As HME providers, we become so accustomed to delivering hospital beds that we underestimate the impact they have on the patient and the patient’s family. Of all the medically necessary equipment that is brought into a patient’s home, the most traumatic is the hospital bed.

Most people associate a hospital bed with terminal sickness. When the bed is placed in the home, the patient and family members are forced to face the reality that the illness is real. Sadly, for older patients, when a bed is brought into a home, the bed shared by a couple for many years is taken down and the hospital bed is left in its place. For the couple, nothing else could signify such a heart-wrenching experience as suddenly not being able to share their bed.

The hospital bed represents not ease for the patient, but the cause of separation, sadness, and fear. For younger patients, a hospital bed is a visible reminder of the loss of independence, coupled with fear of the unknown.

My own grandfather
In 1997, having worked in the HME industry for years, I thought I understood the impact a hospital bed had on patients and caregivers. I had always taken pride in my ability to share my compassion with patients—until my grandfather needed a hospital bed. I realized then that my “understanding” of what customers experienced was purely textbook. Demonstrating compassion and empathizing with a family is nothing like being the family in need.

Before bringing in the bed, the delivery technician should answer any questions caregivers may have.

When the tables were turned, I was no longer a professional but a granddaughter facing for the first time the true reason for a hospital bed being brought in to the home. My grandfather had terminal lung cancer, and his physician had ordered the bed weeks before. Neither my grandfather nor my grandmother wanted to face the reality of placing a hospital bed in their home. It is true that most people think that by avoiding difficult decisions the problem will go away. My grandparents certainly did, but finally, we convinced them that the bed would enable granddaddy to elevate his upper body and make it easier for him to breathe.

Roger Littleton, president of Littleton Respiratory Home Care (far left and far right) and patient care technician Doug Newman (middle photos) call an hour before delivery and always make the delivery on time. While bringing in and setting up the new bed, they ease the family’s stress by talking quietly and moving slowly .

I will never forget the day the bed was delivered. One of my coworkers (and fortunately, a good friend) volunteered to make the delivery. But time had not been kind to my grandfather. We had waited too long to order the bed and granddaddy was too weak to get up on his own. The hospital bed was to take the place of my grandparents’ bed in a certain corner of the room. My grandmother was nervous and fretful, constantly pacing around the small room and getting in everyone’s way.

When the bed was finally assembled with fresh sheets, a beloved grandson-in-law gently picked up my granddaddy and moved him from his bed to the hospital bed. This was the first of several heart-stopping, emotional moments that day. Next, the bed that my grandparents had shared for their entire marriage had to be dismantled and moved to the garage. My granddaddy, who was always a do-it-yourself type, lay and watched, too weak to even offer guidance.

My grandmother’s way of coping with the situation was to clean. Before we could move the hospital bed to the now empty side of the room, the entire area had to be totally clean. I was enjoined to vacuum and clean the baseboards, removing every little speck of dirt—real or imagined.

I explained to her that this was not the best time, because granddaddy was tired and the quicker we allowed him to settle into his new bed the better, but she was insistent. So I cleaned, granddaddy watched, and my grandmother continued to fret and pace.

Finally, we rolled the hospital bed to its new antiseptically clean space in the bedroom. There was no more for anyone to do, so everyone left. I stayed behind and sat with my granddaddy to be sure that he was alright with the change. As I sat with him, I realized how small the bed made him look. It seemed that the bed made him look much older and even sicker.

At that moment, his attitude changed, and I knew that he was preparing himself for death. Later in the day, when things were once again calm, I got in my car to go back to work. Only then was I able to finally let out my feelings and cry.

Know-How Not Enough
This experience taught me that as HME providers, it is not enough to know how to set up a hospital bed. We have to know how to reach out to our patients and their caregivers with true compassion and concern. As home care providers, our primary objective is to make the transition to a hospital bed as smooth as possible for our patients and their caregivers or family members. This can seem especially difficult because emotions tend to run high and the situation does not quite lend itself to “business as usual.”

Hospital beds are sometimes viewed as a space- and time-consuming inconvenience by delivery and warehouse personnel. Billing and accounting staff sometimes wonder if the profit earned from a bed is worth the trouble, especially considering recent reimbursement reductions. We cannot allow attitudes such as these to make us indifferent to the physical and emotional needs of our patients. With patience, planning, and training, we can increase revenues and decrease delivery and setup stress; we can then focus our attention where it should be—on our patients.

Before Delivery
A phone call before delivery to the patient or caregiver is essential to a proper setup. During the phone call, basic information such as insurance verification findings and rent/purchase options should be discussed. Then the customer service specialist should also discuss the practical and emotional side of the delivery. A few well thought out questions will save time and ease the delivery process.

Where will the bed be placed in the home? Patients and caregivers may need guidance in deciding the best place for the bed. The customer service specialist should inquire about the location of stairs and toilet facilities when helping to choose the best place for the bed.

Have arrangements been made to remove any existing furniture to make room for the bed? This is often overlooked and can lead to frustration for the family and the delivery technician. A trained customer service specialist can encourage the family to have furniture moved prior to the delivery, ensuring a smooth setup. However, often you will find that the patient is older and the spouse has no family or friends to help remove furnishings.

Any help your company can provide with removal of furnishings will long be remembered. As the customer service specialist is talking with patients or caregivers, additional needs can be accessed. Perhaps the patient will also need sheets, cleaning supplies, or diapers. This is a great opportunity to offer beneficial supplies.

Most caregivers are unaware of the many items available that will make life easier. Finally, arrange a time for the delivery. Nothing will make a setup more stressful for the patient than having to wait for the delivery. Give the patient a delivery time range, and say that the technician will call an hour before the delivery.

The delivery technician should go into the home first to make introductions, discuss placement of the bed, and answer any questions the family may have. This is a special time where attention to the emotional needs of the patient and family members is needed. Perhaps the patient is still unsure about using the bed. An experienced technician can ease much of the stress by talking quietly and moving slowly when bringing the bed into the home and during setup.

After setup is complete and all paperwork has been discussed and signed, the technician should spend as much time as necessary to make sure the patient and family have a thorough understanding of the bed’s operation. Often, the old bed will have been taken down and left leaning against the wall in the bedroom, next to the new bed.

Roger Littleton, president of Littleton Respiratory Homecare, states that in his 26 years of delivering equipment, he has taken down many family beds and moved them to various locations. “On more than one occasion, I have taken down a family bed, set up a hospital bed, then put the family bed into the van and moved it to a son’s or daughter’s home,” says Littleton. “This certainly is above and beyond the call of duty, but the feeling of satisfaction I receive always makes it worthwhile.”

After Delivery
Customer service specialists should call patients or caregivers the day after delivery to answer any questions or concerns. Erin Littleton, vice president of Littleton Respiratory Homecare, explains, “This phone call may seem time-consuming, but we have found it to be a very efficient part of our daily routine. We can make sure the patient was discharged as planned, answer any questions they may have, and the personal touch shows the patient that we care,” says Littleton. “Often, we answer the same question many times. With the emotional strain they are facing, they just can’t remember everything at once. After spending a night at home, the patient (or caregivers) may realize that they need other items to be more comfortable. Our customer service specialist can offer to deliver these items.”

PickUps
We all hope that a pickup request will be made because the patient is better and no longer needs the bed. Unfortunately, this is not usually the case. Most pick-ups are requested after the death of a patient. Some family members will want the patient’s room to remain untouched for several days, perhaps weeks. Others will want the hospital bed picked up immediately. For these family members, the hospital bed is a stark reminder of pain and sickness.

Roger Littleton has found that being available to make pickups quickly after hours has led to great caregiver satisfaction. He says, “While it is not always the most cost-effective way, being able to provide a quick pickup service has led to great loyalty from our patients’ family members.”

Employee Gratification
Refocusing your hospital bed deliveries based on how they affect the patient and patient’s family will increase job satisfaction throughout your company. Your employees started a career in the home care industry with a desire to help others. In times of lean reimbursement and number crunching, your staff often feels a need to rush deliveries. Giving each staff member the tools to stop for a moment and listen to the patient allows them the satisfaction of helping others. This feeling of making a difference is a great motivator and a source of job satisfaction.

Increased Revenue
How will making additional phone calls, spending more time in the home during the delivery, and accommodating after-hours pickups lead to increased revenue? Easy—through patient and caregiver loyalty.

After setup and paperwork are finished, Doug Newman will spend as much time as necessary to make sure the patient and family have a thorough understanding of the bed’s operation.

We have all heard the horror stories of a patient coming home from a hospital stay and finding a hospital bed sitting on the front porch. The provider who leaves equipment on the porch so callously has accomplished two things. First, he has announced to the neighborhood that Mr Smith is seriously ill, thus putting the area rumor mill into overdrive. Second, he has abandoned the patient and his family at an already stressful time.

Now consider the provider who schedules delivery and serves the patient well. The goodwill and feelings of security this leaves with patients and their family members will last a lifetime. These patients will likely need additional services, and they will always look to this provider first.

The caregivers of these patients are perhaps the most important. Children caring for aging parents are a large market. These children want only the best for their parents, yet find themselves in a strange and unfamiliar world. As they deal with the emotional aspects of caring for a sick parent, they look to providers for guidance and support. Watching your staff tenderly deal with their parents, they will come to you for advice and help. This will be your next generation of patients.

Jennifer Wyatt is accounts receivable manager at Littleton Respiratory Home Care, Wilmington, Ohio. She is also a consultant with lhc Billing & Consulting, specializing in new HME company start-ups and streamlining business processes in existing HME companies. She may be reached via e-mail: jwyatt@accessky.net.