Recovery starts the day they come home
The operation takes a few hours. The recovery takes weeks, and most of it happens at home, where there is no call button and no nurse down the hall.
Whether it is a joint replacement, a heart procedure, abdominal surgery or a repair after a fall, the pattern in the first weeks is similar. The person is sore, tired, less steady on their feet and often on medicines that make them drowsy. They may not be allowed to drive, lift, bend or climb stairs. Everyday tasks that took five minutes now take thirty, or need a second pair of hands.
Recovery at home goes best when the plan is made before the surgery, not in the car on the way back from the hospital. This guide covers what to ask, how to set up the house, what to watch for, and how to decide how much help is needed and for how long.
If the surgery is planned, plan the recovery with it
For a scheduled operation you have time, so use it. At the pre-surgery appointment, ask the surgical team:
- How long the hospital stay is expected to be, and whether they expect the person to go straight home or to a rehabilitation or nursing facility first.
- What the person will not be allowed to do, and for roughly how long: driving, lifting, bending, stairs, showering, getting a wound wet.
- Whether someone needs to be with them for the first nights, and whether the team expects therapy or nursing visits at home.
- What equipment they will need, such as a walker, a raised toilet seat, a shower chair or a reacher, and whether it should be in the house before surgery day.
Then book the help before the surgery date. Caregivers and agencies fill their schedules, and arranging care from a hospital bed on a Friday afternoon is harder than doing it two weeks ahead. If the surgery was not planned, our guide to arranging care before a hospital discharge covers how to use the discharge process to get what you need.
Set up the house for the body they will come home with
Assume the person will be slower, stiffer and less stable than usual, and possibly using a walker for the first time. Before they arrive:
- Set up one floor to live on if stairs are a problem: a bed, a chair with firm arms, and a route to the bathroom that does not involve stairs.
- Clear the walkways wide enough for a walker, and take up loose rugs and cords.
- Light the night route from bed to bathroom. Many falls happen on the way to the toilet at night.
- Move everyday things to waist height so nobody has to bend or climb to reach them.
- Stock the kitchen with easy meals and plenty to drink for the first week.
Our guides to what to fix at home before care starts and helping someone move safely at home go into the house and into transfers in more detail.
The first few days are usually the hardest
The first days home often need the most help. Pain may be at its worst, the person may be groggy from anesthesia and pain medicine, and they are learning to move in new ways. This is the period when having someone in the house, especially overnight, matters most. Help is typically needed with getting in and out of bed and chairs, getting to the toilet, washing, dressing, meals, and keeping medicines on schedule.
Bathing deserves its own plan, because the wound may need to stay dry and the bathroom is where people fall. Follow the surgical team's instructions on when showering is allowed, and see our guide to helping someone bathe safely at home.
Medicines after surgery
People often come home with new prescriptions for pain, and sometimes medicines to prevent blood clots or infection, on top of their usual ones. Get a written list at discharge that says which existing medicines to stop, restart or change. Pain medicines can cause drowsiness, confusion and constipation, which raise the risk of a fall; ask what to use for constipation before it becomes a problem. Keep a simple log of what was taken and when, so two people do not give the same dose. Our guide to managing medication at home sets up a system.
Warning signs to know
Ask the surgical team which signs mean calling them and which mean calling 911, and write the answers down. Commonly listed signs to report include:
- Signs of wound infection: increasing redness, warmth, swelling or pain around the wound, drainage that looks like pus or smells bad, or a fever.
- Signs of a blood clot in the leg: new pain, swelling, warmth or redness in one calf or thigh.
- Sudden shortness of breath or chest pain, which can mean a clot has moved to the lungs. Call 911.
- New confusion, especially in an older adult, which can signal infection, dehydration or a medicine problem.
- Pain that is getting worse instead of better, or that the prescribed medicine does not control.
Put the list and the surgeon's phone number on the refrigerator, where anyone helping will see them.
Therapy and nursing at home
Many recoveries include physical or occupational therapy, and some include nursing visits to check a wound or manage a drain. When a doctor orders it and the person is homebound, this can be provided at home by a home health agency, and Medicare and many other insurance plans cover it for a period when their conditions are met. When the person can travel, therapy is often outpatient.
Home health visits are short and skilled. They do not cover the hours in between: getting up, meals, washing, company, and someone there at night. That day-to-day help is home care, and it is usually paid for privately or through other programs. Our guide to home care versus home health care explains the difference.
How much help, and for how long?
There is no standard answer, because it depends on the operation, the person's health before surgery, and who else is in the house. A reasonable way to plan:
- Plan for more help at the start, including overnight if the person lives alone or their partner cannot safely help them up.
- Step down as they improve: from overnight to daytime, from daytime to a few set visits for bathing, meals and errands.
- Agree up front that the schedule is temporary, and ask the caregiver or agency how much notice they need to reduce hours. Agencies often have a minimum visit length.
Our guide to how many hours of care someone needs helps size the plan, and how to pay for in-home care goes through the ways to fund it.
Where do you start?
Ask the surgical team the questions above and write down the answers. Set up one floor of the house before surgery day. Then decide which hours in the first weeks need another pair of hands. If you want a caregiver for those hours, enter the zip code where the person lives on The Care Royal to see independent caregivers and agencies in that area and what they charge. Searching is free for families, and you decide who you hire.
General information for families, not medical advice. Every operation and every recovery is different; follow the instructions from the person's own surgical team. If you think someone is having a medical emergency, call 911.