1. Going Straight Home
The plan: Best for a quick recovery, where no specialized ongoing medical care is needed.
What to know: Follow your discharge plan carefully and lean on family for support.
2. Home With Help
The plan: Patient needs some assistance but not 24/7 care.
What to know: Physical, occupational, or speech therapists, nurses, and home aides can come to you.
3. Skilled Nursing Facility
The plan: The patient needs daily therapy or medical monitoring, along with dedicated care.
What to know: Short-term rehab stays provide 24/7 care and rehab in one place.
4. Inpatient Rehab Hospital
The plan: Patient needs specialized and focused care with intense daily therapies to regain strength and mobility.
What to know: When someone is facing a more difficult recovery, this focused option creates a holistic care solution that makes sure that all aspects of care are included in the plan.
Still unsure? That’s where a professional Aging Life Care Manager® from our team can help by making sure the care plan looks at the whole picture, not just the diagnosis. Reduce the stress of all involved and move towards regained health, strength, mobility, and wellness.
Maria’s Journey After a Brain Aneurysm: Making a Discharge Plan and Taking the Next Steps
Last month, we shared how Maria came through a successful surgery after a ruptured aneurysm and began her long road to recovery. With her daughter Sofia and their Aging Life Care Manager® by her side, the next steps were already being carefully planned.
A Big Step Forward
Maria’s strength and determination surprised everyone. She was healing faster than most patients who had experienced similar trauma. As soon as she could sit up and speak clearly, Maria made her wishes known.
“I want to go home,” she said firmly from her hospital bed.
Her care manager and Sofia had already been working together to find the right rehabilitation facility. They secured a bed at an acute inpatient rehab center known for helping patients like Maria recover their independence. Even so, Maria was anxious. She wanted her own bed, her own home, her plants, her routines.
When the surgeon visited her new regular hospital room, Maria repeated her request to go home. The surgeon, patient and kind, sat down beside her.
“You are doing incredibly well,” he said. “But going straight home would be risky. Rehabilitation will help you build the strength and skills you need to stay home safely for a long time.”
The care manager was there, listening and offering quiet encouragement. The surgeon smiled and nodded toward her.
“Trust the process. We all want you to be able to go home as quickly as possible and we are also making sure that everything is being done with your wishes in mind. But we need to provide additional care for you before you can be safe at home.”
After a long pause, Maria finally agreed. She would take this next step if it meant getting back home on her own terms.
Preparing for the Move
Over the next two weeks, Maria continued healing in the hospital. Meanwhile, Sofia and the care manager made all the necessary preparations.
- Transportation was arranged through a trusted company.
- Sofia visited Maria’s home to gather her favorite clothes, her skincare items, her favorite pillow, and even two beloved plants to brighten her rehab room.
On the day of discharge, everything came together smoothly.
The hospital discharge planner reviewed the final paperwork. The ambulance arrived right on time. Sofia was able to ride with her mother, providing comfort and support for the short trip.
The care manager drove separately, meeting them at the rehab center.
When Maria arrived, a welcoming team of nurses, aides, and therapists greeted her. Everyone made sure she felt at ease as she settled into her new room. One of the most impressive things they did was make sure she had some nice cold water to drink after her trip. She gave a thumbs up to Sofia indicating that she appreciated the gesture.
Standing in the doorway, Sofia turned to the care manager with tears in her eyes. “This has been so peaceful,” she said. “I can’t imagine doing this without you.”
With the next phase of recovery underway, Maria was surrounded by care, determination, and love.
In our next chapter, we will follow Maria as she works hard in therapy, determined to reclaim her independence and finally make her way home.
Read the previous installments of Maria’s story!
Follow Maria’s story to its conclusion: