Post-Surgery Homecoming

Before you check in to the hospital, make a few practical preparations at home for your post-surgery recovery. It can help reduce frustration later

By Mary Anne Dunkin

Finally, the day has arrived – your surgery was a success and your doctors have given you the green light to go home. Have you properly prepared for your homecoming?

In a recent survey of Arthritis Today readers who had undergone joint surgery, more than 41 percent said they were well prepared for their at-home recovery needs – and were grateful for it. Those who weren’t prepared reported feelings of frustration and depression.

When you plan joint replacement, you not only have the luxury of time to prepare for the surgery, you also have time to prepare yourself and your home for recovery. Arthritis Today has consulted the experts and created this checklist to help you prepare for your homecoming and the weeks of recovery that follow.

Refer to it now and check off each item as you prepare for discharge day. But keep in mind it’s only a guideline – it’s not possible to anticipate your every need.

Much of your preparation will depend on your surgery, the type of arthritis you have, which joints are affected, other health problems and how much help you have at home.

While making some arrangements after surgery will still be essential, taking the time to prepare for your discharge day, well before you check in to the hospital, will do wonders to help ease your transition after you check out.

Before you check in:

1. Consult an expert.
Many doctor’s offices or hospitals employ discharge planners to help plan for your discharge day and beyond.  “I follow patients from the minute the doctor decides they need a joint replacement,” says Rosemary Weser, a discharge planner at the Medical College of Georgia in Augusta. Weser helps patients get ready for surgery, schedules the surgery and meets with them for a pre-op appointment, during which she helps them plan for their return home.

2. Prepare your home. 
Prepare your home for your return: grab bars in the bathroom, ramps to cover outside steps, electronic lifts to carry you up and down stairs. But if your goal is to simply recover from surgery, preparing your home can be simple and inexpensive. Some physical or occupational therapists will come to your home to recommend modifications. If your insurance doesn’t cover that service, here are some things you can do on your own.

Eliminate clutter – Clear the floors of throw rugs, electrical cords, kids’ toys, etc. Move furniture (or have a friend or family member do it) to make pathways wide enough to accommodate a walker.

Elevate seats and beds – If you’ve had hip replacement, you’ll have restrictions on how much you can bend your new joint until the soft tissues around it heal, says Alejandro Gonzalez Della Valle, MD, an orthopaedic surgeon at New York’s Hospital for Special Surgery. If your bed is low, have someone place blocks under the legs to raise it.

Make living convenient – Consider what you’ll need when you return home and place items where you can access them easily – pots, pans and dinner plates on the kitchen counter; the TV remote next to your cozy chair. Stock your pantry and freezer before you leave the hospital. Prepare meals ahead and freeze. If your mail is delivered to an outdoor mailbox, contact your post office to request delivery directly to your doorstep.

Set up sleeping arrangements – If your bedroom is on the second floor, set up a temporary one downstairs. If that’s not possible, limit your trips upstairs – once at bedtime, then back down in the morning – advises Frank R. Kolisek, MD, an orthopaedic surgeon at OrthoIndy, an orthopaedic practice based in Indianapolis. If you discover you need something from upstairs, unless it’s an emergency, wait until someone else can get it for you.

Get the bathroom ready – If you’re having hip replacement, an elevated toilet seat is a must. Lisa Lein, a physical therapist at the University of Alabama at Birmingham Hospital, recommends an adjustable commode that can be placed over your regular toilet seat. If your shower has doors, removing them and replacing them temporarily with a curtain will make it easier to get in and out. Other musts: A shower seat and hand-held shower head. You won’t feel like standing while you shower, says Lein, but you won’t be able to sit in the tub for a while either. 

3. Order assistive devices and other supplies. 
Although doctors recommend waiting until after your surgery to find out exactly what you’ll need, there are some devices you can count on being necessities. Be sure to check with your discharge planner as to what devices the hospital will provide for you to take home, and what your insurance will cover. Here are some devices experts and Arthritis Today readers recommend.

TED hose – These are special tight-fitting stockings that prevent blood clots from forming in the legs after a joint replacement. You’ll need to put them on every morning when you get up and take them off each night before you go to bed, says Dr. Della Valle. You can purchase them from medical supply stores.

Ice packs – Ice packs will help ease pain and inflammation of the incision site.  Have them ready before you leave the hospital. You can purchase ice packs, use bags of frozen peas or make a squishy ice pack by freezing three parts water to one part rubbing alcohol in a freezer bag.

Proper attire – Although you won’t be dressing to go to a party, you won’t want to hang out in your pajamas either. Before surgery, one Arthritis Today reader bought loose clothing that would be easier to get on and off. Monica Blake bought nice workout outfits to wear when she did her physical therapy. “It made me feel like I was in some kind of athletic training program,” she says.

Chair on wheels – You won’t need a wheel chair after joint replacement surgery, but AT readers say a deck chair or office chair with wheels will make it easier to get around in the kitchen.

Carry all – A walker basket can help you get things from A to B when you need your hands to hold your walker. If you don’t have one, try an apron with large pockets, suggests one reader. The apron will also work when you’re upgraded to a cane.

Reachers and grabbers – You won’t be stretching to reach items on high shelves or squatting to pick up the floor or pull up socks for a while. Check your medical supply store for devices that can help you do daily tasks with minimal stretching and bending.

4. Arrange for help 
Upon your discharge, you’ll be able to tackle some basic daily tasks on your own, but you may need help with meals, laundry, housework and shopping for several weeks, says Dr. Kolisek. 

While needing help is a certainty, you won’t know exactly how much you’ll need until you’re home from surgery, says Blake, who asked her aunt to stay with her a week or two after her first knee replacement surgery in 1986. Blake ended up needing her help for a full month. If you’re married, try to plan your surgery for when your spouse can stay home with you for a week or two. If you live alone, ask a friend or family member to come and stay for several days. At the least, have someone check on you a few times a day. If you don’t have friends or family nearby, Weser advises checking to see if your place of worship has a homebound ministry that can help.

If all else fails, you can hire someone to stay with you full or part time through a home health-care or companion service. You can find services in the yellow pages under “Home Health Services,” or through your discharge planner. But check with your insurance first. Most insurers do not cover such services.

5. Getting home
The first order of business in your homecoming will be getting home safely. Although you won’t know the exact time of your departure before your surgery, you can count on a three-to-five-day hospital stay, so having someone on call during that time will help ensure that your ride is ready when you are.

Having the right ride is important. Most experts recommend a large sedan, SUV or mini van, especially for hip replacement patients, who will have positional restrictions on their new joint. 

While some experts OK stretching out on the back seat and get comfortable, particularly for a long car ride, Lein advises sitting in the front seat with the seat back as far as it will go.

If you don’t have someone to drive you home, some taxi services have handicapped accessible vehicles. Your discharge specialist can arrange your ride. In some states, Medicaid covers transportation home from the hospital.

What to expect at home 
You’ve had the time to plan. Now you need time to heal. You may have trouble navigating the stairs, or standing long enough to prepare a meal or do a load of laundry. You may be constipated from inactivity and pain medication. You may be longing to take a long bath. You may have soreness that makes it difficult to do your exercises. At times you may feel frustrated, discouraged, harbor regret, even feel defeated. Recovery can be challenging – but these feelings will pass.

If you have concerns, speak with your doctor or other health professional. Or, think back to the other joint-replacement recipients you spoke with when deciding to have the procedure and give them a call. They probably had many of the feelings or challenges you have.

Do little things to improve your mood, like getting dressed each day instead of hanging out in your pajamas, using downtime to call or write to friends or watching DVDs of old comedy shows.

D-Day (Discharge Day)
At three to four days after surgery, you may be eager to leave your hospital bed for the familiarity of home, or you may feel like you’re just waking up from anesthesia, Lisa Lein, a physical therapist at the University of Alabama at Birmingham Hospital.

On discharge day, your discharge specialist will go over your instructions and provide you with a list to take home. Find out when this will occur and have a friend or family member there as a patient advocate. If you can’t have someone with you, you’ll still have the written instructions. Keep them handy and make sure you get a list of phone numbers to call in case of emergency or if you have questions once you’re home.

Explanation of benefits
Around the time your incision pain is starting to ease, you’ll have to start dealing with the headache of financial paperwork. In addition to the bills you receive from the hospital and your providers, you should automatically receive a document called an explanation of benefits (EOB) from your insurer. (If you don’t, call your insurer to request it.)  The EOB is not a bill. Do not pay it, but read it carefully, because when you do ultimately have to pay your medical bill, it will help you understand how much you are paying for what – and why.

Although EOBs will vary slightly among insurers – and may be more complicated if you have secondary insurance – most will contain this standard information:

“Date of service” is the date you had the procedure for which your insurance is being billed.  One bill may have several dates of service if you were in the hospital for several days.

“Procedure number” is simply an assigned number to your procedure. The hospital or physician must provide this to the insurance company for reimbursement.

“Description” is an explanation of the service for which the hospital is requesting payment.

“Amount submitted” is the dollar amount the hospital charges for the procedure. Most insurers will pay a specified percentage of the going rate in your area (called the “reasonable and customary” charge). If your doctor charges more than that – even if your insurance claims to pay 100 percent – you may be responsible for the difference.

“Amount approved” tells you the dollar amount the insurer approves for surgery. Ideally, this would be the same figure as “amount submitted.” If your doctor or hospital charge more than what is customary in your area, however, the amount approved by your insurer could be less.

“Applied to deductible” – if you have one – is the dollar amount (deductible) you’ll have to toward your care before your insurance starts paying its share. If you have not paid the deductible in full prior to your hospitalization, the amount you will need to pay toward the deductible will appear here.

“Patient payment" is the amount you will need to pay. In some cases, this will include what you owe toward your deductible along with a percentage of the remaining charge. If your insurance has a discount for preferred providers and you use a preferred provider, the amount may be paid in full.

“Insurance payment” is the amount your insurance will pay for each procedure.