When we talk about healthcare, we talk about holistic patient care: we treat the person, not just their condition. Well, if that’s the case, how can a woman in her eighties with hypertension, diabetes, dementia, and other health issues, who was recently admitted to the hospital for 7 days with a diagnosis of pneumonia, and who requires 24/7 presence of another person, and who has excellent healthcare coverage not qualify for subacute care.
Anyone, young or old, who spends days in bed due to an illness experiences physical deconditioning and loss of functional capacity. In the older adult with pre-established chronic conditions, the risk of diminished functional capacity and increased dependence is even greater. Then, is it not in the best interest of the patient to arrange time in a subacute care or a rehabilitation facility to minimize the effects of deconditioning? Is this not the type of patient who will greatly benefit from physical therapy in order to reestablish their functional baseline? What criteria is used by hospital physical therapists to decide which patients are referred to subacute care and rehabilitation? Given this woman’s health history and recent hospitalization her family is at a loss to understand her discharge directly to home.
The scenario described here is one a friend, who, along with her three siblings who care for their mother, described to me. All 4 children work, and as adults, have a barrage of other responsibilities. They all pitch in to help their mother and spread the responsibilities for her care among them, but is it really fair to a family to place additional responsibilities on their shoulders by discharging their mother to home without the benefit of rehabilitation? Is this a safe discharge?
Campbell, C.S. Deconditioning: The consequence of bedrest.