Watch 2020 JRAD Videos

THR For single people - home health care guidance?

Pink Peony

junior member
Joined
Feb 29, 2020
Messages
32
Age
58
Gender
Female
Country
United States United States
I have read a number of threads and still my head is spinning on how long to hire home health care after THR.

I am having out-patient surgery, so will be home the same day, and my doctor recommends/mandates that I must have someone stay with me the first 24 hours. I live in a small home by myself, and the only seating (other than kitchen chairs) is the couch that I will be recovering on. I do have my bedroom, and a small guest room, where I have a pull out coach (for the person to sleep on the first night). All in all, I will be very stressed having a stranger in my house during my recovery, as I really don't have a place for them to not comfortably sitting, and frankly I will feel obligated to try and be a hostess. I do have a neighbor I can text if something urgent arises.

I am having the anterior approach, and consider myself in good/excellent health going into surgery.

Bottom line, I am having a lot of anxiety over "hosting" a stranger in my home. One strategy is to have the person for the first 24 hours, and then schedule (presuming they will just do it for an hour?) a daily check-in for 3 days? However, I am also concerned that I am being overly optimistic about my recovery, and since I don't have any family in the area, if I need more care, I could be in a bind.

Would appreciate feedback on my plan.
 

Celle

MODERATOR
Moderator
Joined
Nov 19, 2011
Messages
39,186
Location
New Zealand
Gender
Female
Country
New Zealand New Zealand
Hi @Pink Peony ,
Usually, surgeons choose carefully who is a suitable candidate to have a hip replacement as an outpatient.. Since you live alone, and don't have family nearby, I think you would be better served by spending the first night in hospital. Did you talk to your surgeon about what help you would have at home?

If it's impossible for you to stay overnight (it shouldn't be), then your surgeon's staff should be able to help you arrange at-home care.

I suggest you phone your surgeon's office and have a talk with his staff about your after-care.
 

Jamie

ADMINISTRATOR
Senior Administrator
Joined
Mar 24, 2008
Messages
60,328
Age
71
Location
Kansas
Gender
Female
Country
United States United States
Hi, Pink Peony.....you are wise to get all this straight before your surgery. It would be rare to have home health stay with you for 24 hours after your surgery. They are not normally that kind of service. There are home care agencies that will do that for you, but your insurance wouldn't cover it like they should for home health.

Here is what I suggest to you:

* Contact your surgeon's office and let them know you are not able to have someone with you for 24 hours after your surgery. There are previsions with hospitals for you to stay just under 24 hours and it's not considered a "day" in hospital. Ask about that for an option instead of going straight home. You may have to be firm and assertive, but explain that you have no one to care for you at home so you will not be able to abide by the doctor's desire to have you released to home. Or, as Celle suggested, they can change you to inpatient surgery. You are not a good candidate for outpatient surgery because you have no one to stay with you after surgery.

* If you absolutely cannot get the surgeon to agree to let you stay in the hospital overnight (23 hours so it's not a full "day"), you can hire someone to stay with you for 24 hours, but it will be expensive. Most resources will be from $15-$30 per hour. That would be $360-$720. This is called Home Care Services.

* Ask your surgeon's office what home health care they will authorize. Home Health Care is different from Home Care and it is usually covered by insurance. Home Health consists of a nurse who comes the first day or two you're home to evaluate you and your home. That should be followed by a Physical Therapist, and Occupational Therapist, and possibly a bath aide who will set up a short program to make sure your recovery goes smoothly. The therapists may come 2-3 times a week. The nurse will likely check on you weekly (and you can call anytime 24/7 for questions or concerns). A bath aide would come 1-2 times a week to help you get showered and dressed. These services all should be covered by your insurance providing your surgeon will authorize it.

Your plan to have someone available to call is not a safe option. Sometimes when problems occur unexpectedly at home, you might not be physically able to get to the phone to call someone....even 911. It is possible to have a drop in blood pressure, for example, that would result in you being too weak to get to a phone or fainting. You could have a fall. These are examples but should show you why it is not a good plan to be alone on the first night. Anesthetics and surgery take a toll on your body and you need to be sure you have someone to check on you now and then throughout the night and to help you or be nearby when you get up to go to the bathroom or kitchen.
 

Jaycey

FORUM ADMINISTRATOR
Administrator
Joined
Jan 27, 2010
Messages
31,926
Location
Yorkshire
Gender
Female
Country
United Kingdom United Kingdom
@Pink Peony You need to have a good discussion with your surgeon. If you live alone you are not a candidate for outpatient surgery. And you should not be making arrangements for extra care.

Please have a very frank discussion with your surgeon's office on this. Perhaps they are not aware of your own situation.
 

Layla

SENIOR FORUM ADVISOR
Senior Forum Advisor
Joined
Jun 26, 2017
Messages
22,396
Location
Minnesota
Gender
Female
Country
United States United States
Happy Friday @Pink Peony

Why does it have to be a stranger? Is that your only option for help?
What about a friend, neighbor, someone from church etc? You may be more comfortable with someone you’re familiar with who will not expect you to “host“ them. I don’t know how anyone could expect that after you just experienced major surgery. Please try to give up that notion.

After the first evening, when you should not be alone, you may be comfortable with someone physically checking in on you for the first week. Most likely you’ll want someone within earshot for your first shower, or until you see how the meds you’re on will affect you, how well your pain is managed etc. You will need a plan / reminder in place so you’re taking your meds on schedule and you may realize there are things you’re not thinking of that a visiting friend or neighbor could help you with as they check in daily for the first week. If not for my husband, I may have forgotten to take my meds, initially.

I think you should hope for the best, but prepare for the worst and in saying that, I’m not trying to frighten you, but only hope you‘ll have a plan in place in case you’re not feeling well for a couple days, foggy brained, nauseous, off balance etc. Have “someone” you know you can rely on, if necessary, in place.

You still have time to think on it and plan ahead. I’m sure you’ll come up with a plan you’re comfortable with. You may not think you‘ll need or want anyone there, but you may feel just the opposite once you’re in those early hours and days of recovery.

Wishing you comfort as you wait for your surgery date.
 
OP
OP
Pink Peony

Pink Peony

junior member
Joined
Feb 29, 2020
Messages
32
Age
58
Gender
Female
Country
United States United States
Celle, Jamie, Jaycey and Layla - thank you all for your recommendations and guidance, it is greatly appreciated.

I did share with my surgeon that I am single, and don't have family. He didn't seem to be concerned, just with the comment that I needed someone the first 24 hours. If I do have to pay out of pocket for that care, I really don't have a lot of other options at this point. However, I am going to ask about staying for 23 hours, as I did have an issue last summer with my blood pressure dropping really low after getting vertigo for the first time.

At this point, I think the surgeries are just being schedule at the out patient, so if I can't get a plan that works, I may need to reschedule for a hospital appointment. While I really, really, really want to get my life back, the pain isn't too bad, and I could delay.

Overall, I really feel frustrated how difficult it is as a single person, to navigate surgeries (especially that first 24 hours) without support from insurance. More people are single than married (at least in the US), and many of us don't have family in the area.

I will update after I hear back from the office. Thank you again!
 

GrannyC

post-grad
Joined
Mar 13, 2017
Messages
1,422
Age
76
Location
NY
Gender
Female
Country
United States United States
I hear your frustration and can understand you are in a difficult spot. I agree with the others that being alone for the first day or two is not a good idea. I know someone who had knee surgery I think it was and she lived alone so she was sent to a rehab facility for a couple days before going home so that might be another option you could ask about. I think that might very well be covered by most insurances and it would give you peace of mind for those early days. Even though you told your surgeon you live alone, he may have thought you had family in the area to help. If I were in your shoes, I’d call his office and speak to his nurse, explain your situation and ask for guidance/suggestions. It can’t hurt to ask. I hope you’ll keep us posted on how things are going.
 

yorkiegs1

junior member
Joined
Feb 28, 2019
Messages
56
Age
66
Gender
Female
Country
United States United States
Suggest you speak to the doctors office. Usually they have a coordinator that schedules surgeries and provides assistance for advice. I had my surgery at the hospital and was in the hospital 3 days. The third day I went home. The hospital nurses get you out of bed and walking same day of surgery. This was not easy but I did it. The next 2 days they got me up again to dress myself and walk n start easy exercises. You will definitely need assistance. The first week is the hardest. After that it gets easier week after week. If your insurance allows my suggestion would to have surgery in the hospital and being that your single with no family either arrange to be transferred to a nursing facility for a week and then schedule in home Health care where a nurse will come in and check on you as well as a Physical Therapist. The hospital through your insurance can arrange for home health care to come in based on the county you live in. That’s how it worked for me. Wishing you good luck.
 

Sunshine68

new member
Joined
Jun 8, 2020
Messages
8
Age
51
Gender
Female
Country
United States United States
@ Pink Peony I too will be having an anterior approach outpatient I am a single mom with a 12-year-old son I’m also a occupational therapist I won’t be having any therapy as I am a therapist LOL I basically know what to do I also have a few close friends in my neighborhood if I need help but I’m pretty independent so I’m sure I will do fine plus having my son around to cook for me if needed
. Personally I wouldn’t feel comfortable with a stranger in my home either I think I would rather spend a few days in the hospital if you can but my ortho has made me feel confident enough that I will be ambulating very well at home with crutches or a walker the first few days. Maybe you can have your friends check in on you throughout the day and bring you food if needed. I definitely wouldn’t shower on your own until you feel comfortable you can always sponge bath. Good luck! When is your surgery?
 
OP
OP
Pink Peony

Pink Peony

junior member
Joined
Feb 29, 2020
Messages
32
Age
58
Gender
Female
Country
United States United States
Thank you Sunshine, my surgery is scheduled for June 29th.

Appreciate your feedback, especially as an occupational therapist. I can be okay with setting up my guest room, it is just I will have to leave my sofa out and won't be able to put the bedroom back together for many weeks. I called the surgery scheduler today, but we played phone tag.

Part of my frustration is inability to email my care team and get quick answers. Everything is a phone call, which is tough as super stressful layoffs at work, all while I am trying to get ready to take time off for surgery. My frustrations are bubbling to the surface.
 

Sunshine68

new member
Joined
Jun 8, 2020
Messages
8
Age
51
Gender
Female
Country
United States United States
My surgery is scheduled for the 25th So hopefully I can leave some feedback on how it goes for me having a 12-year-old boy at home is kind of like being alone LOL. I was told I would leave using crutches or a walker personally I think I would feel safer with a walker than crutches. I don’t know where you live but if I was by myself I would have Publix delivery for food or just stock up enough food for two weeks I’m hoping I can drive after two weeks. I am taking time off of work minimum of six weeks because of the nature of my work.
 

Sunshine68

new member
Joined
Jun 8, 2020
Messages
8
Age
51
Gender
Female
Country
United States United States
I also believe the Anterior approach is a quicker recovery and you’re basically walking out of the surgery center the same day. I’ve worked with patients that have the same doctor that’s doing my surgery and some of them are 30 years older than me and they’re getting up and walking with a walker with only a little bit of assistance! My ortho also said he would just be sending me home with a home exercise program no therapy needed. Definitely have friends check on you and maybe one will stay the night at your house the first night if you’re concerned about your blood pressure. Also are you doing any strengthening exercises before your surgery?
 
OP
OP
Pink Peony

Pink Peony

junior member
Joined
Feb 29, 2020
Messages
32
Age
58
Gender
Female
Country
United States United States
Thanks Sunshine. Per my surgeon, I can only be 25% weight bearing for 3 weeks with the anterior, which doesn't match anything I have read. As you suggested, I thought most people walked (with walker) regardless of approach. I am going to ask this question during my pre-op.

I am walking 7,000 - 10,000 steps a day, and lots of gardening. I use to lift weight 5 days a week, but Covid has been devastating to my fitness routine, plus my workload has increased since working from home (and I miss all the weight machines). I do have a medicine ball, and keep meaning to do more pushups and core work prior to my surgery. Any recommendations?
 

Mojo333

SENIOR FORUM ADVISOR
Senior Forum Advisor
Joined
Mar 8, 2017
Messages
23,112
Age
56
Location
GA
Gender
Female
Country
United States United States
:hi: @Pink Peony and Happy Tuesday
Per my surgeon, I can only be 25% weight bearing for 3 weeks with the anterior, which doesn't match anything I have read. As you suggested, I thought most people walked (with walker) regardless of approach. I am going to ask this question during my pre-op.
Definitely hope you can get all your questions addressed at your pre-op as your surgeon will want this to be a successful recovery as much as you do. Each person's anatomy and pre-op condition is different and as much as anecdotal experiences can be helpful...the surgeon will be your 'intimate' advisor...since he will know best for you.

I also believe the Anterior approach is a quicker recovery and you’re basically walking out of the surgery center the same day.
Many members, including myself (only because this was my experience), laud the anterior approach as having some advantages for early recovery days...but honestly this can actually be a disadvantage for those who take this as a sign that they can do more and are more susceptible to overdoing it (also from experience)
Actually longterm recovery is the same regardless of approach, so the patience muscle will be the most important one to tone up.:) :-) (:

Sunshine has given you some great preop tips and we will love sharing both of your recovery journeys.
Here are some other pre-op thoughts...
  • Tape down rug corners and electrical cords and make sure walkways are clear.
  • Place regularly used items at arm-level.
  • Pre-fill any prescriptions you may need after surgery.
  • Follow your pre-operative instructions.
  • Begin doing exercises to strengthen your upper body and the leg that is not having surgery.
 

Sunshine68

new member
Joined
Jun 8, 2020
Messages
8
Age
51
Gender
Female
Country
United States United States
@Pink Peony Sorry I didn’t realize your Ortho said 25% Which is basically like a toe touch weight-bearing my ortho said weight-bearing as tolerated so as much as I can handle. Every ortho and everybody is different like the other posters said. Honestly if you’re going to be 25% weight-bearing I would definitely have someone stay with you for a few days if that’s possible. Will you be getting home health therapy a few days a week PT and OT can show you exercises and ways to modify your home environment to help you. Definitely tell them your concerns at preop and they should be able to guide you sorry I couldn’t help more. Definitely strengthen your quads, glutes, hip ext and core before surgery As much as your hip can tolerate now
 

CricketHip

FORUM ADVISOR
Forum Advisor
Joined
Jul 12, 2015
Messages
4,471
Location
PA.
Gender
Female
Country
United States United States
Hi @Pink Peony what a lovely avatar name! You sound frustrated and rightfully so. Playing phone tag can be so annoying. If you are like me you want your answers ASAP. Then they return your call and you miss it! aargh. At least you still have some time left to voice your concerns.
My surgeon is a huge fan of outpatient THR's but I stayed over night both times.
I tend to fight some low blood pressure, which clenched my extended stay.

I wonder, if you could speak with the Nurse Practitioner if you would have more success, I noticed they were the ones who got things decided and listened to me.

Additionally, when in the hospital there are social workers and PT's who help decide if you are able to return home. Maybe speak to them, if you are still concerned at that time.

My husband was working some crazy hours with my first THR and I opted to use a home health aide service and they were so helpful. I didn't feel like I was their host and the young lady brought a book and would stay out of my way until I needed her. I was dreading having someone in my house too, but ended up really appreciating them there, when needed.


Good luck with figuring out the dynamics.. good for you for addressing this sooner than later.
 

Celle

MODERATOR
Moderator
Joined
Nov 19, 2011
Messages
39,186
Location
New Zealand
Gender
Female
Country
New Zealand New Zealand
I also believe the Anterior approach is a quicker recovery and you’re basically walking out of the surgery center the same day.
While the anterior approach may initially give a slightly faster recovery, that evens out as time passes. No matter what the approach, complete recovery for a THR is going to take about a full year. You should be able to do most things long before that year is up, but healing will still be going on underneath the surface.

The main reason why your surgeon wants you to have someone with you for the first 24 hours post-op has nothing to do with how fit you are right now. It's because of the potential early consequences of having major surgery - low blood pressure, bleeding, fainting, pain control measures needing to be adjusted. With only 25% weight-bearing, it's likely that you will need more help than people who are allowed full weight-bearing.

It really isn't wise to go home alone during that first 24 hours post-op. Do see if you can get some help from your surgeon's staff. Even staying for 23 hours will go a long way towards safeguarding your health.
 
OP
OP
Pink Peony

Pink Peony

junior member
Joined
Feb 29, 2020
Messages
32
Age
58
Gender
Female
Country
United States United States
Thank you all for your helpful guidance, as it helped to consolidate all your great experience, that would have taken forever to gather. Here is where I am at with help:

* A friend has offered to take me to surgery, however, during my pre-op, they said the person doesn't have to stay, so I still on the fence if I should just take an Uber. There is a possibility it will be a very early morning for my friend.

* Another friend, has offered to stay the night. I still am beyond words, and I did find an option that would stay overnight, but it was all self pay (e.g. not covered by insurance). Thank you Jamie for laying out the options so clearly. My long term job is in jeopardy (which has been incredibly stressful on top of everything else), so preserving money is now critically important. Through this experience, I have learned that I really need to just let other friends know that I could stay the night, etc. if they need help, as it is so difficult for many people to ask. In other words, rather than offering help to another, be very specific about details, i.e. I will spend the night.

* I am having home health care coming over early next week, and I am thinking of hiring a person for the morning of day 2 through the afternoon. That way, my friend can leave that morning. I am on the fence if I should hire for days 3 - 5, I have to confirm again if my insurance covers, although I still have at least a co-pay of 20%. I don't know why insurance companies don't have "easy to understand" tables, as I have found it difficult to get straight answers.

Other supplies:
* I luckily found a beautiful lift chair that will be delivered this week, as so many of you talked about sleeping on a recliner rather than your bed. That also helps, as I can have my friend stay in my bed the first night, which is easier than getting the pull out couch ready. I am hopeful I can re-sell it post surgery, as it will be crammed into my living space. At some point I need bunion surgery, and this chair would be great, but it would have to be in my garage for at least a year? I still need to ask that question of my surgeon about how long to wait for bunion surgery.

* I have an ice machine on order, as this forum has been very clear what a help that has been for their recovery.

25% weight bearing capacity:
* During my pre-op with the PA (not the surgeon), I asked him about the 25% weight bearing that was in the "joint camp" information. He said that I will be weight bearing. I also did a pre-op with physical therapy, and they said the same thing. I went back and re-read, and their literature definately says that this is a restriction for anterior. Very confusing.

* Physical therapy said I need to schedule an appointment 5-7 days after surgery. Reading the "joint camp" information, it says that will be decided after my two week follow-up. Again, different information (and the physical therapy is associated with the practice). I feel like I should offer my services to re-write their joint camp information, as I can't imagine other people aren't confused.

* Next week I will get food ready, and after reading many stories, rather than preparing food (which I won't have time for), I will lay in crackers (which I usually don't buy), nuts, frozen food (Trader Joe's), etc. for at least a week, realizing that I can online order additional groceries as required.

* I have also read about constipation guidance, as I have experienced that before post surgery, and want to stay ahead of it if at all possible. I have cut and paste feedback from others, about how soon they got off opiods.

While nervous, reading this forum for months has helped me feel far more prepared mentally and emotionally. If I just had the "joint camp" material, I would be going into this unprepared. I can't thank this community enough!
 

Jaycey

FORUM ADMINISTRATOR
Administrator
Joined
Jan 27, 2010
Messages
31,926
Location
Yorkshire
Gender
Female
Country
United Kingdom United Kingdom
@Pink Peony sounds like you are very well prepared. Be sure and ask your surgeon's office to clarify if you need to. It's very difficult for patients when the written material does not match the instructions you are given.

I really see no reason for you to have restrictions on weight bearing. That would be very unusual for anterior approach - or indeed for any approach these days.
 

Layla

SENIOR FORUM ADVISOR
Senior Forum Advisor
Joined
Jun 26, 2017
Messages
22,396
Location
Minnesota
Gender
Female
Country
United States United States
You sound pretty organized to me. Depending upon how close the friend is that offered to drive you to your surgery site, they normally allow someone in the room with you during prep as support. If your driver is someone you‘d prefer doesn't stay, then I don’t see any reason why you couldn’t use Uber.

Through this experience, I have learned that I really need to just let other friends know that I could stay the night, etc. if they need help, as it is so difficult for many people to ask. In other words, rather than offering help to another, be very specific about details, i.e. I will spend the night.
This is so true! I think people have good intentions when they say “Let me know if you need anything“ but it’s so much easier to respond to a direct / specific offer of help.

Depending upon insurance and finances, you may want someone there on days 3-5 for an hour or two each day. I know that personally I wouldn’t have been comfortable taking those first couple showers without someone within earshot until I mastered a system. There may also be things you want, or need done, and are having difficulty with that could be addressed by another person that stopped by for an hour or two during that first week. You may just enjoy that bit of company also.

I believe you’ll love that lift chair. I actually slept comfortably all night long in mine for the first three weeks of recovery. I squished soft pillows in the side and imagined it’s what a baby feels like being swaddled, lol.

You can definitely wait until your two week post op to schedule any PT. In many instances PT isn’t even needed. Especially early on. Walking is the best form of exercise, but not to excess.

I feel like I should offer my services to re-write their joint camp information, as I can't imagine other people aren't confused.
You may be kidding but don’t hesitate to take this up with the appropriate party. Either your surgeon, or the surgery site. Mine were closely affiliated. There was another member on the forum, Klassy, who did just that and the hospital updated their information at her insistence. I wouldn‘t hesitate to tell them you found more info online than in the materials they provided and feel free to mention BoneSmart if you’d like. :wink:

Wishing you comfort as you await your date. Not long now. You’re going to love the result!
 

New

Active Antibacterial

BoneSmart #1 Best Blog

Staff online

Forum statistics

Threads
51,554
Messages
1,383,587
BoneSmarties
32,266
Latest member
Nancan
Recent bookmarks
0

Top Bottom