Reducing Hospital Readmission Through Outstanding In-Home Care

Brian Callahan • October 24, 2023

Johns Hopkins reports "patients are most at risk to return to the hospital immediately following discharge. Often new medication routines or lifestyle changes after being sent home can increase the chance of returning to the hospital. Access to community resources and family support can impact the chances that a patient returns to the hospital.


A nurse is helping an elderly woman dress in a bedroom.

Reducing hospital readmission through in-home care has emerged as an essential strategy to significantly improve patient outcomes, lower healthcare costs, and enhance the overall quality of care. The approach involves providing comprehensive and specialized care and support services to patients within the comfort of their homes, thereby reducing the likelihood of rehospitalization.


Hospital readmissions are when a patient is readmitted to the hospital within a certain period of time, typically 30 days, after being discharged. Rehospitalizations can be costly and disruptive for patients, and they can also increase the risk of complications and death.


Risks from Hospital Readmission

There are a number of risks associated with hospital readmission, including:

  • Increased risk of complications and death
  • Increased risk of infection
  • Increased risk of medication errors
  • Decreased quality of life and mental health
  • Increased financial burden


Statistics on Hospital Readmission

According to the Agency for Healthcare Research and Quality (AHRQ), approximately one in five Medicare patients are readmitted to the hospital within 30 days of discharge. Some of the most common reasons for readmission include heart failure, pneumonia, infection, and chronic obstructive pulmonary disease (COPD).


Reducing Hospital Readmission

There are a number of things that can be done to reduce hospital readmission, including:

  • Identifying patients who are at high risk of readmission. This can be done by looking at factors such as the patient's age, medical history, and social support system.
  • Developing a personalized care plan for each patient. The care plan should be based on the patient's individual needs and goals.
  • Coordinating care with the patient's other healthcare providers. This includes the patient's primary care physician, hospitalists, and specialists.
  • Providing patients with education and support. This includes teaching patients about their condition, how to manage their medications, and what to do if they experience problems.
  • Monitoring patients closely and following up with them regularly.This can be done through in-person visits, phone calls, and telemedicine.


Home care can play an important role in reducing hospital readmission. 7 Day Home Care with offices in Manhattan and Lake Success - Long Island, New York can help patients to recover in their own homes and reduce their risk of rehospitalization by helping patients with activities of daily living. Activities of Daily Living (ADLs) are essential for maintaining one's independence and overall well-being. When these activities are compromised due to health issues or other factors, it can significantly impact an individual's ability to function independently and may increase the risk of hospital readmission. Here's how maintaining and supporting ADLs can contribute to reducing the risks of hospital readmission:


  1. Nutrition and Eating: Adequate nutrition is vital for maintaining overall health and preventing the development or exacerbation of various medical conditions. Ensuring that individuals can independently manage their nutrition and eating habits can reduce the risk of malnutrition and related complications, thereby minimizing the need for hospital readmission.
  2. Hygiene and Bathing: Proper hygiene practices help prevent infections and skin issues. By supporting individuals in maintaining their hygiene and bathing routines, caregivers can prevent the development of infections and other health issues that could necessitate hospitalization.
  3. Dressing: The ability to dress independently contributes to a sense of self-worth and autonomy. Support in this area helps prevent falls and injuries that could result from attempting to dress without proper assistance, thereby reducing the risk of hospitalization due to fall-related injuries.
  4. Toileting and Continence Management: Assisting individuals in maintaining continence and managing toileting needs helps prevent urinary tract infections, skin breakdown, and related complications. This reduces the likelihood of hospital readmission for conditions stemming from poor continence management.
  5. Mobility and Transferring: Ensuring that individuals can safely transfer and move around independently helps prevent falls and injuries. Supporting mobility can reduce the risk of fractures and other injuries, which are common reasons for hospital readmissions, particularly among the elderly population.
  6. Self-Care and Medication Reminders: Facilitating independent medication reminders and self-care tasks can help individuals adhere to their treatment plans and reduce the risk of medication errors or non-compliance. Proper medication adherence and self-care can prevent exacerbations of chronic conditions, reducing the need for hospitalization.


Supporting individuals in performing these ADLs often involves a combination of caregiving, assistive devices, and environmental modifications to ensure their safety and well-being at home. By promoting independence in ADLs, caregivers and healthcare professionals can improve individuals' overall quality of life, reduce the risk of complications, and minimize the likelihood of hospital readmission. Additionally, regular monitoring of ADL performance can provide insights into an individual's health status, enabling early detection of potential issues and timely interventions to prevent the need for hospitalization. 7 Day Home Care provides comprehensive Home Health Aide service in Manhattan, Queens, Brooklyn, Nassau County, and Suffolk County, New York. Contact 7 Day Home Care today at 516-408-0034 to learn more about our home caregiving services offered throughout the New York City metropolitan area.


Brian Callahan

7 Day Home Care


By Brian Callahan January 27, 2026
Why Elderly Diabetic Patients Miss Medications (And How Home Care Helps)
Four plates of food: meat, mashed potato, vegetables, and gravy.
By Brian Callahan 7 Day Home care January 27, 2026
Introducing Textured Food Innovations: Nutritious Meals for Seniors with Dysphagia For seniors living with dysphagia, eating safely and maintaining proper nutrition can become one of the most difficult daily challenges. Difficulty swallowing often requires a pureed diet, yet many traditional pureed meals are unappetizing, nutritionally inadequate, or hard for caregivers to prepare at home. In New York, a new solution is changing that reality. Textured Food Innovations is a New York‑based company providing chef‑prepared, IDDSI Level 4 pureed meals designed to help seniors with swallowing difficulties eat safely, maintain adequate nutrition, and enjoy mealtime again — especially when supported by professional home care services like 7 Day Home Care .
By Brian Callahan January 17, 2026
Why Leaving a Loved One With Dementia Alone Can Become Dangerous
By Brian Callahan January 14, 2026
Is It Possible to Care for Aging Parents While Working Full-Time?
By Brian Callahan January 9, 2026
Living With Stage 3 Kidney Disease: Life Expectancy Explained
A healthcare worker assists an elderly person using a walker in a care facility.
By Brian Callahan January 6, 2026
Heart stroke recovery is fragile for seniors. Learn common challenges at home, hidden risks, and when professional home care support is truly needed.
By Brian Callahan January 3, 2026
Life After Hospital Discharge: How Stroke Changes Everyday Life at Home
home care helps
By Brian Callahan December 26, 2025
Learn how in-home care helps seniors with Parkinson’s stay safe, independent, and comfortable at home by supporting daily routines, mobility, and dignity.
By Brian Callahan December 25, 2025
The Quiet Problem Many Families Miss For many families, aging looks like a slow, expected change. A little more tired than before. Slight aches in the knees. Moving a bit slower around the house. These things are often brushed off as “normal old age.” But in reality, many seniors are dealing with something deeper — Vitamin D deficiency — without anyone realizing it. What makes Vitamin D deficiency especially concerning is how quietly it affects older adults. There is no sudden emergency. No dramatic warning sign. Instead, it shows up in small, everyday ways: low energy, weak legs, balance issues, or a fear of going outside. Over time, these changes can reduce independence and increase the risk of falls, fractures, and long recovery periods. Families providing care at home NYC , or those supporting loved ones through home health care in Brooklyn , Manhattan, or Long Island, often see these signs but may not connect them to a nutritional deficiency. This guide is meant to help families understand what Vitamin D deficiency really looks like in older adults — and why it matters so much in daily life. What Is Vitamin D and Why Does It Matter So Much for Seniors? Vitamin D plays a key role in keeping the body strong and balanced. It helps the body absorb calcium, supports muscle function, and contributes to overall bone health. It also plays a role in immune strength and mood regulation. For younger adults, Vitamin D often comes from a combination of sunlight, food, and supplements. But as people age, this balance changes. Why Older Adults Are at Higher Risk Several age-related factors make seniors more vulnerable to Vitamin D deficiency: Less sunlight exposure: Many older adults spend more time indoors, especially in cities like New York where winters are long and outdoor mobility can be limited. Reduced skin efficiency: Aging skin is less effective at producing Vitamin D from sunlight. Digestive changes: The body becomes less efficient at absorbing nutrients from food. Chronic conditions or medications: Certain health issues and medications can interfere with Vitamin D absorption. For seniors receiving support through manhattan home care or from home health agencies in Long Island , these factors often overlap, increasing the risk even further. Hidden and Commonly Ignored Symptoms of Vitamin D Deficiency
Woman in blue scrubs assists older person using a walker in a light-filled room.
By Brian Callahan 7 Day Home Care December 24, 2025
Need home care covered by MassMutual Long-Term Care Insurance? 7 Day Home Care is New York’s top provider, offering fast benefit activation and #1l in-home support.
Show More