An 80-year-old Caucasian man is hospitalized because of ischemic stroke. He has a history of hypertension, chronic renal failure, chronic obstructive pulmonary disease (COPD), and degenerative joint disease. He has smoked one-and-a-half packs of cigarettes daily for 50 years. He lives at home, alone, on the third floor of a five-story building. After three days in the hospital, he is ready to be discharged home, but he has been left with severe neurologic sequelae. He cannot eat, walk, or move without assistance. His nearest relative is a second-generation nephew who states that he has no time nor resources to take care of him. Where should this patient be referred?

Question

An 80-year-old Caucasian man is hospitalized because of ischemic stroke.  He has a history of hypertension, chronic renal failure, chronic obstructive pulmonary disease (COPD), and degenerative joint disease.  He has smoked one-and-a-half packs of cigarettes daily for 50 years.  He lives at home, alone, on the third floor of a five-story building.  After three days in the hospital, he is ready to be discharged home, but he has been left with severe neurologic sequelae.  He cannot eat, walk, or move without assistance.  His nearest relative is a second-generation nephew who states that he has no time nor resources to take care of him.  Where should this patient be referred?

Quizplus · Accepted Answer

Explanation: The patient has multiple comorbidities and needs special and close care, which can only be offered by a nursing home. Even if the patient were declared mentally competent and refuses nursing home placement, the Social Services Administration and Adult Protection Services can refuse to allow him to return to his home unless there is somebody besides a home health aid (HHA) that can be responsible for his care. (Choice B)A visiting nurse with adequate skills can supervise the medication and health status, but cannot stay with the patient permanently. (Choice C)The patient cannot be taken care by a HHA alone, because HHA responsibilities do not include medication and periodical health evaluation. (Choice D)The patient does not have a terminal condition. He is not a candidate for hospice. Educational Objective: Elderly patients who are unable to perform the basic daily living activities and take care of themselves can return home only if they are under the care or responsibility of another person, friend, or relative, who will guarantee adherence to the treatment and medical follow-up. If this is not possible, and if the patient has multiple or serious medical conditions, he should be placed in a nursing home.

An 80-Year-Old Caucasian Man Is Hospitalized Because of Ischemic Stroke