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Placement Problems: nursing home and assisted living.

Placement issues surrounding the elderly are complex and often emotional for both the patient and family members. Whether a patient can return home with home health, live in an assisted living facility, or needs to be placed in a nursing facility requires assessment not only of the patient's capabilities, but also family and financial issues. Occasionally, the patient and family may have planned for a protracted rehabilitation or even nursing home life, but in general, people are not prepared to deal with these issues.

Begin evaluating the living situation of an elderly patient as soon as they are admitted to the hospital. Determine if the patient lives alone, with an elderly spouse, or with younger people in the home or near by. Support of family and friends is often crucial to sending an elderly person home. If the patient is debilitated following a hospital stay or recuperating from a limb fracture, the home should be evaluated prior to discharge to determine whether it needs modification. In addition to modifications to the home, there usually needs to be a caregiver present in the home. In some cases, the extended family must readjust their lives to fill this need.

If it appears that an elderly patient may need to either return home with home health or be discharged to an assisted living home or nursing home the social worker should be contacted immediately. The social worker will meet with the patient and family members to obtain financial and insurance information necessary to set up discharge. Although eligible for Medicare at age 65, many patients have not applied for its benefits and the paperwork may take up to 45 days to be completed.

Setting up a discharge for an elderly person can be frustrating and time consuming. If planned correctly and far enough in advance, it can go smoothly.

DO all of these DON'T do any of these
Think about discharge early in the hospital course. Wait until the day before discharge to think about where the patient will go.
Discuss discharge with patient and family early. Tell the family the patient is going home the day prior to discharge.
Involve social work at an early date. Assume that the family can take care of the patient at home.
Get an early OT and PT evaluation if needed. Assume that the patient has insurance and/or Medicare or Medicaid.

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