Welcome to Baptist Health Lexington's
"Joint Replacement Class: The Preparing

for Discharge" module. My name is Sonja
Kellerman, I have been a case manager

of Baptist Health Lexington for 32 years.

I'm excited to share information about
how our orthopedic care team will work

to prepare you for safe discharge
after joint replacement surgery.

So let's get started.

The objective of our program is to prepare
you and your family member or dedicated

coach for a safe discharge plan
based on your individual needs.

In this online learning tool, we
will discuss your needs at home and

your post-hospital rehab needs.

Our goal is for each patient to safely
discharge back to their home after surgery

with home health or
outpatient physical therapy.

The majority of our patients do this but
it all depends on your participation

and the progress
during your hospital stay.

Your orthopedic care team plans for your
discharge home starting on the first day

of your admission to the hospital.

The team coordinates, creates,
and develops a safe discharge plan

that involves your surgeon, medical
physician, case manager, nurse,

and rehab team, which is your
physical and occupational therapist.

We do this directly with you and
your family or dedicated coach.

You will need a family member or
responsible adult to stay with you for one

or two weeks after surgery.

Our goal is for you to return
home with a safe discharge plan.

It is very difficult to manage
recovery alone even if you were very

independent before surgery.

Therefore, if you live alone, it is
very important to have someone,

either your family member or a dedicated
coach, to come to your home every day and

assist with meals, possibly
bathing and dressing.

In order to return home alone, you
have to be able to get out of the bed

and chair independently and be able to
walk to the bathroom on your walker.

Upon your admission, nursing and
members of the orthopedic care

team gather information about your health
and any unique needs to support safety

while at home, and to
develop your discharge plan.

You are involved in these conversations
throughout your hospital stay.

Each day your orthopedic care team,
again, consisting of your surgeon,

medical physician, case manager, nurse,
rehab team, and pharmacists, meet daily

to discuss and address
any needs you may have.

We update our plan that identifies how we
care for you during your hospital stay and

facilitate a timely and safe discharge.

Everyone has input into your care which
improves your safety and helps avoid

negative outcomes such as pain
control or readmission to the hospital.

Most patients are discharged to home
with home health services or home

without patient PT services.

Once you are cleared by your medical
physician, surgeon and physical therapist,

the care team has determined that
you are able to walk safely and ready

for discharge to home.

Most people stay in the hospital
between one and two days.

But that varies with each
patient depending on how each

progresses after surgery.

To prevent longer stays in the hospital,
it's very important to perform all the

instructions prior to surgery as
described in the previous learning tool.

Also, each patient should do their best to
turn cough and deep breathe every two

hours while awake.

Report to and work with the nursing staff
to decrease your pain to a tolerable level

and a functional level, and
ambulate is ordered by the surgeon.

Performing these tasks help patients stay
healthy after surgery and go home sooner.

In some situations, patients are
occasionally discharged home the same

day of surgery. If you're interested in
doing that, please talk to your surgeon,

he or she must go over that for you to go
home early based on how you're doing

and your safety.

Our total joint program's goal is for all
patients to go home with either home

health or outpatient physical therapy.

The case manager meets with each patient
and family member or dedicated coach

to discuss your support or your help at
home, your mobility and the ability

to manage your own care
while you are at home.

They will also discuss any
equipment needs you may have.

Home Health is an in-home therapy
by physical therapists two to three

days per week.

Home Health is an intermittent service,
approximately one hour per visit.

Outpatient therapy is when you go to an
outpatient clinic or a hospital outpatient

physical therapy department
two to three times per week.

If you choose to do outpatient, you
will need someone to drive you.

The case manager will discuss these
services and provide all available options

for you to choose from.

Medicare and most commercial
insurances pay for skilled services from a

home health agency.

Skilled services include physical therapy,
occupational therapy or skilled nursing.

Most of the total hip and knee replacement
surgeries do not require a skilled nursing

visit unless there's something specific
your surgeon wants them to do

or to monitor.

Most patients only require visits
from a physical therapist.

Your surgeon and orthopedic care team help
determine if you need home health services

or outpatient physical therapy services.

Insurance plans do not pay for a personal
caregiver, outpatient physical therapy

visits are usually covered, but the
number of visits may be limited

during a one-year period.

If you're interested in hiring a personal
caregiver, the case manager can provide a

list of agencies that
provide this service.

Please keep in mind, insurances
do not pay for a personal caregiver,

the patient does.

Once again, our goal is for you to return
home with home health or outpatient

physical therapy, as long as
this can be done safely.

Most joint replacements do not need an
inpatient rehab facility after discharge.

If you do need inpatient rehab, your
case manager will view the available

options and assist with any arrangements.

Medicare and many insurances may
pay for a short stay in a rehab facility,

acute rehab facilities or hospitals
that provide rehab services only.

It is the highest level of rehab and you
must be able to participate in up to three

hours of therapy per day.

There are only 11 to 12 acute
rehab facilities in Kentucky.

Skilled nursing facilities, also
called skilled nursing homes, provide

therapy five to six days per week. You
do not have to be able to participate

in three hours per day.

Commercial insurance and Medicare
Advantage plans require insurance approval

prior to transfer.

The insurance plan will review your
ability to ambulate and other factors

to determine approval.

Medicare Advantage plans include
Humana Medicare, Aetna Medicare,

United Medicare, and several others.

These are Medicare plans but the
insurance company requires prior approval

to any transfer to rehab facility.

Traditional Medicare does not require
pre-authorization but does require

an inpatient stay of three days,
and you must meet medical criteria

to stay three days.

There is no way to get insurance approval
to go to a facility prior to your surgery.

It is based on your medical needs
and how you do with physical therapy,

after surgery. It is not based on your
home environment or supported home.

You may need the following equipment:
a rolling walker, elevated toilet seat or

bedside commode, a tub seat or tub bench.

Medicare and insurance typically cover
the cost of the walker. They do not cover

costs for bathroom equipment.

For example, a shower chair tub bench.

Occasionally these companies will cover
cost of a bedside commode if needed.

Your case manager can assist with
arrangements for any equipment

you may need. If you borrow a walker,
have someone bring it to the hospital so

your physical therapist can be
sure it is right for you to use.

Thank you for listening to
this online learning tool.

Please complete the survey after watching
all five videos in order to receive

credit for participating.
Thank you.