AARP Eye Center
Older adults and their families often wonder where best to recover after a hip or knee replacement — at home or in a rehabilitation facility?
Increasingly, the answer appears to be in their own home — if the procedure is elective, friends and family are available to help and the patient doesn’t have serious conditions that could lead to complications.
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This trend is likely to accelerate as evidence mounts that recuperating at home is a safe alternative and as hospitals alter medical practices in response to changing Medicare policies.
The newest data comes from a study published this month in JAMA Internal Medicine of 17 million Medicare hospitalizations from 2010 to 2016. All the patients were older adults who went either home or to a skilled nursing facility after a medical procedure or a serious illness. Knee and hip replacements were the most common reasons for these hospitalizations.
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People who were sent home with home health care services demonstrated the same level of functional improvement as those who went to a skilled nursing facility, the study found. (Assessments examined their ability to walk and get up and down stairs, among other activities.) And they were no more likely to die 30 days after surgery (a very small percentage in each group). Overall, costs were significantly lower for patients who went home, while hospital readmissions were slightly higher — a possible sign that home health care services needed strengthening or that family caregivers needed better education and training.
“What this study tells us is, it’s certainly safe to send people home under many circumstances,” said Vincent Mor, M.D., a professor of health services, policy and practice at Brown University’s School of Public Health who wrote an editorial accompanying the study.
The new report expands on previous research that came to a similar conclusion. In 2017, experts from New York City’s Hospital for Special Surgery published a study that examined 2,400 patients who underwent total knee replacements and were discharged to their home or to a skilled nursing facility for rehabilitation between May 2007 and February 2011. There were no differences in complication rates at six months or in functional recovery and patient-reported outcomes at two years.