Home Care After a Heart Failure Hospital Stay in Massachusetts

The bathroom scale is the most important piece of equipment in the house. Somebody has to weigh the person every morning, write the number down, and know which number means call the cardiology team today. Done properly that is the single thing most likely to keep somebody out of the hospital, and it takes four minutes a day.

Home health aide care is $45 an hour, one to eight hours a day, no minimum contract and no assessment fee.

What number means something is wrong?

The commonly used thresholds are a gain of more than two or three pounds in a day, or more than five pounds in a week. But the number that matters is the one this person's own cardiology team gives them, because thresholds get set individually. Ask for it, write it on the discharge sheet, and put it where whoever is in the house can see it.

Weigh at the same time each morning, after using the bathroom, before breakfast, in similar clothing. A weight taken after dinner one day and before breakfast the next tells you nothing.

What else is somebody watching for?

• Swelling that is getting worse, usually ankles, lower legs and feet. Shoes that fit on Monday and not on Thursday is information.
• Breathlessness doing ordinary things, or unusual tiredness, that was not there last week.
• Trouble breathing lying flat, or needing more pillows than usual to sleep.
• Waking suddenly at night badly short of breath. That one is not a wait and see.

An aide in the house every morning knows what yesterday looked like, which is the whole point. A family member visiting on Sunday is comparing against last Sunday and will miss a four day slide.

Can an aide do the weights and the monitoring?

Yes, and this is one of the places where an aide earns their money. Weighing, writing it down, keeping the log, noticing the ankles, and calling you when the number moves are all squarely within what an aide does.

What they cannot do is administer medication or make a clinical judgment. Our aides are trained, background checked and insured but they are not nurses. They can be present while a client takes their own medication, help if something goes wrong, and call for help. They report what they see to you and to the care team. They do not decide what it means, and they do not adjust anything.

What about the water pill?

The practical issue nobody warns families about is timing. A diuretic taken in the morning means several urgent trips to the bathroom over the following hours, which matters for two reasons. It is a fall risk if the person is rushing, and it makes mid morning appointments genuinely difficult.

So schedule around it rather than fighting it, and have somebody in the house during that window rather than at noon. If the person is skipping doses to avoid the bathroom problem, which happens constantly, tell the cardiology team rather than letting it continue quietly.

Is the cooking really that important?

Yes, and it is the most underrated part of the job. Sodium is where heart failure diets are won or lost, and almost none of it comes from the salt shaker. It comes from canned soup, deli meat, bread, frozen meals, restaurant food and anything in a jar.

A person living alone on convenience food cannot follow a low sodium diet no matter how committed they are, because the sodium is already in the food before they touch it. An aide who shops and cooks fresh changes that in a way no amount of education does. Ask the cardiology team or a dietitian for the specific target, since it differs, and tell us what they said.

When does this matter most?

The month after a discharge. Heart failure has one of the highest readmission rates of any condition and the readmissions cluster in those first weeks, usually following exactly the pattern above: weight creeping up, swelling, breathlessness, then an ambulance.

So buy the first month properly and then reassess. Three or four hours each morning for the first few weeks covers the weight, the breakfast, the bathing and a cooked meal. Four hours a day is $180, which is about $5,460 for a month. If that is more than the budget allows, three mornings a week at three hours is around $1,170 a month and still gets the scale read by somebody who knows what they are looking at.

Are there appointments to plan for?

A follow up with cardiology within a week or two of discharge is usual, and missing it is one of the more reliable predictors of ending up back in hospital. Ask your town's Council on Aging about free or low cost medical rides, and if the person is on MassHealth, ask about a PT-1 form for a non emergency medical ride.

Also ask the hospital whether cardiac rehabilitation has been ordered, because it is an established program that most people who qualify for never actually attend, usually for want of a ride.

What pays for the hours?

Medicare may send a nurse or therapist for a limited period after the hospital stay if a doctor orders it and the person is homebound. That is visits, not coverage, and the aide hours are custodial care which Medicare has never paid for. Check a long term care policy, Veterans Aid and Attendance, and your local Aging Services Access Point, which runs an income based state home care program.

Care Remedy serves eastern and central Massachusetts from offices in Woburn, Brockton and Springfield. Call 781-957-8076 with the discharge date and tell us whether there is a scale in the house.

This is general information about care at home and not medical advice. Weight thresholds, sodium and fluid targets, medication and what to do about a symptom come from the treating cardiology team.