Home at Last

Written by Bonnie Irving

This article first appeared here: http://news.fraserhealth.ca/News/April-2015/Home-at-last.aspx

When Haresh Bhatt was dining out in Vancouver on May 6, 2014, he and his family would have had no idea that the sudden tingling on his left side would end up having such devastating consequences for all of them – or that it would take five long months before Haresh would sleep in his own bed again.

home-at-last

That tingling heralded a massive stroke for the 50-year-old Coquitlam entrepreneur. Paramedics rushed the barely conscious Haresh to Vancouver General Hospital where he spent five days in the intensive care unit before being transferred to an inpatient ward, where he remained for the next two months, unable to communicate and with little or no movement on his left side. Once stable, on July 10 he was transferred to Royal Columbian Hospital (RCH).

Over the next month in RCH, Haresh showed some neurological improvement, but was still having difficulty communicating beyond one or two soft-spoken words. He needed help with all the activities of daily living – eating, toileting and grooming – and required two people to use a lift to get him up.
With these deficits, on July 31 Haresh was transferred to the high-intensity rehabilitation unit at Eagle Ridge Hospital (ERH) where his length of stay would be determined not only by his progress but also by a clinical assessment of his potential for progress. In this unit the care team, comprising nurses and allied health professionals, worked with Haresh to determine a rehabilitation plan of care including his goals to regain independence.
While his family naturally hoped he could regain much of his previous level of function, the rehab care team had a more modest goal at the outset – to help him improve his sitting posture and to propel himself in a wheelchair. If achieved, this would give him an important measure of independence for the future.
After a month of rehab at Eagle Ridge, Haresh did show some improvement, particularly in his ability to answer questions and to follow brief instructions. However, he still needed help with all his daily activities, and he still required two people and a lift to transfer to a wheelchair. His care team determined that he had progressed as far as he could on their unit.
The question now: could he go home given the amount of assistance he would need or was he more appropriately destined for residential care?
To find out, on September 3 he was transferred to the ERH Patient Assessment and Transition to Home (PATH) unit for an assessment. Depending on the outcome, this move might take him another step closer to home – where he wanted to be and where his care providers knew he would do best. If it was possible, the PATH team and their Home Health colleagues could help make that happen. After all, Fraser Health is the pioneer of the ‘Home is Best’ philosophy in BC.

Home is Best in Action

Like all families in this situation, Haresh’s wife, Hema, and their two daughters were struggling to come to grips with the effects of the stroke on their lives. They didn’t understand why their husband and father had been discharged from the rehab unit before he had recovered.
Those concerns brought Haresh and his family into contact with PATH Manager Irene Cheung. “I explained to Mrs. Bhatt that what was best for her husband was not more time in hospital, with all the risks for someone in his condition,” says Cheung, “but to go home and work with a plan to improve his function as much as possible.”
Gradually Hema Bhatt came to accept that home would be the best place to continue his recovery. “Patients need to go home to be near loved ones and that alone jumpstarts the healing process,” she says today.
Although Cheung was sure Haresh’s chances of improving would increase at home rather than in residential care, she was not sure she could actually get him there. “He was assessed as functioning at a residential care level and he still needed two people to lift him,” she says.
“But the PATH and Home Health teams were determined to get him home,” says Cheung, “and everybody just did whatever they had to do to make it happen.”
Together the PATH and Home Health occupational therapists assessed one of the areas of greatest concern – the modifications Haresh’s home might need to accommodate his changed circumstances. They concluded he needed a non-standard wheelchair to fit narrow doorways, a ceiling lift, a special mattress, a commode, and a bathroom renovation. The solution: the Red Cross could lend the equipment as part of the HELP program and the family would do the necessary renovations.

As well, the community care professional managing Haresh’s discharge planning had determined that Haresh’s extensive care needs would not fit a regular home support schedule. Fortunately, thanks to a government funding initiative called Home First, Fraser Health was able to augment the hours of home support needed for his daily activities. Private services would be needed as well, and the costs of those would fall to the family.
The Home Health program also brought in Fraser Health’s Acquired Brain Injury (ABI) program. Depending on the needs of the patient, ABI’s health professionals and life skill workers can assist patients in their recovery.

Home At Last

By October, every detail had been worked out to facilitate Haresh’s return home, and on October 8, 2014, he was discharged into the care of what Irene Cheung describes as “his strong, supportive family.” His level of function remained about the same as when he was admitted to PATH, says Cheung, but he appeared unfazed by his situation.
For Hema Bhatt, “the fear and all the uncertainties of bringing Haresh home and how we would manage was difficult,” she says.
“But it helped that we had a structured plan and that Fraser Health had helped us organize all the items required – from food to diapers to other health care items including equipment. Having a case manager to listen and guide us was also very helpful.”
Haresh left hospital with an exercise plan created by the PATH physiotherapist as well as information about safety systems such as Lifeline Medical Alert and community resources such as HandyDART.
The family immediately hired a private company to provide physio three times a week until Fraser Health was able to step in three months later. “From then on he started to build strength,” says Hema, “and was able to sit on the side of the bed with the support of a pole.”

Within a few days of discharge, a community care nurse from PATH visited Haresh to assess the home support plan and to adjust the hours of support if necessary. This service is being piloted to ensure the patient and family are coping and to prevent unnecessary readmissions. Within two weeks another Home Health outreach worker visited Haresh to assess the overall situation.
Since he has left hospital and returned home, Hema says there has been a “significant change” in her husband, which she attributes to “the familiar home setting, where children and family and friends come by, chatting and laughing with him.”
Says Hema: “We would have breakfasts and dinners together as a family and encourage conversation with him. He could see us around all the time and we took turns using the iPad and computer with him to watch videos of our vacations and birthday parties, and look at photo albums. Best of all, he could smell the food that was cooking and say ‘Smells good, I’m getting hungry.’”
The community care professional who oversaw Haresh’s case was present six months later when Haresh stood for the first time since his stroke. “It was pretty emotional for the family, and for me,” says Julie Ott. He is now able to transfer without the use of the lift and is able to lift his left leg.

Looking back

Hema Bhatt wishes the events of May 6 had never happened. At the very least she hopes Haresh will regain most of his functions over time. But this journey has taught her that happy endings are not always that neat. For her and her family, having Haresh home is happy ending enough for now.
Says Hema: “In theory it is an overwhelming process for the family, but with help and home health services provided, it all comes together.”

By | 2017-02-16T14:59:48+00:00 September 8th, 2016|Newsletter|0 Comments

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