Introduction
The transition from one setting to another may be difficult for older adults. While many facilities are not attempting to implement the transitional care model to assist patients in adapting to the new environment, many examples of unsuccessful transitions exist (Hirschman, Shaid, McCauley, Pauly, & Naylor, 2015). The present case discusses the choices of an 89-year-old man who was admitted to a hospital for several days because of myocardial infarction (MI). After a week of being in a hospital, the patient was discharged to his home according to his wishes. While follow-up visitations and communication supported the transition, the man’s health affected his reintegration into the home setting.
Impact of Differences and the Advance Directive
In this instance, the patient was admitted to the hospital with the assistance of his daughter, who was with her father when the MI happened. While in the hospital, the patient received the necessary care, regaining consciousness and mobility. The patient’s fall damage (he fell during the MI and hit his head) was also treated. He was discharged to go back home with directions to continue taking medication and slowly resume his physical activity.
Nevertheless, upon returning home, the patient did not adhere to the recommendations. He did not take medications on time and did not balance his physical activity when performing household chores. The setting of the hospital allowed him to rest and communicate with other people, and nurses helped him to take his medication (Kogan, Wilber, & Mosqueda, 2016). The man did not have a supportive framework at home because he lived alone, and his only daughter lived far away from him.
The patient’s decision to return home could not be questioned since it was specified in his advance directive. The man firmly believed that he did not want to reside in a facility and wanted to stay at home regardless of the circumstances. The hospital staff discussed options of changing the advance directive, seeing that the man’s health could quickly deteriorate without proper care. However, since he did not change his decision, he went home after being treated. The patient’s choice presented healthcare providers with an ethical issue – to respect the wishes of the person even if they were detrimental to his health (Lum, Sudore, & Bekelman, 2015). During the follow-up conversations, nurses attempted to review the environment of the patient and see what could be changed to improve medication adherence and help the patient to limit physical exertion.
Financial Issues
In this case, the patient’s placement was explained by his personal wishes. Nonetheless, in some situations, patients’ options are limited due to financial problems. For instance, several nursing homes do not allow Medicare, which usually covers the residence costs partially or in full (Resnick, 2016). People who do not have insurance may not afford to stay in a facility. Some people also refuse treatment, resuscitation, and life support due to financial difficulties.
Conclusion
In the present case, the patient was admitted to the hospital after an MI. Upon discharge, he returned to his home, where he quickly abandoned the practices that were suggested to him by healthcare providers. The lack of a caring culture and professional attention led to complications, as the patient could not care for himself. However, an advance directive limited the extent to which advanced practice nurses could influence the patient’s choice for sites of care. Financial difficulties can have a similar effect if a person’s insurance does not cover the costs of assisted living or nursing homes.
References
Hirschman, K. B., Shaid, E., McCauley, K., Pauly, M. V., & Naylor, M. D. (2015). Continuity of care: The transitional care model.OJIN: The Online Journal of Issues in Nursing, 20(3). Web.
Kogan, A. C., Wilber, K., & Mosqueda, L. (2016). Person-centered care for older adults with chronic conditions and functional impairment: A systematic literature review. Journal of the American Geriatrics Society, 64(1), e1-e7.
Lum, H. D., Sudore, R. L., & Bekelman, D. B. (2015). Advance care planning in the elderly. Medical Clinics, 99(2), 391-403.
Resnick, B. (Ed.). (2016). Geriatric nursing review syllabus: A core curriculum in advanced practice geriatric nursing (5th ed.). New York, NY: American Geriatrics Society.