Patient Home Care Guide

Preface

Loved one getting discharged from hospital?  Worried about how you are going to manage looking after them at home?

Get a copy of this booklet.  It can help you understand the basics of home health care and family caregiving.

Introduction

This booklet is for you if you are about to take a loved elder back home after getting them discharged from the hospital.

The idea behind this booklet is to provide you with some basic information that will help you through the daunting process of looking after a recuperating elder loved one at home.

While the doctors will give you details on further medical treatment, they generally do not have the time to get into the details of routine aspects of caregiving.  These routine aspects, such as managing hygiene, using diapers, preventing bedsores and maintaining a positive environment, go a long way in speeding up the process of recovery.

We hope you find this booklet useful and look forward to your feedback.  Do write to info@oldisgoldstore.com for any suggestions or clarifications.

You are not alone

When you first start looking after an unwell loved one at home, it is likely that you feel overwhelmed by all the responsibilities that come with the role of a family caregiver. After all, if you are not a doctor or a trained nurse, many of the tasks you have to take up will be entirely new to you.

You may very well feel that you are facing challenges that are uniquely your own and you are being left all alone to tackle problems that you are ill-equipped to handle. This is normal and all of us, first time caregivers, go through this initially. Thankfully, this is not true.

With medical science having improved by leaps and bounds, medical conditions that used to be fatal until a few years ago are now being cured or managed thereby ensuring that people live longer lives. As a result, every day, there are more and more people being provided health care at home by family members and professionals.

This is a good thing because there is now a wealth of information and support that will allow you to manage your role as a family caregiver.

So, don’t worry.  There is a lot of support available and you have started down the right path by getting hold of this booklet.

Just remember, you are not alone.

Enlisting family support

First thing to do is to set up the network required to look after the care recipient.  Though there will always be a primary caregiver, who is usually the spouse or child of the care recipient, it is not always possible for one person to look after the recovering patient.  Therefore, it is important for all other near and dear family members and friends to pitch in as best as they can.  

So have a family meeting and distribute roles and responsibilities based on how much time and energy each person has.  Everybody will have to contribute.  It will mean that there will be some change in everyone’s life and schedule and they will have to acknowledge that and be prepared for it.  To summarize

1. Call for a family meeting.
2. Make sure everyone understands all the new activities involved in looking after the elder one.
3. Identify the primary caregiver.
4. Identify all those who can help and are willing to do so.
5. Ensure that all of them get trained in all aspects of caregiving. That way, each one can substitute every other one.
6. Keep all medical records and emergency numbers in a common place accessible by everyone.
7. Write down and keep the medical regimen updated.
8. Understand and accept the fiscal responsibilities. If the elder one is financially independent, then get their consent for expenses.  Otherwise, ensure that everyone involved understands who is paying for what.
9. Ensure that the primary caregiver has some “me” time.
10. Be affectionate and caring to the caregivers also. Their job is not easy and they need some love and support too!

Getting professional help

Looking after an elder ailing person is not an easy task.  One bedridden person at home can keep an entire army occupied, sometimes.  So, it is not always possible for family members alone to look after the elder patient. 

Under such circumstances, don’t hesitate to get yourself professional outside help.  There are many agencies that provide home nursing and nursing assistance support.  Approach one of them or ask your hospital for more details.  Sometimes, the nurses and ward boys on duty will be able to recommend agencies and freelance professionals.

Do not just hire the first person that is recommended. Meet a few. Interview them.  Do background checks and reference checks where possible and ensure that you are comfortable with the person you are hiring.

Remember that this person you are hiring is going to be in your house for long periods of time and will eventually know the schedule and whereabouts of all the members of your household.  So, it is important to hire someone you feel is reliable.

Once you have hired one or more professionals, make sure that the environment is conducive for their working.  Do not use them for household work or other non-patient related work.  Do not expect them to work 24 × 7.  Treat them nicely so that they are in a good frame of mind which will enable them to treat their patient with kindness and caring.  Don’t leave cash lying around and remove all valuables from sight so that there are no temptations or misunderstandings.  In summary,

1. Hire outside help as required.
2. If you cannot find someone through your personal network, use an agency.
3. Do a thorough background and reference check.
4. Treat them nicely so they will pass on that treatment to your loved one.
5. Don’t expect them to work 24 × If they are not alert, they may not be able to provide the best care.
6. Provide them with comfortable sitting and sleeping facilities as required, depending on how much attention the patient requires.
7. Always ensure that there is one family member around all the time.
8. Be kind and caring to the ailing loved one all the time. Professional caregivers take a cue from you as to how to treat the patient.
9. Keep valuables and cash out of sight and access from the caregiver.
10. Do not use them for other household work. Treat them as the professionals they are.aking your home elder friendly

When you have a loved one who is bedridden or is having mobility issues at home, you quickly realize how senior unfriendly one’s house can be. However, you can do simple things to make the house more senior friendly.

1. Keep the room where the elder stays airy and bright.
2. Get a cot that is comfortable. Consider a hospital type cot that allows you to raise their head side up and down as required.
3. Remove clutter from the room. This will prevent the care recipient from tripping over furniture.
4. Make the path from the bed to the bathroom easy to navigate.
5. Always ensure that there is enough light, even at night.
6. Install grab bars at appropriate places.
7. Place anti-slip mats on wet areas such as the bathroom and toilet.
8. Provide the elder one with a remote bell so they can get your attention quickly when required.
9. Make visitors wash their hands and feet before meeting the ailing one. Have a hand sanitizer readily available and use liberally.  Do not hesitate to set the ground rules for visitors.
10. If possible (or if you are moving into a new place), ensure that the flooring is on the same level and all major sections of the house are accessible by wheelchair.Hygiene

Hygiene is one among the most important ingredients for successful recovery. Maintain the highest level of hygiene possible in the house at all times.  This includes you, all visitors, hired help, the patient themselves and the entire environment within the house.  Ailing elders are susceptible to infection and unnecessary health complications can make them suffer more, will lead to additional physical and mental stress for you and cost more by way of hospitalization, doctor’s fee and medication.

1. Keep the environment clean.
2. Ensure that all are aware about the need for hygiene.
3. Inform visitors and make sure they wash their hands and feet before meeting the ailing one.
4. Do not allow anyone with cold, cough, fever or other infections to even enter the room of the elder or cook for them or in any other way come in contact with the elder.
5. Change sheets and diapers regularly.
6. Give the ailing elder one a bath once a day. If that is not possible, then as often as feasible.
7. Keep hand sanitizers ready and use them liberally.
8. After any hygiene related activity like changing their diaper, or giving the patient a bath. wash hands with soap thoroughly before touching anything else.
9. Keep the ailing one’s nails (finger and toes) clipped at all times.
10. Teach all hired help the basics of hygiene. Don’t be surprised if they are not aware of the need for hygiene.Bedsores

One of the biggest (and thankfully eminently avoidable) problems faced by bedridden patients is the bedsore.  Also known as pressure ulcers, bedsores occur in people who are lying in bed for long periods of time.  When a person is lying down in the same position for extended periods of time, some parts of the body get compressed between their bones and the bed.  This creates a disruption in the blood circulation to some of the skin cells.  Deprived of oxygen, these skin cells die thereby forming the nucleus of a bed sore. Bedsores can be extremely painful, take a long time to heal and lead to further complications if left untreated.

To prevent bedsores from developing, there are a few simple steps to follow.

1. Maintain body hygiene.
2. Give regular full body baths or wipe downs (at least once a day). At that time, do a thorough and close inspection of the body for telltale signs. A bed sore starts as a slightly red botch on the skin.  If left untreated, it will become darker and then finally the skin will break.  You should catch and treat them at the time they are red botches on the skin.  Constant vigilance is the key to preventing bedsores.
3. Ensure proper cleaning after they pass stools. Faecal matter on the skin can lead to bed sores.
4. Change diapers regularly. Diapers get saturated after a while.  Once saturated they become damp and a damp environment can lead to infections.
5. Install an airbed. An airbed, also called an alpha bed or an anti-decubitus mattress is a must have for every bedridden patient.  It is a PVC mattress that comes with an electrical air pump.  The pump regulates the air in the mattress constantly thereby ensuring that no part of the patient’s body is constantly under pressure. An airbed is put on top of an existing mattress.Diapers

Adult diapers are a caregiver’s best friend.  Used (and changed) properly, they reduce a lot of work for the caregiver, while providing immense comfort for the care recipient. 

1. Choose the right brand, model and size.
2. There are two models, sticking type and panty type. For bedridden patients, the sticking type is recommended as it is easy for the caregiver to put on the patient and is more absorbent and longer lasting.  The panty type is more suited for more mobile elders who can put them on and remove them by themselves.
3. The right size will prevent leaks. Some brands will go by waist size and some other by hip size.  Body shape among bedridden elders can vary significantly so sometimes the waist may be even wider than the hips.  So, you may have to try one or two sizes before deciding which is the best fit.  For first time users, measure the circumference at navel height and use that to choose the right size.
4. Diapers have multiple layers. The inner most layer (the one in contact with the body) allows liquid to go through.  Inside that, there is a layer of cellulose. This is a cotton-like material extracted from plants that absorbs urine immediately.  Sprinkled on the cellulose is a powder called the Super Absorbent Polymer (SAP) that converts the liquid into gel.  This ensures that the inside of the diaper is always dry.  It also ensures that there is no backflow when the diaper is squeezed.  The outer most layer is a non-permeable layer that prevents urine from coming out.
5. A diaper need not be changed every time the patient passes urine. A typical adult diaper can hold two to three bladderfuls. [A typical bladder can hold 300–350 ml of urine].
6. Change diapers before they become saturated. Once saturated, the liquid does not get absorbed by the diaper leading to damp conditions inside the diaper and leakage.  A leaky diaper will mean hygiene issues.  In addition, a leaky diaper will mean the caregiver will have to change all the patient’s soiled clothes and the sheets on the bed—a task that is tiring and taxing for all concerned.
7. If the patient has passed stools inside the diaper, then the diaper needs to be changed immediately. While the diaper can absorb the liquid in the stools, it cannot do anything with the solid matter, which will remain in touch with the skin and sensitive private parts if the diaper is not changed immediately.  Use a cleansing foam to remove faecal matter, if available.
8. Watch out for bedsores and nappy rash every time you change the diaper. Consult a doctor if you notice either.   Use a nappy rash cream if required.  Do not put talcum powder inside the diaper.  It will block the pores and prevent the diaper from absorbing the urine.
9. Disposing off diapers is a problem. For one thing, they are not bio-degradable. Secondly, they are not washable or reusable.  Finally, they are not even recyclable.  The only thing you can do is to ensure that you make optimal use of each diaper you buy.  Remove all faecal matter from diapers (you can empty the faecal matter into the commode and flush it), bundle them tightly, seal them in a cover if possible and put them into the dustbin.  Just make sure they are not accessible to stray dogs.
10. Some brands of diapers have wetness indicators. Some have double sticking tapes. Some feel more like cloth than plastic. Some are more absorbent than others. The prices vary, of course.  Consider all aspects including your budget before you decide on the brand. 

Common home healthcare equipment

There are quite a few products you may have to get familiar with.  Here are a few to get started on.

Cots

A patient cot is an important piece of equipment that can make life comfortable for the ailing one and easier for the caregiver.  There are many types of patient cots—Semi Fowler, Fowler, 3-function, 5-function, motorized and non-motorized, and with wheels and without.

A semi-fowler cot will allow you to lift the head side up so that the patient can be completely supine (as on a regular cot) or can be made to recline at various angles.

A Fowler cot, apart from allowing one to raise the head side (as in a semi-fowler), will allow you to raise the cot at the knee level as well so that the leg can also be raised.

A 3-function cot, will in addition to the above, allow the height of the cot to be adjusted.  A 5-function cot is a typical ICU cot that will allow you to tilt the bed in multiple ways.

While a manual cot will provide cranks to do the raising and lowering, a motorized version will provide a remote control with buttons.  Buy a motorized cot if the patient is interested in and capable of using the remote to change their own position, otherwise go for a manual cot.

Avoid wheels.  They are usually required in a hospital environment, but at home they may be counter-productive.

Cots come in various ranges from low end economy made of mild steel and painted, to hi-tech aluminium, powder coated, with ABS head boards and side railings and motorized.

For typical home use, a manual semi-fowler cot should be sufficient. 

Other equipment

There are various other pieces of equipment that you may require depending on the needs and condition of the patient.  These include:

1. BP monitor – A BP monitor is used to check the blood pressure of the patient.  The manual one used by the doctor is called a sphygmomanometer and is the most accurate one.  However, there are electrical and battery-operated single button operation BP monitors available in the market that are easy to operate and quite accurate.
2. Nebulizer – A nebulizer is used to convert medicine in the form of liquid into a fine mist that can be breathed in. Medicines for the lungs are usually administered this way.
3. Phlegm suction apparatus – This is a suction apparatus that is used to remove phlegm from the throat of a patient. Useful when the patient is unable to cough out the phlegm themselves.  A lot of care needs to be taken while using this apparatus.  Get training from a doctor or an experienced nurse before using it.  Ensure that the tip of the catheter does not come into contact with any part of the throat or tongue.  Also ensure that you do not put the catheter too far down the throat.  The tip should always be visible to you.
4. Bed top table – This is a simple small table that can be placed on the bed used during feeding time.
5. Pulse oximeter – A pulse oximeter is a small device that can be clipped on to a finger or toe. It is used to monitor the pulse rate and the oxygen saturation levels in the blood.
6. Ryles tube – A Ryles tube is used for the purposes of nasal feeding. It is a silicon tube that is passed through the nostril into the stomach.  Liquids can be poured down this tube.  Required for patients who are unable to eat through their mouths.  Care should be taken to ensure that it is not pulled out.  Only doctors or experienced nurses can install a Ryles tube.  May require hospitalisation as a wrong placement (where the tube goes into the windpipe instead of the food pipe) can be fatal.
7. Oxygen concentrator – An oxygen concentrator is an electrical device that generates oxygen. Required for people who have difficulty in breathing or have lung infection. Where power cuts or frequent, an oxygen cylinder is a necessary backup as it can be used even if there is no power supply.  The cylinder, however, needs to be refilled regularly, even if not used.
8. Compression stockings – Compression stockings ensure proper blood flow to the extremities in bedridden patients.  The correct size should be bought for optimum effectivity. 
9. Bed pans, urine cans, commode chairs – A bed pan is used for passing stools while in bed and a urine can is a similar device for passing urine. A commode chair is a bed side chair that looks and works like a typical commode.  A detachable pail is used to collect the urine and stools. This pail can be taken to the toilet and cleaned. Very useful when the patient has very limited mobility.
10. Wheelchairs – Wheelchairs come in many shapes and sizes, with fixed and removable arms rests and foot rests, with and without commodes, with big wheels and small wheels, light and heavy, motorized and non-motorized. A good wheelchair shop will guide you to choose the right one for your needs.

For support and further information

For additional details and support contact:

Old is Gold Store

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