A Look at Discharge Planning for the Elderly Part III

Here are some things that a social worker or discharge planner will consider when developing a Discharge Plan:

The presence of stairs can challenging if a patient needs to be able to climb them to get to his/her bedroom etc. If this is an issue for a patient, a variety of options will be explored. For example, if a patient can be moved to a bedroom downstairs or not. The social worker may recommend having the CCAC install home safety devices that may include a bath bar, a bath seat etc. The CCAC may provide advice on what to do to prevent accidents such as picking up loose rugs.
The discharge plan will also include rehabilitation. To get a patient home, social workers must examine the need for rehabilitation. A patient’s compatibility for rehab is determined by whether or not he/she is going to get any better and if the patient will be able to grasp the information without confusion.

Another issue with the transition home is dealing with the level of supervision that a patient requires. A social worker will ask; Does the patient live alone? Is it appropriate for him/her to still be living alone? If there isn’t another option, what supports can be put in place to assist the patient? Obviously, CCAC can’t be employed and their services are limited, especially with recent government cut backs.

There is also the option to hire live-in care as a more cost-effective alternative. The problem is affording it and agreeing to it. Some may not have room to have a live-in caregiver. Some may not want somebody living in their home.

Home-care can be very limited. A trained homecare giver will come to change diapers, but certainly not four times a day. They will teach family members to use a feeding tube, but will not always be there to use administer it.

The physical transition from the hospital to home is usually the easiest part of the whole process. A thoughtful transition plan can make it work.

Add comment April 21st, 2009

A Look at Discharge Planning for the Elderly Part l

Sometimes when an elderly patient is discharged from a hospital, he or she may not be able to continue living without extra care. To make the transition home with live-in-care, to a rehabilitation hospital, or to a long-term care facility, patients and their families must go through a detailed planning process called Discharge Planning.

Discharge Planning involves the exploration of sensitive issues that are centered around a patient’s mental and physical capacity. The purpose of this process is to establish realistic expectations in terms of a patient’s full or partial recovery, financial resources, the availability of family caregivers, live-in-care options, and legal issues like powers of attorney. This assessment will include an analysis of the physical barriers a patient may face at home and resources that are available to a patient in terms of community and commercial support.

It can be hard for family members to accept change in a loved one. Even if the best results are obtained, an older patient can still decline after a hospital stay. It may be hard for family members to agree on the level of care needed and for the patient to go along with the decision. Patients may refuse much needed live-in care help. Occasional assistance provided by family members may not be a sufficient solution for long term care. A thoughtful and realistic “Discharge Plan” can ensure a well-organized and secure transition for a patient who requires a change in lifestyle.

1 comment April 1st, 2009