Every patient on an inpatient hospital unit receives a similar support team, and units are ideally designed to meet the staffing needs of their patients.
While hospitalized, a person typically has access to nurses, specialized therapists, and support staff 24 hours a day. Additionally, they can speak to their physicians daily to clarify their treatment plans or to problem-solve new challenges.
However, everyone's homelife is different, and how they will manage to continue their care may be affected by how much help they have access to. And many, many people do not have much support at home at all.
When considering discharge, a care team needs to review a patient's average day, including who they live with and who they can reach out to for help.
Common topics to be covered include:
Before hospitalization, how much support did the person need? What did they typically need help with?
Are there any challenges with steady income, housing, or support?
After leaving the hospital, will they be living alone or with others?
Is there anyone around most days who can help with medications, chores, and transportation?
If they are alone and need help, who would they typically call? How far away is this person and how often can they realistically help?
When speaking with patients, sometimes people are surprised that a team member is asking this level of detail about their home life. For many, the structure of their homes and how they navigate their day to day needs is intensely private, and there is some hesitance to discuss these challenges with relative strangers. In response, I usually like to bring up the example of transportation because I think it's a great example of how easily discharge planning can go awry.
I work as a psychiatrist in the greater Los Angeles area. It's a city infamous for 5 miles potentially taking nearly an hour to drive. We have a minimally developed public transportation, and the costs of gas and personal transportation can be quite high.
An inpatient team I work with could work for days to advocate for a patient to see the most skilled and relevant providers in the region...but if the patient can't get there, then it's a broken discharge plan from the start. Sometimes, the accessible location, that can be gotten to easily throughout the week, is ultimately the far more helpful long-term plan.
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