a home care benefit payment.
3) Medical will make reimbursements if the patient qualifies as a low income recipient
4) Reaching out to other family members to pool resources, especially when it will help give respite to those family members that would be unduly burdened by providing the needed care
5) Assignment of life insurance benefits: A policy assignment provision in a life insurance contract is one that permits the owner of the policy to sell, give or to pledge the policy as collateral. It is a common, but not universal, provision in modern policies.