Going Home From the Hospital After Pneumonia

Pneumonia is one of the most common reasons older adults are hospitalized, and one of the most common reasons they go back. In older adults it doesn't always look like a bad cough and fever. It can show up as confusion, weakness, a fall, or simply not eating.

Recovery takes longer than most families expect. The infection may clear in a week or two, but a cough can linger for six weeks or more, and it's normal for energy and strength to take a month or longer to come back. The first few weeks at home are when problems are most likely to come up.

This guide walks through managing medications and oxygen, helping your loved one breathe and move, the warning signs to watch for, how to help prevent another pneumonia, and how to rebuild strength.

Medications and oxygen

Antibiotics. Finish the full course, even if your loved one feels better after a few days. Space doses evenly, follow the label about food, and ask the pharmacist about interactions with blood thinners and other regular medications. Call the PCP right away for three or more watery stools a day, which can be a sign of a serious gut infection called C. diff that sometimes follows antibiotics.

Inhalers and breathing treatments. Many people go home with a new inhaler or nebulizer. Ask the nurse or pharmacist to watch your loved one use it before discharge, since many older adults have trouble with the technique. A spacer can help.

Cough medicine. Coughing helps clear the lungs, so check with the doctor before giving any over-the-counter cough suppressant or "nighttime" cold medicine. Many contain ingredients that cause drowsiness, confusion, or falls in older adults.

Steroids. If prednisone was prescribed, follow the taper exactly. Steroids can raise blood sugar, cause trouble sleeping, and affect mood.

Home oxygen safety

Some people go home on oxygen, at least for a while.

• Use it exactly as prescribed. More isn't better.
• No smoking, candles, or open flames anywhere near the oxygen, and keep it at least 5 to 10 feet from gas stoves and heaters.
• Skip petroleum-based products like Vaseline on the face or nose; ask about a water-based alternative.
• Secure the tubing to prevent tripping, and keep a backup tank for power outages.
• Keep the oxygen supplier's 24/7 number handy, and ask the doctor when oxygen levels should be rechecked.

The first 72 hours at home

• Keep the lungs working. If the hospital sent home an incentive spirometer (the plastic device you breathe into), use it about 10 times an hour while awake. If not, take 10 slow, deep breaths every hour, followed by a couple of strong coughs to clear mucus.
• Sit up, don't lie flat. Sitting in a chair or propped up in bed helps the lungs expand. Lying flat all day lets fluid settle.
• Push fluids unless the doctor has limited them. Fluids thin mucus and make it easier to cough up.
• Balance rest and movement. Rest is part of healing, but short walks several times a day help clear the lungs and prevent weakness and blood clots. Expect your loved one to tire easily.
• Help with getting up. Weakness, low oxygen, and new medications make falls more likely in the first week. Keep the walker close and help with nighttime bathroom trips.
• Eat small, frequent meals with protein. Breathing hard burns a lot of energy, and appetite is often low.
• Check temperature and oxygen. Check temperature once or twice a day. If you have a pulse oximeter, ask the doctor what oxygen level should prompt a call, and write readings down.

What warning signs mean you should call 911 or the PCP?

Some cough, tiredness, and shortness of breath with activity are normal for several weeks. What matters is whether things are slowly getting better or getting worse.

Call 911 for:

• Severe trouble breathing, struggling to speak in full sentences, or breathing that's very fast
• Lips, face, or fingertips turning blue or gray
• An oxygen level below the number the doctor gave you that doesn't improve with rest (if you weren't given a number, ask for one before they leave the hospital)
• Chest pain
• New or sudden confusion, or being very hard to wake
• Signs of sepsis: shaking chills, a very high or unusually low temperature, cold or blotchy skin, very little urine, or a racing heart

Call the PCP or nurse line for:

• A fever that returns after going away, or doesn't improve after 2 to 3 days on antibiotics
• Cough or shortness of breath getting worse instead of better
• Mucus that changes color, increases, or has blood in it
• Not eating or drinking, or signs of dehydration
• New swelling in the legs
• Three or more watery stools a day

Helping prevent the next pneumonia

Watch for swallowing problems. Many pneumonias in older adults happen when food, liquid, or saliva slips into the lungs (aspiration). Signs include coughing or choking while eating or drinking, a wet or gurgly voice after swallowing, food pocketing in the cheeks, or meals taking much longer. If you notice these, ask the PCP for a swallow evaluation with a speech therapist.

To lower the risk:

• Sit fully upright to eat and drink, and stay upright for 30 minutes afterward
• Take small bites and sips, and avoid talking while chewing
• Avoid rushing meals or eating when very drowsy

Keep the mouth clean. Bacteria from the mouth can travel to the lungs. Brush teeth and gums twice a day, clean dentures daily, and keep up with dental visits.

Stay active. Moving around and sitting up helps the lungs stay clear. Long hours in bed raise pneumonia risk.

Get vaccinated. Ask the PCP whether your loved one is up to date on the pneumonia (pneumococcal), flu, COVID-19, and RSV vaccines. Family members and caregivers should stay up to date too.

Avoid smoke. If your loved one smokes, quitting is one of the best things they can do for their lungs. Keep the home smoke-free for everyone.

Limit germs. Wash hands often, ask sick visitors to wait, and avoid crowds during flu season while your loved one is recovering.

The PCP follow-up visit

Schedule a PCP visit within 7 days of coming home. It's a chance to make sure the lungs are clearing and to talk about why the pneumonia happened.

Questions to ask:

• Are the lungs clearing as expected? Do we need a follow-up chest X-ray, and when?
• How long should the cough and tiredness last before we worry?
• Is home oxygen still needed? When will oxygen levels be rechecked?
• What made my loved one more likely to get pneumonia? Could swallowing be a factor? Should we see a speech therapist?
• Should any medications be changed, especially ones that cause drowsiness or affect swallowing?
• Are vaccines up to date?
• Would home health or physical therapy help?

Rebuilding strength

Pneumonia takes a lot out of an older adult. Even after the infection clears, weakness and shortness of breath with activity can last for weeks.

Home health. If your loved one has trouble leaving the house and needs skilled care like nursing or physical therapy, Medicare may cover home health visits at no cost, with a doctor's order. A home health nurse can check oxygen levels and lung sounds, watch for signs the pneumonia is returning, help manage medications and oxygen, and teach breathing exercises. The hospital case manager or PCP can make the referral, and you can request a specific agency.

Outpatient physical therapy. If leaving the home isn't an issue, outpatient physical therapy is a great option. A physical therapist can rebuild strength, endurance, and balance, lower the risk of falls, and help your loved one return to their usual routines. Ask the PCP for a referral if it wasn't set up at discharge.

Be patient. It's normal for energy to take a month or more to come back. Increase activity a little each day, celebrate small wins, and let the PCP know if your loved one seems to be getting weaker instead of stronger, or seems down and withdrawn.

When home isn't safe enough

Sometimes pneumonia is a sign that your loved one needs more help day to day. It may be time to talk about more support if:

• Pneumonia keeps coming back, or keeps leading to ER visits or hospital stays
• Swallowing problems are getting worse, or eating and drinking are steadily declining
• They're short of breath with very little activity, or need more and more oxygen
• They're spending most of the day in bed or a chair, and getting weaker
• Confusion hasn't cleared
• The family caregiver is worn out

Other options for more help include in-home personal care aides, adult day programs, assisted living, short-term rehab, and palliative care. Starting the conversation early, while your loved one can take part, makes the decision easier for everyone.

Be ready next time. Read Packing an ER Go-Bag for an Older Adult and download the free printable checklist.

This article is general information for family caregivers, not medical advice. Always follow the instructions from your loved one's care team.