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Preparing for the Transition to Home

Preparing for the Transition to Home

Tracy
Hi everybody. It’s… It’s good to see you all here. I hope you had a good week. I hope things are progressing, things going all right.

Travis
Excuse me a minute, Tracy. Can I say something?

Tracy
Sure.

Travis
I know that my Mom probably told you guys everything that happened last week. I just don’t have an excuse for it. I mean… I guess I just felt overwhelmed, and I thought that partying with my friends would help it. It just didn’t. And I owe an apology to all of you.

Tracy
Was there something specific that happened?

Travis
No. It was just the situation, I guess. I mean…with my dad being in the hos… with my dad being in the hospital and me trying to be the “man of the family” I’m just not doing that good of a job at it.

Michelle
Oh honey, you’re wonderful. You’re a big support, and I don’t know what I would do without you. But you’re also still a kid, and I have to remember that and stop laying so much on you.

Travis
Mom, I asked to be involved in this. I mean really, I insisted on it, I guess I just didn’t know what it would be like.

Tracy
So, Travis, are you doing better now?

Travis
Much better. I mean I’m getting my act together, and my Dad’s doing a lot better, too. I mean he had surgery to fix his skull, and it’s amazing how much it helped. He’s talking more, and he doesn’t have as many headaches.

Michelle
Tom’s cranioplasty went really well, and it’s made a big difference. Like Travis said, he’s talking more, he’s smiling at appropriate times, he’s eating on his own… We’re feeling pretty positive for the first time in a long time.

Tracy
Congratulations!  That’s great.

Michelle
Thank you. You know, I think some of the hardest things about caregiving are the constant ups and downs. One minute everything seems so bleak, and the next minute there are these incredible highs. It feels so good to have hope, but I have to remind myself that there will be another challenge right around the corner.

Travis
Mom, let’s just enjoy this moment.

Carl
Well said, Travis. There’s going to be many highs and lows in the coming months, and maybe years. Julie and I have learned to appreciate when things are going well.

Megan
Yeah and I actually found a church near the hospital, and that’s exactly what the Pastor told me. So I’ve spent this week really focusing on the little things that tell me Clay’s progressing, and that really helps. And yesterday when I got back to his room after meeting with his team, he actually waved at me. And of course, it was just lifting his fingers a few inches, but it was really awesome.

Tracy
Oh, I am so proud of you of all, and I am thrilled with… with Clayton’s improvement and Tom doing so well. Remember, recovery can be a series of small steps, but each step is so important. And, of course, there will be big steps too, like Clayton waking up. And of course, Michelle and Travis will be helping Tom take that big step in the next few weeks when he comes home.

Michelle
We’re so happy, and so is Tom. But, truthfully, I’m a bit nervous. There’s so much to do to get ready.

Tracy
Well that’s what we’re going to cover today. You know, the transition to home can be both exciting and really stressful. One thing you want to remember is that you don’t have to do it all by yourself. Ask others… Asking others for help is not a sign of weakness. Of course, there will be some people who want to help you along the way without even being asked.

Now as Tom makes the transition home or, in some other cases, to another facility, your POC, your case manager, and your VA or your military liaison, they’ll all be there to help. Now you need to discuss the transition home with your health care team and work with them to make a plan based on your family member’s needs.

If you can, try a trial weekend at home. That will help you decide how much help you’re going to need, any modifications to the home that might be necessary, and just what to expect in general.

Carl
Sam was home for a weekend a few weeks before he came home. We realized then that we had a lot to learn, and a lot to do to get ready for a more permanent transition. I’m glad that we got a head start when we did,

Tracy
Was Sam’s health care team helpful in the planning?

Julie
Oh gosh, absolutely. We couldn’t have done it without them. They helped us find all kinds of resources that Sam qualified for, and really just helped us every step of the way.

Tracy
Well let’s talk about some of those steps. Like Carl and Julie, it’s really important to be prepared before your family member comes home. Give yourself plenty of time to get that done. Like Carl said, you know it doesn’t just happen overnight.

One of the first things you’ll need to do is talk to your health care team about the home safety evaluation. Your home may need to be altered just to make it safer. You want to make it as suitable as possible for your loved one’s needs. Home modifications can be relatively minor and inexpensive... things like oh installing grab bars, handrails, lever handles on the doors.

And in other cases, those modifications could be a little bit more major, more expensive. Things like installing elevators or lifts, or modifying kitchens for easier meal preparation, installing emergency communication systems if that’s necessary. There is a program, called the Specially Adapted Housing Grant, that’s available through the VA, they can help cover the cost of modifications.

And be sure not to rush into those major modifications because your loved one’s needs may change over time. You can plan other modifications as his rehabilitation continues. 

Now as you get ready to bring your family member home, you’ll also need to plan for any special equipment that might be required. So be sure and make a list of the assistive devices that your family member is using in the hospital now, and ask the case manager or the discharge planner to make sure that you’ll have that same equipment. Okay. Now having equipment prescriptions written in advance, so that those devices will be there when your loved one gets home that’s important. Without the prescription, the cost of those devices might not be covered by the military, the VA, or your insurance company.

Megan
So what kind of equipment… of…assistive devices might we need?

Tracy
Well, Megan, assistive devices can be anything from simple to complex equipment, anything that helps that person with TBI be more independent. Some of the more simple things could be a magnifying glass, or a timer to remind the person when to take their medications. And they make a special grip that you can put on to your fork or your pen that helps with writing and eating. It’s really cool. More complex devices might include a personal digital assistant, or a PDA, a hand-held GPS helps them find their way around, or special telephones that help people with speech and hearing problems communicate. In some cases your family member with TBI might need a cane, or a walker, crutches, a special bed might be necessary. Your health care team will help you decide just exactly what your loved one will need, and where to locate the items.

Julie
One thing we learned with Sam’s devices was to keep the phone number for the medical equipment company right by the phone just in case we had any problems. Carl got to know the people from the company, so we always knew who to talk to.

Tracy
That’s a really good suggestion, Julie.

Assistive Devices

For people with TBI, it can be a challenge to accomplish daily tasks such as talking with friends, going to school and work, or participating in recreational activities. Assistive devices can make it easier for a person with a disability to manage these activities.

Assistive devices can be anything from simple to complex devices such as:

  • a magnifying glass
  • a timer to remind the person when to take medications
  • a touch-fastener grip attached to a pen or fork for eating or writing
  • a PDA (Personal Data Assistant)
  • a special telephone that helps people with speech and hearing problems to communicate
  • braces, splints
  • canes, walkers, crutches
  • calendar or memory notebook for tracking appointments, planning, organizing
  • medical alert bracelet or emergency call system 
  • eye patches, prism glasses 
  • special beds

Keep the phone number for equipment companies available for emergencies or machine malfunctions.

Your family member with TBI will be evaluated during rehabilitation to see if assistive devices would enhance his or her independence and capabilities.

Find out if the devices being used during inpatient stays should be included in the discharge plan. Devices prescribed by a provider are more likely to be funded by the military, VA, or insurers.

Does My Home Need to be Modified?
Home modifications may be relatively minor and inexpensive, such as installing grab bars, handrails, and lever handles. They may also be major and very expensive, such as:

  • installing elevators or lifts 
  • enlarging doorways to allow wheelchair passage 
  • modifying kitchens for easier meal preparation 
  • installing emergency communication systems

Don’t rush into major modifications because your service member/ veteran’s needs may change over time.

Ask the health care team what, if anything, needs to be done to modify your home before your family member is discharged. You can plan other modifications as his or her rehabilitation continues.

Related Information:
Before the Transition
Assistive Devices
Medication Log
Glossary
Frequently Asked Questions
"In the very beginning, I didn’t want to know anything because I was so scared. But a little while later… the doctors would throw out tidbits to me, like he might never speak again and he might never walk again… but I couldn’t understand why. So then I wanted to understand the part of the brain that was injured and why he was having these symptoms or why he was having this diagnosis." -  Patty H.

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