Discharge Planning - Essay Example

___________ ____________ ____October 2007 Discharge planning Introduction Discharge planning may be described as a scheme or a process that structures the needful to transfer a patient from one stage of care to another. The discharge plan might incorporate sending someone to a rehabilitation center or the patient's own residence, a nursing home or some other place outside the hospital. If a patient is totally discharged from the hospital or nursing home and sent to his place, it usually does not indicates he has recovered completely. Other possibilities might be that the patient is in a relatively stable condition of health and therefore can be shifted from hospital level care. The family members or close associates of the patient are also consulted. However, it is the physician who is authorized to decide the discharge and give his final opinion. The concerned family member needs to consult the discharge planner who may be a nurse, the administrator or even a social worker who has taken the responsibility of the patient. It is important to trace the discharge planner or find out by asking whether there is a planner appointed. Above all, it needs to be ensured at any cost, that the discharge is safe and all right for the patient's health. It needs to be assured that the place where the patient is shifted does not pose any immediate danger to his health condition and the right kind of health care plan is undertaken to look after the patient's well being. Then nursing orientation for aged is to be full and professional. For instance as nursing and therapeutic tools now there are a range of evidence based cognitive, behavioural and family interventions.(Mari & Adams,1996;Drury et al,1996) which could be easily deployed in aged mental in-patient care; however these ere rarely used by nurses. These approaches were meant to achieve the target of weaving a participative style of mental health treatment so that risk factors are broadly dispersed. Why older people are more susceptible to poor discharge planning Aged people in most countries, especially in third world nations are the most neglected family members. It is often found that even an affluent family does not want to take the financial responsibility of the useless old member. Old age homes are there but a charitable organization may not be able to provide the entire cost of treatment, taking into consideration that this age group is more prone to severe illnesses. Hence one needs to depend on reimbursement programs on a large scale. However, these organizations are mostly profit oriented and hence the reimbursement facility granted to the old people is much less than the rest. It is assumed that risk is greater to aged people's life. Thus a risk measurement and analysis is an important component of health care programs. Often, the hospital would tell the patient to go home once the reimbursed amount is exhausted. It would now depend on the mercy of the social organizations or the consideration of the family members. The cost based reimbursement plan is more accountable for such consequences. However, the shift from cost based reimbursement to prospective based reimbursement plan is a significant move. In the Medicare program, this shift is very crucial for the health of aged people. It essentially ensures that this program mostly affects adults aged above 65 years. This program emphasizes on cost containment, an important step taken in the direction of discharge planning for aged people. The idea is to provide them safe and adequate care under the supervision of the hospital services. The ageing process - physical aspect The process of aging is a natural one; it is progressive and irreversible physiologically. Despite the proper kind of nutrition and regular health care activities, age is bound to control every human being. Biologically we may define the aging process, as a set of altered or modified rates of progressive changes is response to the genetic background of an individual and the daily living habits. Aging is therefore a normal and inevitable occurrence. Yet, the specific changes brought about by aging are different in different cases. This depends upon the exposure of an individual to the surroundings, that is, the kind of social, physical and financial environment and backdrop. Different people may have access to different sets of support facilities and environment. This shows in their physical aging. This complex process may be defined in three main ways. Chronological definition suggests the involvement of number of years. This is the most common measure of age and also easiest to assess. Socially people recognize age in terms of the number of years covered by an individual's life span. Functional definition of age refers to the ability of individuals to contribute socially and economically to the society, nation and to his family. Old age finds a person with different inabilities and hindrance that prevents him from his previous range of capacities. Physiological aging refers to the determination of age through the function of the body. Aging brings about some anatomical changes such as the reduction in metabolic rates which downgrades the overall body performance. Ageism and ageist attitudes and discharge planning Old age is often feared by most individuals. The main reason is often the loss of highly values attributes like youth, beauty and vitality. Loss of health is the most crucial aspect that aging brings along with it. Aging finally leads to death and that is another factor of fear that is created in us. Since one cannot avoid this it is crucial to go for the right treatment. Through communications, older people are often portrayed in as a matter of ridicule and in a negative light. Myths and misconceptions about old age need to be avoided and sensitive care needs to be provided amongst the old folk. Ageism has been perpetuated in more than one ways. The big industries and media all point adversely towards ageism. The commercials of old age creams and anti wrinkle lotions all create an inferior complex in aged people. Older people are rarely taken in good jobs well suited to their qualifications. Health care system can also continue this kind of ageist attitudes while dealing with elder patients. Often certain health related complaints are disregarded as symptoms of ageism. The potential medical reason is hardly addressed and hence the negligence at this level is greater in case of elder people than the others. Thus age is used to determine the treatment instead of the actual cause of ailment. This required special care and attention while dealing with old age people and their health problem. Along with physical treatment psychological boosting is also essential. The patient should be cheerful and not sink into the worries and fear of old age. Why are old people more susceptible to poor discharge planning A patient should be discharged when the hospital's care can be replaced by some other stages of health care. Otherwise, it is better to prolong the treatment in a hospital for such patients as they are often under neglect outside hospitals, whether it is at the patient's own place or any other social organization. Problems like anemia, cataract of the eye, high blood pressures, kidney problems and other related ailments are often ignored by the physician. These issues are either related with old age or any permanent treatment is overruled sue to the age factor. For instance cataract operation might prove to be harmful for an old person. Similarly blood transfusion might also highlight danger in old people. The problem of finance and insurance is another area where the old patients need assistance. They have to be provided full support in settlements of bills and insurance claims to make discharge event free of conflicts. Multi disciplinary team working in planning safe discharge Multidisciplinary teams refer to groups of professionals coming together from various diverse disciplines under a common roof and for a common purpose. Such teams not only help solving the difficult cases, but might also sort out some other issues like identification of service gaps and any loopholes in the coordination system between agencies and the resources. Discharge planning systems in hospitals are often in dire need of such teams. This team may perform multifold functions. This team might not only look into the safe discharge of the patients but also look into the different areas of development in order to attend to the needs of the emergency unit patients such that they may be discharged soon and returned to the community. However, in case of aged people, their purpose should not simply restrict to these activities. The team would study carefully and closely whether the disease has been rightly diagnosed and looked after with prescribed medication. How well the patient would be taken care of when released and sent back to his family is another major concern. The team also needs to analyze and weigh the possibilities of the stage of care where he needs to be discharged. Proper amenities and a friendly ambience need to be surrounding the aged patient such that he may feel psychologically and morally well. The nurses have a great role to play. They might form a part of this group and look after the various aspects concerning the old patient. Being a nurse might also mean listening to irrelevant talks spoken by a nostalgic patient as well as keeping a proper record of the medicines and daily care routine under taken With regard to emergency patients, the following things need to be ensured: Preventing unnecessary and inappropriate admissions into the hospital; Bringing down the number of presentations of patients to a bare minimum Providing safe and effective discharge from the emergency unit back to the previous community. Emergency care is often risky for the older people and hence risk identification is another responsibility of the team. In order to identify the high-risk patients, risk-screening tools may be employed. Psychological and psychosocial impact of improper discharge plan An aged person in any case feels neglected and uncomfortable in a social setting. Several complexities are created within himself. Often as their need in a family reduces and almost nullifies, the other members might simply neglect him. This creates a negative psychological impact on the person concerned. Feeling of neglect and often abuse from one's own people is severely painful and even more troublesome than any ailment. Any physical ailment might still not overpower a person as long as the mental weariness does not take over us. An old person needs to be rather stronger in his mind in order to compensate the loss of physical strength. However he cannot do this without the right kind of environment and boosting of the morale. Mere medical treatment might not help. Old age is after the age of 'second childishness' and hence the patient needs to be nurtured and looked after almost like a child. Now improper discharge might act adversely to the interest of the patient as well as the patient's family is they are actually concerned about the patient. When an aged person is moved to a rehabilitation center from hospital care and proper care is not taken there then the patient's condition might deteriorate faster and also he might be abandoned and less cared for. The provision of a warm ambience is very crucial for such patients. These patients if not adequately cured and left to return tot heir residence creates a worse situation because when the semi-recovered state is revealed the patient may be even more abandoned by the family and the concerned individual therefore might be compelled to withdraw from social interaction out of his inner complexities. In such a case the patient might give up all hopes of recovery and recede into a shell, which would create a further deterioration of the brain and body. This is particularly applicable for older adults suffering from mental ailments. Strategies in health promotion and rehabilitation with regard to discharge planning Though it is usually believed that old age people suffers from weak conditions of the health and mind, today studies reflect that the old population are robust psychologically and capable of change, that is flexible in their outlook. In today's world aged people are on a regular exercise regime and knows when to control their diet. As far as discharge is concerned, the proper discharge move may be granted by ensuring the following aspects: Greater involvement of the family members is required. The discharge team needs to involve the members more and more into the organization. This serves the purpose of taking their consent as well as explaining to them the severity of the situation. More than anything this also marked the patient feel better. In order to manage the discharge planning on a broad scale a regular diary or notebook needs to be maintained. Here the team members might be more alert by noting down the time and status of each patient. In this manner a proper monitoring may be performed. A multidisciplinary team may be brought in. This team might be assigned with the task of looking into the emergency unit. This team might decide whether a certain patient is to be released from the concerned emergency unit of the hospital. Also the team would decide whom to take and whom to leave behind. A proper risk screening method leads to discrimination but this is not really in favor of the person concerned. Prospective payment reimbursement programs need to be developed and more attended instead of cost based approach. The hospital needs to be a little more considerate in their approach towards old patients. For instance, as soon as their reimbursement payment gets exhausted, they need not be immediately asked to move out. Instead, the patient needs to be given some time to arrange for a new center. Policies undertaken by the government - some organizations: National Service Framework (NSF) for Older People: NSF has set new standards for old people and the care they are entitled to. The aim is to prevent them from being discriminated from accessing any health and social service. The older people need to be treated as individuals and they should receive proper care and health services irrespective of the general rules and their problems need to be individually addressed. The standards would also provide integrated services to promote faster recovery from ailments, keep away from unnecessary admissions in hospital, support timely discharge and maximise independent living. Age Concern: This organization sets up various policies in order to ensure the inclusion of older people into the social circle, to help the aged people make the most out of their old age and their program aim to reach out to the most excluded section of the older population. The organization highlights the level of attention being paid by the government towards older people and also helps us to get a better picture of the degree of exclusion of older people. This would make us aware where we are lacking in building up a society where our seniors might rest in peace. For instance for mental patients in aged there are specific initiatives of the government. In Modernizing Mental Health Services: Safe, Sound and Supportive (Department of Health, 1998) the UK government has put forward its elaborate strategy for improving mental health services in England in the forthcoming future and at the same this document recognizes that instances of mental illness carry with them the enhanced risk of suicide, involvement in violence, stigma and social exclusion. These are the sources of risk. Risk in mental health care systems can be defined as the degree of probability of any of the above listed events happening. As O'Hara (2005) states, "Figures published today reveal there were over 40,000 attacks on mental health nurses in England last year. One nursing assistant was bludgeoned to death. How can such incidents be prevented....... In her eight years as a mental health nurse, June Murray has witnessed what she calls "some very violent situations". She has had a rib broken while trying to restrain a patient, she's been kicked in the chest. And then there are her colleagues. "There have been lots of times where nurses have been injured. In one instance there was a stabbing during lunch. A patient suddenly picked up a knife. There was no way of seeing the attack coming." 1 2 The responsibilities and roles of the frontline mental health care providers i.e. nurse have undergone a remarkable change. They have become the central focus of all systemic changes seeking to identify, measure and mitigate risks in mental health environments. It has been a long haul from the year1968, when the first review of mental health nursing bearing the title Psychiatric Nursing Today and Tomorrow( Ministry of Health,1968) was published. In those days the UK mental health system had a massive population of nearly 130,000 in-patients with a majority of them being in old Victorian asylums. By 1994, when the second position paper on the status of mental health nursing, titled, Working in Partnership (Department of Health,1994) came about there were only 25,000 in-patient beds with further reductions on the cards(University,1996) Clinical governance: Clinical Governance is not merely for the doctors, nurses and allied professionals but also for all who deliver some kind of health service or another. The policies include issues of cleanliness, comfortable environments, good food and proper level of communication. It is a body that sets a high level of standard for the health care delivered to the aged patients and this would involve people from all disciplines and not just the professional doctors and nurses. The Essence of care: The Essence of care sets certain benchmark for local medical practice and the medical practitioner may follow this standard and compare and contrast the level of health service delivered by them. Eventually, as time progresses, the idea of patient centered care has come in. Under this system, individual concerns of the patient is addressed. Information on treatment plans, preventive and follow-up care reminders, access to medical records, assistance with self-care, and counseling are provided to the patient who is rather engages as a partner in the service. An interaction of various disciplines are also observed and these standards and policies framed do not delineate the doctors and nurses separately. Hence this standard needs to be maintained by all. Sometimes social workers are also providing medical assistance to the aged people and going by the benchmark set, they would be bound to take standard care of the concerned people. The discharge planning department has therefore become a culmination of people from different cultures. Hence these people from various communities interact for a common purpose and after a careful analysis and understanding, the discharge planning is structured. Conclusion: The process of ageing is natural and the old population needs to be explained that this is not a curse. The showing of wrinkles, weakening of the muscles and graying of hair are all a grace of life itself. The society needs to accept this gracefully. Every young doctor and nurse would someday become old and of course that day they would not like to be treated casually. The treatment provided to the aged group therefore provokes a negative attitude in them. They often want to retreat into their shell and never come out till death. As far as discharge plan is involved, this should be undertaken with special attention to the individual needs and specific problems should not be overruled as an inevitable companion of old age. Each problem should be attended and the discharge time should appropriate for the specific patient with his specific problems. An all round cooperation and integrated support system combined with a multidisciplinary management structure is required to ensure the appropriate guideline for planning the discharge of aged patients. Work Cited 3 Mari J., Streiner D. Adams C., (1996).Family Interventions for those with schizophrenia. The Cochrane Library, London: BMJ Publications 4 Drury V., Birchwood M., Cochrane R., Macmillan F. (1996).Cognitive Therapy and Recovery from Acute Psychosis: a controlled trial.169, 5, 593-607. 5 Department of Health (1998).Modernizing Mental Health Services. 6 O'Hara,Mary.(2005). Risk assessment.Retrieved from www.SocietyGuardian.co.uk on March 3, 2007. 7 Ministry of Health (1968).Psychiatric Nursing Today and Tomorrow: Standing Mental Health and Standing Nursing.Advisory Committees.Ministry of Health: Central Health Services Council 8 Department of Health (1994).Working in Partnership: Review of the Mental Health Nursing Review Team HMSO London. 9 University of Manchester/Department of Health (1996).Learning Materials on mental health (Risk Assessment).University of Manchester School of Psychiatry and Behavioural Sciences: Manchester. Other Reference Works Age Concern, Policy, 2007, retrieved on October 27 2007 from: http://www.ageconcern.org.uk/AgeConcern/socialinclusion.asp Clinical Governance Support Team, Clinical Governance Frequently Asked Questions, retrieved on October 27 2007 from: http://www.cgsupport.nhs.uk/About_CG/FAQs.asp Davis, Karen, Stephen C. Schoenbaum and Anne-Marie J. Audet, A 2020 Vision of Patient-Centered Primary Care, Journal of General Internal Medicine, 20 (10): 953-57, October 2005 Lippincott, Springhouse, Lippincott Williams & Wilkins, 2002 Department of Health, The Essence of Care: Patient-focused benchmarking for health care practitioners, 2001, retrieved on October 27 2007 from: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4005475 Department of Health Change Agent team, Health and Social care change agent team, 2003, retrieved on October 27 2007 from: http://www.dh.gov.uk/prod_consum_dh/idcplgIdcService=GET_FILE&dID=9688&Rendition=Web Department of Health, Older people's NSF standards,2007, retrieved on October 27 2007 from: http://www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Olderpeoplesservices/OlderpeoplesNSFstandards/index.htm Moss, Joanne E., Carolyn L Flower, Liza M Houghton, Danielle L Moss, David A Nielsen and David McD Taylor, A multidisciplinary Care Coordination Team improves emergency department discharge planning practice,2002, retrieved on October 27, 2007 from: http://www.mja.com.au/public/issues/177_08_211002/mos10160_fm.html National Mental Health Information Center, Community Integration for Older Adults with Mental Illnesses: Overcoming Barriers and Seizing Opportunities, retrieved on October 27 2007, from: http://mentalhealth.samhsa.gov/publications/allpubs/sma05-4018/sec3.asp Shepperd, S. Parkes J., McClaran J., Phillips C. Discharge planning from hospital to home. Cochrane Database of Systematic Reviews 2000, Issue 4. Art. No.: CD000313. DOI: 10.1002/14651858.CD000313.pub2, 2003 Woolf, Linda M. Ageism, 1998, retrieved on October 27, 2007 from: http://www.webster.edu/woolflm/ageism.html Read More