Returning to the community
When people have been in hospital for acute treatment or from there to a care home for some respite, they will have adapted to those environments and then when they finally come back home, there is some adjustment to do. It seems like a simple thing to do to return home again and that the freedom of being away from an institution would be nothing but positive!
After someone has spent time in an institution, whether hospital or care home, their routine will have been changed to accommodate that of the institution, common changes are around their food and fluid, which is made for them and often at set times. They will also have made their drinks a particular way, such as weak or strong, with or without sugar and for people with a cognitive impairment, it can then become confusing about what is the “normal way” and therefore how they make it for themselves. The food is almost always catered in a particular style and some things, because of the time and/or difficulty of mass catering some types of food become vertically impossible to eat in institutions. So although a person with dementia might not barbeque food for themselves, they would not have eaten it whilst away from home and will have become unaccustomed to eating it, if it is made for them. There may be other foods that they have not eaten for a long time due to being away from home.
Continence can be another issue that will have been managed differently in an institution, in part due to staffing levels, but also because when someone is unwell, they are less active and less likely to do some things for themselves, which would be far easier when they are well. If toileting takes 30-40 minutes, there is often not enough staff to facilitate this multiple times per day, which means that it is easier to manage by pad or sometimes by catheterising the person in the short term. This is then an adjustment to coming back home and having to get to the loo each time there is a toileting urge.
The other thing that is less practical and more ephemeral is just the ability to do what you want when you want. The freedom to make your choices can seem like a big responsibility after having been asked or told what to do and when. For someone with a cognitive impairment, it can seem overwhelming to be expected to make your own choices.
It is important to remember that the return home has happened because the person is feeling better than they were when they went into hospital or respite. They are make capable and physically resourced to manage for themselves than they were when they were acutely unwell. These adjustments to being back at home can take a few hours, days or weeks to adapt to and patience is required when dealing with that person, as coming back home could have stresses that their carer might not have considered.
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