Joint PREP ClassJoint PREP ClassShoulder ReplacementShoulder Replacement

T. Andrew Israel, MDT. Andrew Israel, MD

Luther Midelfort Orthopaedic & Luther Midelfort Orthopaedic & Sports Medicine CenterSports Medicine Center

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Goals for you and your familyGoals for you and your family

Recognize shoulder replacement is a Recognize shoulder replacement is a

reliable operation to improve quality of life reliable operation to improve quality of life

Describe what to expect of the shoulder Describe what to expect of the shoulder

replacement procedure.replacement procedure.

Discuss the risks of shoulder replacement Discuss the risks of shoulder replacement

surgery.surgery.

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Goals of Your Shoulder Goals of Your Shoulder ReplacementReplacement

Improve your quality of life by:Improve your quality of life by:

Relieve your painRelieve your pain

Improved motionImproved motion

Improved strengthImproved strength

Better functionBetter function

Shoulder Joint ReplacementShoulder Joint ReplacementIndicationsIndications

Bone on bone Bone on bone

osteoarthritisosteoarthritis

Intact rotator cuff Intact rotator cuff

tendonstendons

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Shoulder ArthritisShoulder Arthritis

Loss of Loss of

cartilage cartilage

leads to leads to

narrowing narrowing

of the joint of the joint

spacespace

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Shoulder ArthritisShoulder Arthritis

As the As the

cartilage cartilage

wears, bone wears, bone

spurs form spurs form

and the and the

shoulder shoulder

becomes becomes

stiffstiff

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Surgical Technique of Total Surgical Technique of Total Shoulder ReplacementShoulder Replacement

Replaces the worn Replaces the worn

bony surfaces with bony surfaces with

metal ball and plastic metal ball and plastic

socket (glenoid)socket (glenoid)

Restores shoulder Restores shoulder

motion and stabilitymotion and stability

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Implant MaterialsImplant Materials

A plastic socketA plastic socket

A Metal ball attached to a stemA Metal ball attached to a stem

-Non-cemented press fit into the -Non-cemented press fit into the

humerushumerus

oror

- Bone cement is used to cement - Bone cement is used to cement

the stem into the humerusthe stem into the humerus..

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Implant MaterialsImplant Materials

A plasticA plastic socket socket is is

cemented into the cemented into the

glenoid. glenoid.

A A metal ball and metal ball and

stem stem goes down into goes down into

the humerus.the humerus.

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HemiarthroplastyHemiarthroplasty

A metal ball and A metal ball and

stem goes down stem goes down

into the humerus.into the humerus.

No plastic socket No plastic socket

is placedis placed. .

Reverse Total Shoulder Reverse Total Shoulder IndicationsIndications

Completely torn Completely torn

rotator cuff with rotator cuff with

severe arthritissevere arthritis

Complex fracturesComplex fractures

Previous failed Previous failed

shoulder replacementshoulder replacement

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REVERSE TOTAL SHOULDERREVERSE TOTAL SHOULDER

Socket and ball are Socket and ball are

reversedreversed

- Humeral head (ball)- Humeral head (ball)

becomes thebecomes the

socketsocket

- Glenoid (socket) - Glenoid (socket)

becomes the ballbecomes the ball

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Surgical TechniqueSurgical TechniqueIncisionIncision

The incision is made in the front of the The incision is made in the front of the

shoulder shoulder

Your surgeon will make the incision long Your surgeon will make the incision long

enough to see the joint area enough to see the joint area

Your surgeon will use techniques to spare Your surgeon will use techniques to spare

musclemuscle

Surgical techniques continue to improve as Surgical techniques continue to improve as

technology advancestechnology advances

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Day of SurgeryDay of Surgery

Your surgeon will meet you in SurgiCenter Your surgeon will meet you in SurgiCenter

to initial your shoulder and answer final to initial your shoulder and answer final

questions.questions.

Family can wait with you in SurgiCenter.Family can wait with you in SurgiCenter.

You will go to the Operating Room (OR) You will go to the Operating Room (OR)

Surgery lasts 2Surgery lasts 2 hours.hours.

You will then go to the recovery room for 1-2 You will then go to the recovery room for 1-2

hours.hours.

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After Surgery in the Hospital After Surgery in the Hospital

Physical & Occupational Therapy is critical for a Physical & Occupational Therapy is critical for a

good outcomegood outcome

Therapy starts the day after surgeryTherapy starts the day after surgery

- Wear an arm sling immobilizer full time for 4 - Wear an arm sling immobilizer full time for 4

weeksweeks

- No forceful contraction of muscles such as - No forceful contraction of muscles such as

pushing up out of chair or bed.pushing up out of chair or bed.

- Follow the exercise program set up for you 4-5 - Follow the exercise program set up for you 4-5

times a day for 4-6 weeks.times a day for 4-6 weeks.

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Shoulder precautionsShoulder precautions

Do not overdo it! Early overuse may result in severe Do not overdo it! Early overuse may result in severe

limitations of motionlimitations of motion

Do not lift anything heavier than a glass of water for Do not lift anything heavier than a glass of water for

the first 6 weeks the first 6 weeks

Do not participate in contact sports or any repetitive Do not participate in contact sports or any repetitive

heavy lifting after your shoulder replacement.heavy lifting after your shoulder replacement.

Avoid placing your arm in any extreme position for Avoid placing your arm in any extreme position for

the first 6 weeksthe first 6 weeks

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Other Doctors in the hospitalOther Doctors in the hospital

Additional Doctors take care of non-orthopedic Additional Doctors take care of non-orthopedic

issues (such as high blood pressure or diabetes).issues (such as high blood pressure or diabetes).

If you have an Internal Medicine doctor here, they If you have an Internal Medicine doctor here, they

will see you after surgery. will see you after surgery.

If your regular doctor does not see patients in the If your regular doctor does not see patients in the

hospital, a Hospitalist will see you after surgery.hospital, a Hospitalist will see you after surgery.

If you are not getting a medication you think you If you are not getting a medication you think you

should, please ask.should, please ask.

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Blood Clot PreventionBlood Clot Prevention

Enteric coated aspirin 325 mg twice a day while in Enteric coated aspirin 325 mg twice a day while in

hospital to prevent blood clots. Continue at home hospital to prevent blood clots. Continue at home

for 3 weeks.for 3 weeks.

TED hose worn for 3 weeks after surgery, you may TED hose worn for 3 weeks after surgery, you may

remove these at night.remove these at night.

SCDs (calf squeezers) are on in the hospital SCDs (calf squeezers) are on in the hospital

whenever you are in bed.whenever you are in bed.

Exercising your legs and being up and walking Exercising your legs and being up and walking

promotes blood flow.promotes blood flow.

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Risks of SurgeryRisks of SurgeryAnesthetic ComplicationsAnesthetic Complications

Anesthesia providers meet with you the day of Anesthesia providers meet with you the day of

surgery.surgery.

They discuss anesthetic options including nerve They discuss anesthetic options including nerve

blocks for postoperative pain relief.blocks for postoperative pain relief.

Nausea and vomiting are common but more serious Nausea and vomiting are common but more serious

side effects or complications may occur.side effects or complications may occur.

Please tell the anesthesia provider of any past Please tell the anesthesia provider of any past

experience with anesthesiaexperience with anesthesia..

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Risks of SurgeryRisks of SurgeryBlood ClotsBlood Clots

Lower risk for blood clots with total Lower risk for blood clots with total

shoulder replacementshoulder replacement

Clots can go to the lungs and be fatalClots can go to the lungs and be fatal

Your risk is reduced to <1% if treated with Your risk is reduced to <1% if treated with

medication (aspirin) and TED hose medication (aspirin) and TED hose

Being active and walking helps to prevent Being active and walking helps to prevent

blood clotsblood clots

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Risks of SurgeryRisks of SurgeryInfectionInfection

You will get antibiotics at the time of surgery You will get antibiotics at the time of surgery and for 24 hours after surgery.and for 24 hours after surgery.

Surgeons, assistants and scrub techs wear Surgeons, assistants and scrub techs wear “spacesuits”.“spacesuits”.

Using all precautions, risk of infection is Using all precautions, risk of infection is ~1%.~1%.

Infection may occur months or years after Infection may occur months or years after surgery.surgery.

Infection may mean removal of your Infection may mean removal of your implantsimplants..

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“ Spacesuits worn during surgery”

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Risks of SurgeryRisks of SurgeryBlood lossBlood loss

Bony surfaces bleed during surgery.Bony surfaces bleed during surgery.

There may be some bleeding after surgery.There may be some bleeding after surgery.

Your surgeon may use a drain in the Your surgeon may use a drain in the shoulder shoulder

Your blood count will be checked each Your blood count will be checked each morning after surgery.morning after surgery.

If you have symptoms from a low blood If you have symptoms from a low blood count, you may need a blood transfusion.count, you may need a blood transfusion.

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Risks of SurgeryRisks of SurgeryMedical ComplicationsMedical Complications

Surgery is a stress to your body.Surgery is a stress to your body.

Heart and lung problems, stroke, stomach Heart and lung problems, stroke, stomach problems, constipation - all may occur.problems, constipation - all may occur.

A physical with your regular doctor and an A physical with your regular doctor and an EKG are required before surgery.EKG are required before surgery.

Despite precautions, unforeseen medical Despite precautions, unforeseen medical complications may still occur.complications may still occur.

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Risks of SurgeryRisks of SurgeryDislocationDislocation

This is an artificial joint and may slip out of This is an artificial joint and may slip out of joint.joint.

If it does dislocate, this often requires a trip If it does dislocate, this often requires a trip to the hospital to have the shoulder put to the hospital to have the shoulder put back in place.back in place.

You may be required to wear a brace if it You may be required to wear a brace if it dislocates.dislocates.

Multiple dislocations may require revision Multiple dislocations may require revision surgery to fix the problem.surgery to fix the problem.

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Risks of SurgeryRisks of SurgeryNeed for RevisionNeed for Revision

We encourage patients to wait as long as We encourage patients to wait as long as possible before replacement.possible before replacement.

Implants wear with time..Implants wear with time..

Wear rate is about 1% a yearWear rate is about 1% a year

Revision surgery may involve changing the Revision surgery may involve changing the plastic or changing one or all metal parts.plastic or changing one or all metal parts.

Revision surgery is more challenging with a Revision surgery is more challenging with a more difficult recovery.more difficult recovery.

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Recovery timeRecovery time

3-4 months: ‘normal’ activity3-4 months: ‘normal’ activity

6 months: ‘normal’ endurance6 months: ‘normal’ endurance

12 months: maximal recovery12 months: maximal recovery

Focus on exercises for movement and Focus on exercises for movement and then strength then strength

Getting back to work is individual- Getting back to work is individual- check with your surgeon check with your surgeon

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SummarySummary

Shoulder replacement is a reliable operation Shoulder replacement is a reliable operation to improve quality of life with less pain, to improve quality of life with less pain, improved motion, strength and better improved motion, strength and better function.function.

As with any operation, there are associated As with any operation, there are associated risks.risks.

All of the precautions we take are to minimize All of the precautions we take are to minimize risk and to provide for a “routine” operationrisk and to provide for a “routine” operation

Joint PREP ClassJoint PREP Class

PPatientatient RResource and esource and EEducation ducation

PProgramrogram

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Goals for you and your familyGoals for you and your family

Discuss steps to take to get ready for the Discuss steps to take to get ready for the surgical proceduresurgical procedure

Discuss what to expect of the surgical Discuss what to expect of the surgical experienceexperience

Recognize why it is important for you to Recognize why it is important for you to participate in your plan of careparticipate in your plan of care

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Plan Ahead Plan Ahead

Appointments: Appointments: Your regular doctor for pre-surgery;Your regular doctor for pre-surgery;Blood work, EKG, Physical exam, discussBlood work, EKG, Physical exam, discussmedicationsmedicationsYour surgeon for final discussion and updateYour surgeon for final discussion and updateStop smoking – talk to your regular doctor to Stop smoking – talk to your regular doctor to

get helpget help

Call your surgeon if you get a fever, cold, Call your surgeon if you get a fever, cold, infection or rash before your surgery dateinfection or rash before your surgery date

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Plan AheadPlan Ahead

Plan for your return homePlan for your return home

Identify who will take care of you after Identify who will take care of you after surgery; Plan for about 2 weekssurgery; Plan for about 2 weeks

Identify who will assist you with shoulder Identify who will assist you with shoulder exercises for 4-6 weeksexercises for 4-6 weeks

Practice daily activities Practice daily activities notnot using the arm using the arm affected by surgeryaffected by surgery

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Plan Ahead (cont)Plan Ahead (cont)

Simplify meals. Plan for 2 weeks of easy or no Simplify meals. Plan for 2 weeks of easy or no preparation meals preparation meals

Pick up throw rugs and other hazards that may cause Pick up throw rugs and other hazards that may cause you to trip.you to trip.

Place frequently used items in convenient locations…Place frequently used items in convenient locations…not too high or not too lownot too high or not too low

Any planned dental work should be finished about 2 Any planned dental work should be finished about 2 weeks before your surgery dateweeks before your surgery date

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What to bring to the hospitalWhat to bring to the hospital

Loose comfortable clothing to wear homeLoose comfortable clothing to wear home

Non skid comfortable shoesNon skid comfortable shoes

Personal items: toiletries, books etc.Personal items: toiletries, books etc.

Medication list, inhalers, C-PAP maskMedication list, inhalers, C-PAP mask

Prepaid long distance calling card (optional) Prepaid long distance calling card (optional) Cell phones are not allowed to be used in Cell phones are not allowed to be used in the patient roomsthe patient rooms

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What not to bring to the What not to bring to the hospitalhospital

Valuables/JewelryValuables/Jewelry

Credit cards, check book or large Credit cards, check book or large sums of moneysums of money

Your medications (except inhalers)Your medications (except inhalers)

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The day before surgeryThe day before surgery

A SurgiCenter nurse will call you to:A SurgiCenter nurse will call you to:

Review your medicationsReview your medicationsTell you what medications to take Tell you what medications to take

and not take the day of surgeryand not take the day of surgeryReview eating, drinking and Review eating, drinking and

smoking restrictionssmoking restrictionsGive hygiene instructions Give hygiene instructions Tell you what time to arrive at Luther Tell you what time to arrive at Luther

HospitalHospital

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Day of surgeryDay of surgery

Take medicationsTake medications

at home as at home as

instructedinstructed

Check in atCheck in at

Luther Hospital Luther Hospital

Registration DeskRegistration Desk

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Day of Surgery Day of Surgery (continued)(continued)

You will be taken to the SurgiCenterYou will be taken to the SurgiCenter

You will be asked your name and date You will be asked your name and date of birth by everyone who has contact of birth by everyone who has contact with you – this is done for your with you – this is done for your safetysafety

Family and Friends are welcome. Try Family and Friends are welcome. Try to limit to 2 people on day of surgeryto limit to 2 people on day of surgery

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SurgiCenterSurgiCenterNursing admission in the SurgiCenter- We will ask Nursing admission in the SurgiCenter- We will ask

you many questions and get you ready for your you many questions and get you ready for your surgerysurgery

Leg squeezersLeg squeezers

and TED hose and TED hose appliedapplied

Anesthesia visit Anesthesia visit

Surgeon visitSurgeon visit

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Leg Squeezers – SCDs Leg Squeezers – SCDs

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Going to the Operating Going to the Operating RoomRoom

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Operating Room (OR)Operating Room (OR)

MonitorsMonitors

AnesthesiaAnesthesia

Surgical scrubSurgical scrub

Foley catheter Foley catheter

Staff will Staff will communicate to communicate to your family if the your family if the surgery is longer surgery is longer than 2-3 hoursthan 2-3 hours

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Recovery Room/Post Recovery Room/Post Anesthesia Care Unit (PACU)Anesthesia Care Unit (PACU)

Your nausea and Your nausea and pain are managed pain are managed as you awakenas you awaken

When you are When you are ready, you will be ready, you will be transferred to a transferred to a hospital roomhospital room

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Arrival in your Hospital Arrival in your Hospital RoomRoom

You will have…You will have…

Oxygen Oxygen

An IV An IV

Your affected arm will be in a shoulder Your affected arm will be in a shoulder immobilizer after surgeryimmobilizer after surgery

(May) have a foley catheter(May) have a foley catheter

A pulse oximeter – a device that fits on your A pulse oximeter – a device that fits on your finger to measure blood oxygen levelfinger to measure blood oxygen level

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Pulse OximeterPulse Oximeter

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Arrival in your Hospital RoomArrival in your Hospital Room(continued)(continued)

We will check on you, We will check on you, take your vital signstake your vital signs

You will be able to start You will be able to start drinking and eating drinking and eating when readywhen ready

Activity as you tolerateActivity as you tolerate

Help you with control of Help you with control of pain and nauseapain and nausea. .

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Pain ManagementPain Management

It is vital for you to describe your pain and where it is located.

Rate your pain: The Pain Scale0—1—2—3—4—5—6—7—8—9—10NO MODERATE WORSTPAIN PAIN POSSIBLE PAIN

We must work together to treat your pain-what makes it better/worse?

Using medication, deep breathing-relaxation, distraction, position change are some ways to help manage pain and discomfort

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After Shoulder SurgeryAfter Shoulder Surgery

The nurse will check your bandage on your The nurse will check your bandage on your shouldershoulder

Report any soreness, numbness or tingling in Report any soreness, numbness or tingling in your arm or fingers to the nurseyour arm or fingers to the nurse

Ice will be applied to your shoulder to reduce Ice will be applied to your shoulder to reduce pain and swellingpain and swelling

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Post operative dayPost operative day

You will have….You will have….

Blood workBlood work

MedicationMedication

For pain control For pain control

Aspirin 325 mg for blood thinning to Aspirin 325 mg for blood thinning to prevent blood clotsprevent blood clots

Activity – Occupational and/or Physical TherapyActivity – Occupational and/or Physical Therapy

You are a Partner in your care!You are a Partner in your care!

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Discharge PlanningDischarge Planning

You will be discharged home from the You will be discharged home from the hospital when:hospital when:

Your medical condition is stableYour medical condition is stable

You are able to manage safely at home with You are able to manage safely at home with assistance assistance

You are able to do your exercises safelyYou are able to do your exercises safely

Your pain is under acceptable controlYour pain is under acceptable control

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Post operative day/Discharge Post operative day/Discharge dayday

The person who will be taking care of you after you The person who will be taking care of you after you go home needs to come to the hospital to learn go home needs to come to the hospital to learn about:about:

Safety Safety

Exercises – Therapy Exercises – Therapy

When and how to use When and how to use shoulder immobilizer, slingshoulder immobilizer, sling

Lifting restrictionsLifting restrictions

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Day of Discharge cont’Day of Discharge cont’Prepare for discharge to home or transitional care Prepare for discharge to home or transitional care

Receive discharge instructions for:Receive discharge instructions for:

Incision care/bathing instructions to keep incision Incision care/bathing instructions to keep incision clean and dryclean and dry

Icing and how to keep swelling downIcing and how to keep swelling down

How to take pain medications correctly How to take pain medications correctly

Continuing aspirin 325 mg at home for blood Continuing aspirin 325 mg at home for blood thinning for 3 weeksthinning for 3 weeks

Wearing TED hose for 3 weeksWearing TED hose for 3 weeks

When to contact your SurgeonWhen to contact your Surgeon

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To control swelling and pain at To control swelling and pain at homehome

Apply ice to your shoulder Apply ice to your shoulder afterafter exercises (do exercises (do not apply heating pad) for 4-6 weeks as directednot apply heating pad) for 4-6 weeks as directed

Pain medication as directed especially before Pain medication as directed especially before exercisesexercises

Physical therapy/exercises as directed Physical therapy/exercises as directed Elevate and support your hand and arm on Elevate and support your hand and arm on

pillows above the level of the heart when at restpillows above the level of the heart when at rest

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After DischargeAfter DischargeA person to care for you will need to be A person to care for you will need to be

available 24 hours a day to:available 24 hours a day to:assist you at home the first two weeksassist you at home the first two weeksdrive you to appointmentsdrive you to appointmentsencourage you in your home exercise encourage you in your home exercise

programprogram

Change your incision dressing every dayChange your incision dressing every day

Wear the immobilizer sling for 4 weeks, Wear the immobilizer sling for 4 weeks, according to your surgeon’s directionsaccording to your surgeon’s directions

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BathingBathing

1. You may 1. You may showershower when your incision when your incision is dry (no drainage) is dry (no drainage) Support your arm Support your arm as directed by as directed by therapy therapy

2. 2. Place a plastic Place a plastic barrier over the barrier over the incision, taped in incision, taped in place, prior to place, prior to showeringshowering

3. Wash under arm, 3. Wash under arm, dry thoroughly and dry thoroughly and place dry padding place dry padding to absorb moisture to absorb moisture

4. Place a new 4. Place a new dressing on the dressing on the incision after incision after showershower

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DrivingDriving

No driving. Talk with your surgeon about No driving. Talk with your surgeon about when you will be allowed to drive againwhen you will be allowed to drive again

After permission you must :After permission you must : Be off narcotic pain medicines to driveBe off narcotic pain medicines to drive Able to sit in car comfortablyAble to sit in car comfortably Drive in a safe areaDrive in a safe area

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A Follow-Up Appointment with your A Follow-Up Appointment with your surgeon will be made 10-14 days after surgeon will be made 10-14 days after

surgerysurgeryAt your appointment:At your appointment:- X-ray will be done of your shoulder- X-ray will be done of your shoulder- Your stitches will be removed- Your stitches will be removed- - We will give you care instructions about We will give you care instructions about

your: incision, bathing, exercises, and a your: incision, bathing, exercises, and a handout titled ‘handout titled ‘Joint Replacement- Dental Joint Replacement- Dental Procedures and Antibiotics’Procedures and Antibiotics’

- You will see an Occupational or PhysicalYou will see an Occupational or PhysicalTherapistTherapist

Total Shoulder ReplacementTotal Shoulder Replacement

Therapy Services:Therapy Services:

Focusing on FunctionFocusing on Function

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PurposePurpose

To discuss what to expect in therapy the To discuss what to expect in therapy the first days after surgeryfirst days after surgery

To identify Total Shoulder motion To identify Total Shoulder motion precautionsprecautions

To discuss home exercise programTo discuss home exercise program

To identify what you need to do to achieve To identify what you need to do to achieve the best outcomethe best outcome

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After SurgeryAfter Surgery

You will wear a sling except when You will wear a sling except when performing self-cares and exercisesperforming self-cares and exercises

You can move your elbow, wrist and You can move your elbow, wrist and fingersfingers

You should not move your You should not move your shouldershoulder until you have assistance from until you have assistance from nursing or a therapistnursing or a therapist

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After SurgeryAfter Surgery

Therapy is important for a good outcome!Therapy is important for a good outcome!

Therapy starts the day after surgeryTherapy starts the day after surgery

You will learn motion precautions for your You will learn motion precautions for your healing shoulderhealing shoulder

You will learn how to move your arm safely You will learn how to move your arm safely when:when:

Taking care of yourself Taking care of yourself Taking sling on/offTaking sling on/offWalking/moving aboutWalking/moving about

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Therapy After SurgeryTherapy After SurgeryTherapy Goals:Therapy Goals: PASSIVE range of motion of surgical PASSIVE range of motion of surgical

shoulder (Maximum: 0-140 degrees shoulder (Maximum: 0-140 degrees flexion, 40 degrees external rotation)flexion, 40 degrees external rotation)

Control pain and swellingControl pain and swelling Be independent in taking care of Be independent in taking care of

yourself and moving your shoulderyourself and moving your shoulder Prepare for a safe return to homePrepare for a safe return to home

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Activity limitationsActivity limitations

Limit shoulder elevation to Limit shoulder elevation to 140 degrees flexion140 degrees flexion

Limit shoulder external Limit shoulder external rotation to 40 degreesrotation to 40 degrees

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Therapy for homeTherapy for home

You will learn a home exercise program that You will learn a home exercise program that includes:includes:

Passive range of motion for your shoulder Passive range of motion for your shoulder (no muscle flexing)(no muscle flexing)

Active range of motion for your elbow, wrist Active range of motion for your elbow, wrist and fingers (moving them on your own)and fingers (moving them on your own)

Techniques to control swelling and painTechniques to control swelling and pain

It is recommended that a person be available It is recommended that a person be available at home to assist youat home to assist you

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At home you will:At home you will:

Continue with range of motion Continue with range of motion exercisesexercises

Wear immobilizer/sling Wear immobilizer/sling

Practice your total shoulder Practice your total shoulder precautionsprecautions

Call the therapy department with Call the therapy department with questions or concernsquestions or concerns

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You are a Partner in Your Care!You are a Partner in Your Care!

Make your plans…Make your plans…

Start getting ready for surgery!Start getting ready for surgery!

Social Services and Case Social Services and Case ManagementManagement

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Roles of Social Services and Roles of Social Services and Case Management in Your CareCase Management in Your Care

Social Workers and Nurse Case Managers Social Workers and Nurse Case Managers work in teams to assist with:work in teams to assist with:

Insurance Insurance Counseling/supportCounseling/support Transition planningTransition planning Advance Directives for HealthcareAdvance Directives for Healthcare

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InsuranceInsurance

Before surgery, you will need to notify your Before surgery, you will need to notify your insurance company of your surgery plansinsurance company of your surgery plans

Once you are in the hospital, your Nurse Once you are in the hospital, your Nurse Case Manager will monitor your approved Case Manager will monitor your approved stay days and be a contact person for your stay days and be a contact person for your insurance company for any questions or insurance company for any questions or concernsconcerns

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Counseling and SupportCounseling and SupportSurgery and hospitalization are stressfulSurgery and hospitalization are stressful

Meeting your emotional needs is Meeting your emotional needs is important to all staff at Luther-Midelfortimportant to all staff at Luther-Midelfort

If you have any concerns about your care If you have any concerns about your care or are feeling “out-of-sorts”, please feel or are feeling “out-of-sorts”, please feel free to discuss these things our Social free to discuss these things our Social Services staffServices staff

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Discharge PlanningDischarge Planning

A Social Worker or RN Case Manager A Social Worker or RN Case Manager will meet with you to discuss your will meet with you to discuss your transition plan to home or a transition plan to home or a transition facility. transition facility.

You, your family, your doctor and You, your family, your doctor and your therapist all will help determine your therapist all will help determine what transition plan is best for you.what transition plan is best for you.

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Options at DischargeOptions at Discharge

Home with family to care for youHome with family to care for you

Home with outpatient servicesHome with outpatient services

Home with or Home CareHome with or Home Care

Skilled Nursing FacilitiesSkilled Nursing Facilities

Transitional Care Units or Swing BedsTransitional Care Units or Swing Beds

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Advance Directives for Advance Directives for HealthcareHealthcare

What are Advance Directives?What are Advance Directives?

What are the 2 types of Advanced What are the 2 types of Advanced Directives?Directives?

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Declaration to Physicians or Declaration to Physicians or Living WillsLiving Wills

Describes the kind of life-sustaining care you Describes the kind of life-sustaining care you would want would want only if you had a terminal only if you had a terminal condition or were in a persistent vegetative condition or were in a persistent vegetative statestate

Living Wills direct your physician regarding Living Wills direct your physician regarding life-sustaining treatment or a feeding tubelife-sustaining treatment or a feeding tube

Living Wills do not give authority to anyone to Living Wills do not give authority to anyone to make health care decisions on your behalfmake health care decisions on your behalf

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Power of Attorney for Health Power of Attorney for Health CareCare

Your agent can tell your physician what Your agent can tell your physician what kind of care you would want in kind of care you would want in all types all types of health decisions, not just concerning of health decisions, not just concerning life-sustaining treatmentlife-sustaining treatment

You appoint an agent to make all health You appoint an agent to make all health care decisions for you in collaboration care decisions for you in collaboration with your physicianwith your physician

In most cases, going to court to appoint In most cases, going to court to appoint guardianship can be avoidedguardianship can be avoided

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Who Can Help you Complete an Who Can Help you Complete an Advance Directive?Advance Directive?

Luther Hospital Social Services-no Luther Hospital Social Services-no costcost

Luther Hospital Chaplaincy-no costLuther Hospital Chaplaincy-no cost

Your personal attorney-attorney feeYour personal attorney-attorney fee

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Safekeeping of Advance Safekeeping of Advance DirectivesDirectives

Store the original document in a safe Store the original document in a safe placeplace

Give a copy of the document to family Give a copy of the document to family membersmembers

Give a copy of the document to your Give a copy of the document to your Physician so that it can be kept in Physician so that it can be kept in your medical recordyour medical record

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To complete an Advance To complete an Advance Directive or for any questions Directive or for any questions

Call Social Services Department at Call Social Services Department at 838-3278,838-3278, oror

Ask for a Social Worker or Chaplain Ask for a Social Worker or Chaplain when you are admitted to Surgi when you are admitted to Surgi Center the day of your surgery. Center the day of your surgery.