Wait times and wait lists for public eating disorder treatment programs are at an all-time high. Your child likely cannot afford to wait for treatment. They keep getting sicker, and the longer the eating disorder persists, the harder it is to overcome it. Instead of waiting for hospital treatment, you, the caregiver(s), can provide care through the Hospital at Home approach.
Hospital at Home
To understand what Hospital at Home is, it is helpful for us to first understand what hospital eating disorder programs look like. There are a few different hospital program types, including inpatient (in-hospital), residential, and day treatment eating disorder treatment programs. Inpatient treatment programs require individuals to live at the hospital; these programs are typically best for those who are not medically stable.1 In residential programs, individuals stay at a live-in facility and are provided 24-hour care.1 Folks in residential programs are medically stable. Day treatment programs involve treatment at the hospital during the day, and then folks go home to sleep.1 Each program includes medical monitoring, nutrition counselling, psychotherapy, meals at structured times, and meal support. We will be talking more about these soon.
A Hospital at Home Canada program is similar to in-hospital treatments but provides intensive eating disorder treatment at home. You will take an active role in eating disorder recovery by helping your child with feeding, meal support, exercise cessation, and more. A team of healthcare professionals will support you and your child along the way.
Who’s Involved?
The most important individual involved in Hospital at Home is your child. Each child will have their own individualized treatment plan. Your child’s needs, likes, dislikes, and perspectives will be considered. You will also play an essential part in your child’s recovery. You will help support your child, both physically and mentally. The treatment team for Hospital at Home includes a family physician, a Registered Dietitian, and a Registered therapist.
The Physician
Your family physician is the expert on the physical and medical issues related to the eating disorder. They will monitor your child’s weight and height, heart rate, blood pressure, temperature, and respiratory rate. It is necessary for the physician to monitor your child’s growth because adolescents should not weigh less than they did the day before. Additionally, eating disorders can lead to low heart rate, blood pressure, temperature, and respiratory rate. Monitoring these values can help your treatment team catch low levels quickly. Low levels may lead to heart failure or death.
Your physician will also conduct medical tests, including bloodwork, an electrocardiogram (ECG), and a bone scan. Bloodwork can help measure substances in the blood and determine how your child’s body is functioning. An ECG can test for disturbances in heart function associated with an eating disorder. A bone scan can determine the strength of your child’s bones, as EDs often lead to low bone density and increased bone fractures.
The Registered Dietitian
The Registered Dietitian (RD) is an expert on foods and nutrition. RDs provide nutrition education and examine factors influencing food intake. They focus on normalizing eating and will develop a meal plan based on your child’s needs. Your first appointment with an RD will be an initial assessment. The RD will review your child’s food intake, digestive symptoms, disordered eating behaviours, and more. The Dietitian will not provide a treatment plan in the initial assessment. After the initial assessment, your RD will develop an eating disorder recovery plan. Follow-up appointments will occur where your Dietitian will provide you and your child with a meal plan and nutrition information. They will overcome barriers with you and your child as well.
The Registered Therapist
The Registered Psychotherapist (RP) or Registered Clinical Therapist is the expert on mental health symptoms. They provide psychotherapy and will help your child explore the behaviours, thoughts, and feelings related to the ED.
During the initial assessment, the RP will review your child’s family history, mental health concerns, medications, treatment history, schooling, and more. At Change Creates Change, our Psychotherapists will meet with you and your child separately during initial assessment appointments. Like appointments with the Registered Dietitian, the RP will not provide a treatment plan in the initial assessment. Your RP will develop a treatment plan after the assessment, and follow-up appointments will occur.
Follow-up appointments will include goal setting, interrupting eating disorder symptoms, emotion regulation, building coping skills, and more. The follow-up therapy appointments may occur individually with your child or with both you and your child.
What’s Involved?
Appointments with the treatment team will occur weekly for the first 6-8 weeks of treatment. Then, appointments will occur bi-weekly for the next 6-8 weeks. After about 12-16 weeks, appointments will occur as needed.
Meal Plan
In addition to attending appointments, you and your child will follow the meal plan provided by the Dietitian. Recovery first involves restoring your child’s physical health through refeeding and normalized eating patterns. We must reverse malnutrition before we can start improving your child’s mental health. The refeeding process involves mechanical eating. Mechanical eating is ‘eating by the clock’ and eating regardless of whether your child is hungry or not. For mechanical eating, we follow the rule of 3’s: 3 meals a day, 3 snacks a day, no more than 3 hours apart.
Meal Support
You must also provide meal support for your child. Meal support involves meal planning and preparation, as well as providing distraction during and after meals. Your child should not consume meals outside the home during the beginning stages of recovery. You and your child can practice the skills learned during therapy sessions to help manage the emotional discomfort that may come with refeeding.
Exercise
Your child must stop exercising or engaging in sports for a full recovery. Also, they will likely need to take time off school and extracurricular activities to focus on eating disorder recovery. Taking time off school will increase the speed of recovery. You may need to take time off work as well to support your child.
Why Hospital at Home?
Public eating disorder programs have long wait lists, particularly since the onset of COVID-19. Eating disorders dramatically increased during the pandemic. This rise in EDs can be contributed to a variety of factors, such as changes to routines, triggering social media messaging, and social isolation.2 Hospital admissions for eating disorders in children and adolescents rose by 83% during the pandemic.2 Similarly, in Canada, new cases of anorexia nervosa rose from 25 to 41 per month.3 Therefore, the demand for hospital programs has increased. The hospital programs may continue to deal with staffing shortages and a lack of funding as well.
Hospital Admission Criteria
Also, hospital programs typically have strict admission criteria. Your child might not meet these criteria, but this does not mean their ED is not severe—it simply means there are insufficient resources available for everyone with an ED. Also, there may not be a hospital program close to where you live. If you live in a rural community, you may need to drive several hours for daily treatment or to visit your child.
The Impact of Eating Disorders
Eating disorders can cause heart damage, bone fractures, gastrointestinal issues, disrupted hormone levels, and other health problems, which worsen over time.4 Also, children with EDs are at a high risk of suicide. One-quarter to one-third of folks with anorexia nervosa or bulimia nervosa have attempted suicide.5 Therefore, ED treatment cannot afford to wait.
Early Detection
Early detection, early intervention, and early change are key predictors of eating disorder recovery. Starvation reduces your child’s brain mass, function, and maturation during a time it should be growing.6 Since the brain is not maturing as it should be, it can be more difficult to recover from an eating disorder.6 This cycle can be vicious. Early treatment improves the speed of recovery, considerably reduces ED symptoms, improves the likelihood of long-term recovery, and leads to better outcomes.6,7
Benefits of Hospital at Home
Hospital at Home provides a solution to these problems. You can start treatment almost right away, without having to worry about wait lists, strict admission criteria, or long drives. Beginning treatment early will provide your child with the best chance of recovering. Additionally, research suggests that the least intensive treatment environment is best for patients.8 Providing treatment at home can be a more comfortable space for your child.
How We Can Help
We at Change Creates Change are here to help you navigate your child’s recovery. Providing hospital care for your child at home is not easy or intuitive. There is a lot to learn, and it can be a large time investment. That’s why we offer a Hospital at Home course. This course will help you learn everything you need to know about providing hospital care at home before you start. Topics discussed in the course include:
- The refeeding process
- Meal plans
- Meal support therapy
- Managing gastrointestinal discomfort
- Interrupting eating disorder symptoms
- Exercise cessation
- Restoring your child’s weight
- Managing emotional discomfort
- And much more
