Should Your Aging Parent Go To An Acute Rehabilitation Facility, Skilled Nursing Facility or Have Home Health Rehabilitation After Hip Replacement Surgery

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Should Your Aging Parent Go To An Acute Rehabilitation Facility, Skilled Nursing Facility or Have Home Health Rehabilitation After Hip Replacement Surgery

In this article we will discuss if your aging parent after having hip replacement surgery, should go to an acute rehabilitation facility, skilled nursing facility or have home health rehabilitation after hip replacement surgery.

 Is Hip Replacement Surgery Considered a Major Operation? 

Is Hip Replacement Surgery Considered a Major Operation

Total hip replacement (THR), also referred to as a total hip arthroplasty (THA) is considered a major surgical operation. Individuals who usually undergo a THR have serious wear-and-tear or damage to the ball-and-socket joint of the hip.

The surgeon opens the hip up, removes the damaged bone, and replaces it with actual hardware.

Although the medical field has made leaps and bounds of improvement in joint replacement surgeries, and have even found ways to trim down hip replacement surgery recovery time, patients still require post-operative recovery then rehabilitation.

 What Are The Hip Replacement Surgery Recovery Times and Expectations Working with Physical and Occupational Therapy? 

With innovative methods and robotic-assistive surgeries, patients are often able to return home after a 1 to 2 day hospital stay.

In absence of extraneous medical complications, patients transfer straight from the operative room to inpatient recovery where they will participate in physical and occupation therapy.

After the anesthesia wears off and the post-operative pain gets under control with medication, patients can get up and walk with rehabilitative therapists just a few hours after surgery.

 How it is Determined if Your Aging Parent Should Be Discharged to an Acute Rehabilitation Facility, Skilled Nursing Facility, or Have Home Health Physical Therapy and Occupational Therapy During Their Hospital Stay? 

Ultimately, the surgeon will make the order for which setting your aging parent should transfer to after surgery.

However, the order comes after thoughtful examination and medical opinions from the entire team. There are usually three main determinants that are considered:

Prior level of Function (PLOF): Was the patient functioning independently and safely prior to surgery, or did they require some level of help?
Support at home: Does the patient have environmental (i.e. equipment, home layout, etc.) and familial/caregiver assist at home?
Patient medical history: Does the patient have other medical diagnoses that could complicate or prolong the healing timeframe?

 What Makes A Senior A Candidate for Acute Rehabilitation After Having Total Hip Replacement Surgery and What Are The Expectations? 

Acute rehabilitation provides intensive therapy with the intent of joint recovery within a short duration of stay.

The patient will be required to participate in a certain number of minutes per day in occupational and physical therapy which will provide several types of intervention (i.e. physical exercise, stretches, activities of daily living management, caregiver and patient education, etc.).

Acute rehab also insures 24/7 medical support.

 What Makes A Senior A Candidate for a Skilled Nursing Facility After Having Total Hip Replacement Surgery and What Are The Expectations? 

If a patient does not quite meet their bare minimum goals to safely function at home with the support of family and/or home health, then a skilled nursing facility is a transitional option.

The patient would be discharged to skilled nursing for 24/7 nursing care and regular rehabilitative therapy.

Therapy services often take place every day, and duration of stay depends on therapy recommendations, doctor and nursing recommendations, and payer source (i.e. health insurance).

 What Makes A Senior A Candidate for Home Health Physical and Occupational Therapy After Having Total Hip Replacement Surgery and What Are The Expectations? 

Commonly, patient will transition home from the hospital after a total hip replacement but require additional support to safely function at home. This will include the use of adaptive equipment needed after hip replacement surgery.

This is helpful for patients who don’t require 24/7 care anymore, but still need some help to safely function at home.

Home health services provide regular nursing and therapy services with the intent to strengthen and restore movement and functional participation within the home environment.

 What Are The Benefits of Going to Any of These Facilities or Having Home Physical and Occupational Therapy? 

There are several benefits for participating in any of the mentioned rehabilitative options after discharging from the hospital:

Acute rehabilitation: 24/7 medical care and intensive therapy services to promote faster recovery and swifter return home.
SNF: 24/7 medical care and less intensive daily therapy services spread across a longer duration of stay in order to promote safer return home.
Home Health: Regular, but not daily, medical and therapy services so recovery can be completed in the comforts of the patient’s home.

 How Does A Total Hip Replacement Candidates Prior Level Of function Determine Their Discharge Plan from The Hospital?  

As mentioned before, prior level of function (PLOF) can highly determine where a patient will go after receiving a total hip replacement.

This can include information regarding fall history, reaction and progress to previous therapies and medical care, sedentary versus active lifestyle, and the level of assistance received for daily living tasks and mobility prior to surgery.

If a patient was not doing well at home before surgery, then more than likely the medical team will recommend transferring the patient somewhere else for longer rehabilitative time to prevent injury, infection, or other medical complications.

 How Does Pain Tolerance Slow Rehab Progression in the Hospital and Delay Discharge to Home and Likely to Acute Rehabilitation or a Skilled Nursing Facility? 

Whether the patient agrees or not, pain perception highly impacts rehabilitative progress.

Low pain tolerance compromises rational thought, concentration, balance, and functional participation which can lead to falls or injury. Also maintaining long term precautions after total hip replacement surgery is imperative even if pain tolerances make it uncomfortable to perform functional activities of daily living.

On the other hand, low pain tolerance can also lead to less activity participation, which means the patient will avoid or refuse to complete therapy interventions thus halting rehab progression.

   What Should Seniors Do Prior to Having a Total Hip Replacement to Better Prepare and Have the Best Outcomes For Discharge Planning? 

Patients and their loves ones can help prepare for total hip replacement surgery in several ways:

Create a pre-surgery exercise regimen: Without causing further damage to the pre-operative joint, keep the hip muscles and joints as mobile and strong as possible so that regaining mobility after surgery will be a bit easier.
Improve nutritional intake: If the patient hasn’t already done it, create a diet that accounts for appropriate vitamin, mineral, protein, and carb intake.

Patients should feed their muscles and joints with optimal nutrients now in order to promote faster healing and reduce chances for post-operative infection.

Have supports in place prior to surgery: Patients should have a game plan worked out with their loves ones regarding their home and the use of adaptive equipment needed after hip replacement surgery.

This includes making the home safe for walker use by rearranging furniture and researching adaptive equipment (i.e. shower chairs, grab bars, removable shower heads, etc.). Furthermore, have a committed schedule for whoever is available to care for the patient while they are healing at home.

 What is The Importance of Communicating with Hospital Discharge Planners on The Best Facilities if There Is A Need to Go to a Skilled Nursing Facility or an Acute Care Rehabilitation Facility Postoperative Hospital Stay? 

If caregivers and family members or worried about discharging their aging parent directly from the hospital to home.

Then a very thorough and honest discussion needs to take place with the doctor, the nursing staff, social work, and therapy staff.

Voice your concerns early so that the best transition takes place before discharge is even considered.

 Conclusion and Summary: 

A total hip replacement surgery is a major surgical operation that requires recovery time and rest, especially in combination with age and other medical diagnoses.

Discharging home does not have to be the only option for aging parents and their loves ones.

With proactive discussion between families, patients, caregivers, and medical staff, and with thoughtful preparation, aging parents can be admitted to therapy services that best suit their needs for a smooth road to their recovery.

 

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Author: Samuel

Samuel is a physical therapist with over 20 years medical experience. He has extensive knowledge in functional rehabilitation in the acute care hospital and in-home care settings. He has spent most of his career helping seniors transition from hospital or rehab care to living independently at home. In his free time he likes to travel and read autobiographies.

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