Monitoring a Parent After Hospital Discharge

Before leaving the hospital

Use the discharge conversation to get what you need. Ask the doctor and nurse, and write the answers down.

• What was the diagnosis, and what happened in hospital, in plain words?
• What changed? New medicines, stopped medicines, changed doses, new equipment, new restrictions.
• A written medicine list with names, doses, timings, purpose and for how long. Ask why each is needed and what to watch for; see polypharmacy and deprescribing and giving medicines safely at home.
• What can your parent do? Walking, stairs, bathing, eating, driving, going out. Any restrictions on weight-bearing or movement.
• Equipment needed: walker, commode, bed, oxygen, dressings; see hospital admission and discharge for seniors and hospital room at home complete setup.
• Wound care, drains, catheters or feeding tubes: training for the family.
• Diet and fluids: any restrictions or supplements.
• Warning signs to watch for, and who to call, with phone numbers, including after hours.
• Follow-up appointments, tests and reports to collect, and who arranges them.
• Who to contact if there is a problem with the medicines.
• Whether home nursing, physiotherapy or other services are available.
• The discharge summary and test reports: take copies.

If you do not feel ready, say so. Ask for more teaching, a trial of a task, or a delay if home is unsafe.

Prepare the home

• Stock the medicines collected from the pharmacy before discharge, and check against the list.
• Set up the bedroom and bathroom for safety: bed height, night lights, clear floors, bathroom seat and grab bars, commode if needed; see bedroom setup for night safety and bathroom safety checklist.
• Prepare the equipment in advance and learn to use it.
• Food: simple, nutritious meals, supplements as advised; see malnutrition in older adults and cooking for one older adult.
• Arrange help: a family member staying for the first days, or a trained attendant; see hiring a home attendant checklist and care costs in India budgeting.
• Transport and a seat for the journey home; see getting an elderly person in and out of a car.
• A clean, warm, comfortable room.
• A place for medicines, records and a notebook.

Set up simple monitoring

Ways to call for help - A phone within reach, charged, with numbers on speed dial. - A panic pendant or fall detection watch, worn, with contacts agreed. Falls are common after hospital stays. - A bell or call button if someone is in the house.

Basic health checks, only as advised by the doctor; do not collect numbers that no one will use.

• Temperature, if there is a risk of infection or fever; see digital thermometer guide and fever in older adults.
• Blood pressure and pulse, if advised, at set times; see how to measure blood pressure at home and bp monitor buying guide.
• Blood sugar, for people with diabetes; see how to test blood sugar at home.
• Oxygen saturation, only if advised, understanding its limits; see pulse oximeter guide and pulse oximeter accuracy limits.
• Weight, daily, for heart failure or fluid problems; see daily weights in heart failure.
• Fluid intake and urine output, if the doctor asks.
• Pain, appetite, sleep and mood, in a simple diary.
• Wounds and skin, checked daily.

See home health monitoring starter kit, how often to check vitals and monitoring during illness.

Other tools, where they suit: door or motion sensors to show normal activity, a medicine reminder, a daily check-in call. Use the least intrusive option and agree with your parent; see door sensor guide and privacy and dignity with monitoring.

A daily routine

Keep it simple and written down.

Morning - Greet and ask how they slept, how they feel, pain, breathing, appetite. - Take readings that were advised. - Give morning medicines from the organiser; see pill organiser guide. - Check skin, wound and equipment. - Help with washing and dressing, as needed; encourage doing as much as possible. - Offer breakfast and fluids.

Through the day - Encourage gentle movement as advised, walking in the house, chair exercises, rest periods; avoid long bed rest; see chair exercises for seniors. - Offer fluids and small meals. - Watch for confusion, breathlessness, pain, dizziness, urine problems and bowel changes. - Allow rest; recovery is tiring. - Keep company, which helps mood; see loneliness and isolation in older adults.

Evening - Take medicines, readings and a check of the skin. - Prepare for the night: lights, commode, phone, pendant. - Note the day in the diary: what was eaten, drunk, medicines taken, any problems; see care diary and handover notes.

Medicines: the biggest risk

A large share of readmissions involve medicines. Be careful.

• One person is responsible for the medicines, supported by a checklist.
• Compare the new list with what was taken before. Remove old, stopped or duplicate medicines from the home, or set them aside; ask the doctor.
• Use a weekly organiser and set alarms; see setting up a weekly medicine box and medicine reminders for forgetful parents.
• Do not skip, double or stop medicines without advice.
• Know the side effects to watch for: dizziness, drowsiness, rash, stomach upset, bleeding, swelling; see medicine side effects families should watch.
• Take care with blood thinners, insulin and heart medicines; follow the plan exactly and know the warning signs.
• Do not add over-the-counter, herbal or traditional medicines without asking the doctor or pharmacist; see supplements and medicine interactions.
• Keep medicines safe and out of reach of confused people; see dementia and medicines at home.
• Ask the pharmacist to review the list and answer questions.

Warning signs: when to act

Agree on these with your doctor, since they depend on the condition. General warning signs after hospital include:

Call 112 or go to hospital now for: - chest pain or pressure, severe breathlessness, blue lips; - fainting, collapse or unresponsiveness; - signs of stroke: face drooping, arm weakness, slurred speech; see stroke warning signs and first hour; - sudden severe pain, heavy bleeding, vomiting blood or black stools; - a fall with head injury, severe pain or inability to move; see what to do after a fall; - a fit; - sudden confusion or severe drowsiness; - very low sugar not responding to treatment; see diabetes and low sugar emergencies; - signs of heart failure getting worse quickly, or a possible blood clot in the leg or lung.

Call the doctor or discharge contact the same day for: - fever or chills; - new or worsening breathlessness, cough or swelling of the legs, or weight gain of 2 kg or more in a few days (heart failure); - wound redness, heat, swelling, discharge or opening; - poor eating or drinking, vomiting or diarrhoea, or very little urine; - increasing confusion, agitation or sleepiness; see delirium in older adults; - new pain or pain that is not controlled; - dizziness or low or high readings outside the agreed ranges; - medicine problems: missed doses, side effects, not enough tablets; - constipation for several days, or trouble passing urine; - a worsening mood or hopelessness; see depression in older adults; - you feel unable to cope.

See knowing when to call the doctor.

Follow-up and continuity

• Book and keep follow-up appointments, and take the medicine list, records and notebook; see preparing for a doctor's visit with a parent.
• Collect test results and share them with the family doctor.
• Check that the family doctor has the discharge summary, and arrange a visit within the first week or two.
• Ask about teleconsultations if travel is hard; see teleconsultation and home readings.
• Rehabilitation: physiotherapy and exercises as advised; see rehabilitation after fracture or surgery: physio plan.
• Review equipment after a few weeks and return what is not needed.
• Update the emergency card and medical summary; see emergency contact card and medical summary.
• Plan ahead for what to do if your parent worsens, including whether they would want readmission; see advance care planning in India.
• Insurance and claims: keep bills and reports; see health insurance for senior citizens in India.

Balance safety with independence

Recovery is helped by regaining independence, not by being watched constantly. Do not take over tasks that your parent can do. Encourage and praise progress. Make clear that monitoring is temporary and for a reason, and reduce it as they recover. Ask how they feel about it, and adjust. Protect privacy and dignity; see dignity and consent in care. If your parent is frightened or low after the stay, listen, and ask the doctor about support.

Look after yourself

Caring for someone after hospital is tiring. Share duties, rest, eat and ask for help; see caregiver burnout signs and prevention, sharing care among siblings and respite care and taking a break.

When to ask a professional

Contact the hospital discharge team or family doctor for questions about medicines, warning signs and follow-up. A home nurse can teach wound care, injections and monitoring. A physiotherapist and occupational therapist can help with mobility and the home. A pharmacist can check the medicine list. For information on services for senior citizens, call Elderline 14567. In an emergency, call 112.