On my last prac I was looking after a older lady (90+) who was initially admitted for a laparotomy. In most cases the patient is discharged anywhere between 4-10 days. This patient had her operation at the beginning of my second week and was still not discharged by the time I finished the prac. She had no chest issues that were keeping her in hospital and after consultation with her surgical team I found no medical reason to keep her in hospital.
The reason she was still at hospital was because her carer had informed the social worker that the patient was not coping at home. This was revealed to us at a team meeting. The patient lived at home pre-admission and had services for cleaning and cooking and family help for shopping. She was still home alone for large amounts of time with no help. It was reported that her mobility was impaired to such a level that there were hygiene and toileting issue beginning to emerge. She was also found many times asleep in her lounge chair because she was not able to make it to her bedroom.
Consequently the patient's main physiotherapy concern was mobility. This patient was a typical candidate for low-level care and a request for the DCGM (Department of Community and Geriatric Medicine) team to review her was promptly sent with the aim of an ACAT (Aged Care Assessment Team) assessment.
When I discussed this with the patient I recieved quite a negative response from her and was promptly told that the only place she was going to would be back home. The treatment session I had planned was refused and the patient would not talk to me. Even though the medical and allied health team, together with the family, decided that the patient was not coping at home, the patient was still adamant that she was going home.
Now I don't believe I was being dishonest, but to be able to perform any rehab with this patient it was necessary for me to not mention low-level care again. The patient repeatedely commented during the rest of our treatment sessions how she was going home. I didn't say anything contrary but neither did I agree with her. In the end I believed that the best course of action was to maintain a rehab program while she was still on the surgical ward. Maybe later on in her rehab process the issue could be raised again but in order to provide the most effective rehab while she was still on my ward I chose to not disucss low-level care again.
1 comment:
I think this was a wise idea because as much as we have an input into the discharge of patients, in the end it is not our job to organise their living arrangements. It is more important for her to recieve treatment rather than get caught up in a pointless argument with the PT. I too have found that sometimes it's better to say nothing at all and stay clear of touchy subjects all together.
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