Case #2: Ms. H
Assume you work in a subacute unit* as a discharge planner and Ms. H is referred to you and will be ready for discharge soon.
Ms. H is a widow, 75 years old, Hispanic, and living with her daughter, M, son-in-law, J, and their two children, ages 3 and 5, in a rural community (you pick where). Ms. H’s primary language is Spanish. She understands and speaks English but often relies on her family for translation.
Ms. H stated her health had been good before hospitalization and attributed it to her family, spicy food, outdoors, and religious beliefs. She takes pride in taking care of her family. During most days, Ms. H spends time outside with women in the neighborhood and takes care of her grandchildren while M and J work nearby.
They own an SUV. There is no public transportation, but there is Medicaid transportation (county contract). Ms. H presently has no insurance but is a citizen and would meet the Medicaid eligibility requirements (low income/assets).
Ms. H takes a baby aspirin and wears bifocals. She was recently diagnosed with mild hypertension but has not filled the prescription (Inderal = propranolol) provided by her doctor, located in the nearby town where her children work. She believes that her prayers can cure mild hypertension, but M wants her to take the medication.
While running after one of her grandchildren, Ms. H fell. Neighbors called an ambulance. Ms. H has a hairline fracture of her left wrist and an intertrochanteric left hip fracture. Surgery was performed (hip fixated with “nails,” which are screws), and Ms. H has been in the sub-acute unit of a hospital in the nearby town for two weeks. She is ready for discharge.
Treatments differ for intertrochanteric hip fractures. Ms. H’s hip “nails” will remain in place. She’s been “rehabbed” but wants to go home, and M and J also want her to return to their home. At a minimum (for her physical health), Ms. H will need physical therapy (PT—they’ll assess what type of mobility devices are required but don’t provide them—you get them from a medical supply company or an aging agency might have a loan closet), occupational therapy (OT) (these are home health services Medicare/Medicaid covers if ordered by an MD), daily living assistance, and mobility assistance. Don’t forget psycho-social implications. For more information on intertrochanteric hip fractures: http://www.mayoclinic.com/health/hip-fracture/DS00…
(Please note that some people have total hip arthroplasty (hip replacement) for this type of fracture)
* What is sub-acute care? (or rehab)?
The definition of Sub-acute Care developed by the American Health Care Association (AHCA), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and the Association of Hospital-Based Skilled Nursing Facilities is as follows:
Sub-acute care is comprehensive inpatient care designed for an acute illness, injury, or worsening of a disease process.
It is a goal-oriented treatment rendered immediately after, or instead of, acute hospitalization to treat specific active complex medical conditions or administer one or more technically complex treatments in the context of a person’s underlying long-term needs and overall situation.
An interdisciplinary approach is used to formulate a goal-oriented plan of care for each resident.
The Subacute care team is dedicated to providing appropriate interventions to avoid unnecessary and frequent hospitalizations. An actual Subacute care provider should focus on training patients to achieve their highest level of independence as quickly as possible. Subacute care is generally more intensive than traditional nursing facility care and less intensive than acute care.
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