Instead of arguing with an older adult who says, “I don’t want any assistance,” try to follow up by asking “Tell me more. What are you concerned about?” They may reveal there are circumstances at home — perhaps hoarding, perhaps physical neglect — that an older adult doesn’t want someone to see. Or the patient’s cognition is compromised and often, a breakdown in communication is responsible. Patients may have questions and concrete terms; which services would be provided, by whom, for how long, how much it would cost, and what the expected benefit would be. Shame, pride, and the unknown prompt resistance. People really want to feel listened to and validated, not lectured.
The issue I have noticed is many seniors and caregivers confuse “Home Health Care” with “Home Care”. The two types of services are not the same: Home health care is delivered by medical professionals and is available to older adults who are homebound and need intermittent skilled care from a nurse, a physical therapist, or a speech therapist (among other medical providers). Typically, these services last four to six weeks after a hospitalization, with a nurse visiting several times a week. Some patients receive them for much longer. Home Care is delivered by aides who help individuals shower and get dressed, and cook, clean, and serve as a companion. In most cases home care is not covered by Medicare. Once the difference is clearly explained to older adults, the conversation must change when speaking to our elderly. “Look, we think you really need help,” can sound offensive. It is better to say “We want to help you take care of yourself.” I have found the positive way to convey this information is to use plain language. For example: “A nurse will check your medications and make sure they’re all in order. She’ll assess if you need physical therapy to help you regain your strength. She’ll teach you and family members how to care for you once home care is over.”
With these tips and clarity, I firmly believe elderly offered home health care when they’re being discharged from a hospital will be more likely to accept them. Without these services, older adults’ odds of being readmitted to the hospital within 30 or 60 days double, according to one study.