Are your bedbound (or total care) homecare patients usually forced into LTC?

[jm_emt]

As a home care nursing aide, I found it nearly impossible to transfer many total care patients out of bed. This is especially true when they had painful conditions such as metastatic cancer or orthopedic issues.

Since being bedbound is so dangerous from a medical standpoint (problems: pressure ulcers, hypostatic pneumonia, UTI, contractures, loss of muscle strength/mass, excess fluid in the airway, depression, etc.), it would seem that these pts would be forced into long term care pretty quickly.

I wonder if forced institutionalization happens to most of these patients, or do bed-bound patients just spend weeks and months confined to the bed, and become more and more debilitated until they wind up in the hospital or in Hospice care?

[Rose_Queen, BSN, MSN, RN]

My maternal grandmother spent 5 years in a hospital bed in what used to be her parlor after a series of strokes. We had a hoyer lift in the house and a motorized wheelchair. She had to be fed as she wasn't able to do it herself. She had a foley as she was unable to control her bladder. No, she wasn't forced into a nursing home- in fact, Medicare paid for in home care for her and my grandfather following a hip fracture because it was actually less expensive. Before my grandfather's hip fracture, there was a cadre of family members who did the care- my grandfather was still, at 80, a very independent and strong man. He wasn't able to get my grandmother in and out of bed with the hoyer, but he was able to take care of cooking meals, feeding her, and managing her medications.

I truly think it's a combination of factors: family involvement and support, where money is coming from, and what is more economical.

[jm_emt]

It seems that unless there is lots of family caregiver support, many patients would be forced into LTC.

[Libby1987]

They can't be forced unless they're deemed incompetent and conserved. Most aren't in my experience and you have to fail at home, which often lands them repeatedly in the ED until they're finally transferred to LTC.

[Not_A_Hat_Person, RN]

My state is moving toward managing more and more chronically ill, bedfast patients at home. It's cheaper for the feds and more comfortable for the patients. One requirement is that 2 family members can provide the necessary care if nursing staff is not available.