Geriatric Quick Consult Placement Problems Do #2
|
| Knowledge | Action |
|---|---|
| Initiate discharge discussions with the patient and family early in the hospital course.
Determine what the patient wants from their living situation and what the family is willing and capable of doing. You will find that there are times when the patient and family members do not share the same goals. The patient may wish to return home and have the family provide care while the family may not be capable of doing so. You must evaluate the situation early so that a plan can be agreed upon. |
|
| First you must determine your recommendation regarding placement.
Medically, a patient should not be discharged to any living situation unless stable. Nursing homes are not extensions of inpatient stays. They are designed for medically stable persons. Vitals are routinely taken monthly and patients are reviewed and seen by physicians every 30 days. A patient prematurely discharged will be back in the ER very quickly. A person dependent in 3 or more ADLs or requiring skilled care (wound care, trach care, or RN care) is considered nursing home appropriate by Medicare and Medicaid. OT and PT should review the patient to help determine ADLs and level of need. Assisted living sites are appropriate for persons needing minimal help with ADLs (generally self sufficient) versus Adult Homes that will accept persons with more needs. |
|
| Once you have determined your recommendation regarding placement you should explain how you came to this decision to both the patient and family.
In addition, be sure that every member of the care giving team knows the discharge plan. If there is a disagreement within the family, they will quickly attempt to find team members to reinforce their desires. Have a family meeting to finalize discharge and include the patient so that everyone is involved in the same discussion. |
|
