General

What should we do in this clinical scenario ??????

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20 Jul 2016 - General
 

An elderly (around 95 years old) lady, staying alone, with background history of ischaemic heart disease, hypertension, previous stroke, mild cognitive decline,  was initially admiited around 2 weeks ago due to reccurrent falls at home, not coping well at home, also with urinary tract infection. She was treated for her UTI. Patient was accessed and seen by physiotherapist, occupational therapist, speech and language therapist, and medical social worker during this admission. The conclusion from the multi-discplinary team (MDT) suggested that patient is not safe to go back to her home alone, as she need help in daily activity., and need assistance of 1 for mobilistion.. Suggestion was made for her to go to nursing home, where someone can care for her. But, patient refuse the suggestion to go to nursing home, very keen to go back to her home. So, what should you do ???? Any suggestions?

 

@Maria Cristina Inserto, haha you can’t follow her home, is an invasion of privacy!!! Yes, she needs help and supervision at home. Depend on the health care system in specific area or country, patient may possibly need a 24 hours carer or frequent home help visit up to around 4-5 times per day. Her house environment may need to be modified (as per occupational therapist assessment and suggestions), to create a safer environment for her, tailoring to her need. For example, if she is not safe to ...
 (Total 121 words)
This is very understandable but really frustrating. But given her condition, it is obvious that she needs round-the-clock care and supervision. She is 95 years old and she will really have a better time at a nursing home, but since she refuses this, then care has to be brought to her home. Either a nurse or a caregiver should be provided to her, so that her home life could be transformed to liken that of a nursing home.

Oh she doesn't have relatives to make this decision? But is sh...
 (Total 127 words)
This is very understandable but really frustrating. But given her condition, it is obvious that she needs round-the-clock care and supervision. She is 95 years old and she will really have a better time at a nursing home, but since she refuses this, then care has to be brought to her home. Either a nurse or a caregiver should be provided to her, so that her home life could be transformed to liken that of a nursing home.

Oh she doesn't have relatives to make this decision? But is sh...
 (Total 127 words)
This is very understandable but really frustrating. But given her condition, it is obvious that she needs round-the-clock care and supervision. She is 95 years old and she will really have a better time at a nursing home, but since she refuses this, then care has to be brought to her home. Either a nurse or a caregiver should be provided to her, so that her home life could be transformed to liken that of a nursing home.

Oh she doesn't have relatives to make this decision? But is sh...
 (Total 127 words)
This is very understandable but really frustrating. But given her condition, it is obvious that she needs round-the-clock care and supervision. She is 95 years old and she will really have a better time at a nursing home, but since she refuses this, then care has to be brought to her home. Either a nurse or a caregiver should be provided to her, so that her home life could be transformed to liken that of a nursing home.

Oh she doesn't have relatives to make this decision? But is sh...
 (Total 127 words)
This is very understandable but really frustrating. But given her condition, it is obvious that she needs round-the-clock care and supervision. She is 95 years old and she will really have a better time at a nursing home, but since she refuses this, then care has to be brought to her home. Either a nurse or a caregiver should be provided to her, so that her home life could be transformed to liken that of a nursing home.

Oh she doesn't have relatives to make this decision? But is sh...
 (Total 127 words)
@ Marinelle Castro, to make thing more complicated, what if she don’t have a next-of-kin or her next available relative was not keen to be contacted or involve (not so unusual situation) ??? Ultimately, the decision will be on the patient herself. As long as she can understand the risks she was taking, knows the consequences, and know about other alternatives option, then she can make an informed decision of going home, which is the place that she will be happy to live in. We are living in a f...
 (Total 167 words)
Since there are safety concerns in sending her home, I suggest that someone should contact her legal next of kin and allow that person to help the patient make a decision. If there are no living relatives, then this issue should be discussed with the ethics board and legal team of the hospital. Because of serious safety issues in sending her home, if something unfortunate happens to her upon discharge, the healthcare team could be potentially held liable, so in my opinion it's wise to have a...
 (Total 113 words)

Yes, patient has a capacity to make her decision, and she should be discharged home if she wishes to go home. But, as healthcare professionals, we need to let the patient know this will be a risky discharge, and she might be back to hospital soon. As you all pointed out, maximum home support will be crucial for her. Occupational therapist will assess her needs or equipments needed for her activity of daily living, and a pendant alarm for her in case of any emergency. Physiotherapist could t...
 (Total 169 words)
I will send an occupational therapist to her home to see if any home adjustment can be made to ensure she is safe to mobilize around. For example to will need motion activated night light, anti slip floor mat, even ground, reduction of obstacles at home, low bed etc. Every few days, a home nurse should be visiting her to ensure she is taking her medication and to help her out if she has any issue. Provision and training of her with a proper walking aid is also essential. It may be a simple walki...
 (Total 206 words)
(1) Maybe I'll be asking the elderly if she knows some of her relatives living close to her, to constantly check on her from time to time. If the elderly insist of going back at home, we can politely ask her neighbors to check on her from time to time too. But this is not a guarantee because of course, if this is situation is happening in the Philippines there's a lot of people who can at least take care of us. Be related by blood or not. I am not just sure if how does other countries de...
 (Total 137 words)