Thorough and appropriate discharge planning is likely to have a number of beneficial effects: The older patient is likely to receive continuity of care following their discharge; the likelihood of readmission is minimised; and the patient is more likely to be able to remain in the community rather than move into a higher level of care. Increasingly, older people are being discharged from acute care after an exacerbation of one or more chronic conditions. When they go home, they may have a range of needs for specialised healthcare or follow-up, rehabilitation, and short- or long-term non-clinical support services.
Discharge planning is important for all people in hospital but particularly older people. Because they don't often have the same sorts of resources that younger people have, and they don't have the same level of resilience, so they might have been just managing at home and then some sort of event has occurred - illness, injury - and they’ve had to go to hospital and during that phase they loose condition so you really need to be really aware of the situation they are going home to and that they are able to manage, that they’ve got enough resources there to maintain them.
If not enough attention is paid to discharge planning in older people, the most obvious thing that can happen is that they return to hospital and fairly quickly and sometimes more than once - so that you get a revolving door syndrome - and the worst case scenario is that they loose function each time they come in and then they might need to go into residential care. So its admission to residential care before they really need to.
When they first go home, they’ve had an illness or an injury they’ve been in a supportive environment in the hospital and a different environment. So they’re really not in their usual level of functioning. They’re dealing with new medications sometimes, they may be weakened, so they’re going to have more problems with managing their new medications, they may get the dosage wrong, and if they are in a weakened state they may be at a greater risk of falls, they may be having dizzy spells and you need to be alert to those sorts of possibilities.
Sorts of things that nurses need to be aware of when they’re thinking about discharge planning: first of all the persons consent and involvement in the process. They need to be an active participant. And you need to be holistic in your assessment. Not just looking at the diagnosis that they’ve come in with, but looking at their environment, their social situation, the sorts of supports they have around them and what their overall needs are going to be. What’s going to enable them to stay at home and to stay at home successfully.
Discharge planning should really start from the point of admission. You need to be thinking about what they’re going back to, what the skills they need are going to be, once they go home, so the care provider needs to be thinking about that, what are they going to need to be able to do so they can go home? What are the things they need to be doing in their home situation? Do they need to be able to manage stairs or do they need to be able to manage a long path? They may just have the pension as their day-to-day financial support and so they are really limited and they are really thinking about what things cost, so they may agree to a service but then once they get home and think about the cost of the service and getting to the service and what they are going to be, then they may not follow through. Transport is also a big issue; they often don’t have their own car or they can’t drive anymore and so your really need to be aware of the accessibility of services.
The older person needs to feel empowered. They are very aware of loosing their independence and often very protective of their independence and so they need to feel empowered in the process, rather than taking a caretaker position "you need this, this and this and this is what we’ve arranged for you", they have to be a partner in the process. They have to make choices and be involved, so that they are happy with what they are getting.
For discharge planning to be effective, it needs to be collaborative, involving the older patient, their carers and family. Decisions should be made by all involved, so that the plan is realistic, appropriate and achievable. Follow-up services need to be available, accessible, and affordable for the person who will be using them.
Factors relating to the older client’s cultural background may also have a large impact on discharge planning.
The next three pages of this course module pose a series of multiple choice questions to quiz you on what you have learned.
In the video, Maria discusses some of the reasons why it is important that the older person is an active participant in the discharge planning process. After investigating the links below, consider the following questions:
- How might you go about ensuring that the older patient is going home to an environment that is going to be safe for them?
- Who might you involve if you think that the patient may need special equipment in order to be safe in their home following discharge?
- How might you begin to prepare a carer for a role that may be new or different, following the discharge of their older relative?