Melissa O'Connor, PhD, MBA, RN, FGSA, FAAN, endowed professor in Community and Home Health Nursing, M. Louise Fitzpatrick School of Nursing, Villanova University, and director, Gerontology Interest Group, discussed several factors for clinicians to consider in creating plans to discharge adults from skilled home health care.
Safety is of utmost priority in deciding whether to discharge a patient from home health, especially whether they can adequately care for themselves or if their respective caregiver has enough support to do so as well, said Melissa O'Connor, PhD, MBA, RN, FGSA, FAAN, endowed professor in Community and Home Health Nursing, M. Louise Fitzpatrick School of Nursing, Villanova University, and director, Gerontology Interest Group.
What are some of the factors that are considered when creating plans to discharge adults from skilled home health services?
That's a really good question. We interviewed patients and their caregivers, as well as home health clinicians, which includes therapists, nurses, physicians, and social workers. So, it wasn't just nurses. And this is what we learned: One of the most important things that clinicians consider is safety, and what was most important to patients was that they could care for themselves, which makes sense. So, does the patient and/or caregiver have an understanding of what is often a chronic condition? When should they reach out to their primary care provider and when do they need emergent care?
So, all of these things are really important that clinicians consider before they're going to discharge. Some other things that they consider is their functional status, their ability to prepare and take their medications correctly. We know that medication errors are a very common issue among older adults that leads them back into the hospital or into the emergency room.
Do they have access to community-based resources according to their needs? Such as Meals on Wheels, lab work, transportation. Another consideration for clinicians is if the patient has reached their maximum potential—if a patient stops progressing, home health has to discharge. Another consideration is having a caregiver and if the caregiver has support; that was really important to the patients and caregivers that we interviewed. And it's not just the status of their chronic conditions, of course, which a lot of people might think in home health.
Clinicians take very seriously how the patient will be able to manage in their home after home health discharges. So, they pay very close attention also to when patients live alone, because sometimes they have unique needs or unique circumstances that make them unable to manage as well as someone who maybe doesn't live alone. So, all of those things are what we consider before we discharge someone from home health.