New regulations and payment models depend upon successful patient discharge home without a re-admission in the immediate future. Physical therapists will play a huge role in determining whether or not a patient is “ready for discharge” home and once home, to continue their care and safety planning.
This is an opportunity to re-write “best practices” in home care for the entire team. In the end the patient should benefit by preventing a physical decline that could occur, especially with the short acute care stays we are currently seeing and with patients coming home sicker and sicker.
Are you ready for this paradigm shift? How will it affect the care you give? If you work in home care, do you see closer collaboration with the discharging hospital’s physical therapist as being necessary? If a home care patient refuses treatment for “not feeling well”, how do you handle that so someone is staying on top of the situation? Do you get nursing involved with a visit that they (perhaps) were not planning? What frustrations do you face in home care that will make this difficult? Is your home care agency preparing you properly for these changes?
We look forward to hearing from you on these issues. Please share your ideas and your experiences as well as your frustrations.
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