during the crucial first 2 weeks after surgery.
1. Home assessment
What kind of home does the patient live in? Are there a lot of stairs?
Is there a lot of clutter? Is there a caregiver who's up to the task?
These and other questions need to be answered well before the day of
surgery. You don't want to do a total joint and send a patient into an
unsafe environment. So our evaluation starts with a pre-surgical visit
by a therapist 2 to 3 weeks before surgery — someone who clearly
understands what the patient is going to be going through those first
days of recovery, and who can spot issues that a patient wouldn't nec-
essarily recognize. Do pathways need to be widened? Is the bed on
the same level as the bathroom? What kinds of stairs is the patient
going to have to deal with, and how often?
We know our therapists will work with our patients and make good
suggestions about improving the home setup — How about if we
move this couch out of here, and move this bed into this room? That
first visit is early enough to ensure that therapists have the time and
opportunity to rearrange furniture or whatever else is needed to make
the environment safe.
That initial home visit also plays a big part in our decision-making
process. After we put in a referral, our agency visits the patient and
reports back to us with a form that touches on all of the important
variables. Our decision as to whether to do the surgery inpatient or
outpatient is based not just on the patient's health history and comor-
bidities, but also on the therapist's feedback.
2. Welcoming care
The next important visit is on the day of surgery. We give the agency a
heads-up when a patient is leaving our facility, and they send a thera-
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