Is There Such a Thing as a “Safe Discharge Plan”?

affordable home care services for seniors assisted home care for older people at home caregivers elderly home care service private pay home care non medical senior care senior home assistance home care in MinnesotaA typical scenario is that an elderly person takes a fall at home. Whether or not there are resulting fractures, the family and/or physician is afraid to discharge the person back home because now, since having had a fall, the person is deemed unsafe at home. Next, many times without consulting the person involved, the family is off in a hurry and under pressure to tour assisted living facilities, hoping they can find a place other than home to place the person as soon as the hospital discharge order is written.

Let me tell you what is wrong with this plan. Many times, families are under the impression that when a person lives in an assisted living facility they will be watched so closely that they a) will never fall, or b) will have someone right there with them when they do fall.  However, as we all know, a fall can happen just as easily in an assisted living facility as it can at home. Accidents happen anywhere for a variety of reasons. People get weak and deconditioned when institutionalized as well as when living at home. In some facilities for some people, the rate of falling can actually be higher than it is for them at home.

The other, and perhaps more important factor, is that families and doctors often make these decisions without consulting the person who will be affected! It is easier to send the patient off to an assisted living facility or to a nursing home to get her out of the hospital as soon as possible. It takes time to put together a plan for services in the home (physical and occupational therapy, help with housekeeping, delivered meals, adapted equipment, etc.) and many times hospital administrators are pressuring the discharge planners to release the patient as soon as possible. This, for a social worker, is an ethical dilemma because the patient may not have been consulted or the plan to institutionalize may or may not be the best option.

A core ethical standard for a social worker is the concept of autonomy or self-determination. This is the right to govern one’s self or to freely choose one’s actions as long as the choices do not interfere with autonomy or rights of other persons. So often, we forget that an injury from a fall, or a fall in and of itself, is only a physical problem. Granted, it can affect other areas of the person’s life, but my point is that just because someone is physically affected by a fall in one way or another does not mean they are mentally incapable of deciding whether or not they want to return home. A family’s fear of their loved one falling again often leads them to implement plans to move the person to a facility without that person’s input and without the knowledge of what the person desires to do. 

affordable home care for older people home help for the elderly home assistance private pay home care companies assisted home care in Minnesota  respite for caregiversUnless a person is deemed incompetent in a court of law, that person has the right to make decisions for himself whether or not the family agrees with the decision. If a person makes a decision that seems questionable, the family has a right to its opinion, but ultimately, the decision rests with the person. The discharge planner involved, as well as the physicians or other professionals, have an obligation to explain to the person all of the options, as well as the consequences of each option.

If the person chooses to go back home, then it is the duty of the involved professionals to assist that person in changing behaviors and activities that will minimize the risk of falling again. I tell my clients, “Use common sense.” If you want to stay home, then don’t be going down the basement steps carrying a basket full of laundry. Don’t be walking your trash to the garage on an icy sidewalk. If you have a cane or a walker, use it! Wear your Lifeline so if you do fall, you can call for help.

It’s challenging for those who are taking care of elderly parents to accept their loved one’s decision when that decision differs from what they feel is best. Again, however, each person, if competent, has the right to make that decision for themselves whether the decision is good or poor. They have the right to fail. My grandmother, after choosing to return home from hospitalization after hospitalization, finally made the decision herself to live in a nursing home. She realized that it was time to choose a different path. We were there to support her decision. If we had pushed her into moving any sooner, she likely would have resented us and would have always wondered if she could have stayed home.

 

Julie Ellingson, LSW

March 9, 2017


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