The health care of an older adult extends beyond the traditional medical management of illness. It requires evaluation of multiple issues including physical, cognitive, affective, social, financial, environmental and spiritual components. (Ward & Reuben, 2010). According to the American Nurses Association (ANA), nursing case management is a “health care delivery process whose goals are to provide quality health care, decrease fragmentation and duplication of care, enhance the client’s quality of life, and contain costs” (ANA, 1992).
The “Elder Care Case Study” provided for this task requires the nurse to assume the role of a case manager who is responsible for determining the most appropriate discharge placement for an elderly patient, Mr. Trosack, who will be discharged from the hospital after undergoing total hip replacement surgery. Hip fracture among the elderly is a common and serious healthcare issue. Results from a large population study showed that about one quarter of hip fractures in the elderly results in permanent disability which would have not have occurred otherwise (Ziden, Scherman, & Wenestam, 2010, p.103). The first healthcare issue in determining a discharge plan for this patient is safety. Mr. Trosack is vulnerable to a variety of factors that may complicate recovery and possibly require readmission to the hospital. The safety of his environment must be critically examined to prevent a recurrent fall and hip fracture or dislocation. The patient will be using a walker upon discharge and resides alone on the second floor of an apartment building necessitating the use of a long flight of stairs. A fall down these stairs was the trigger event that caused his hip fracture and current hospitalization. Preventing recurrent falls and injury is a significant priority when planning care for the elderly client and is vital for Mr. Trosack. His discharge plan must ensure that he is able to maneuver safely to accomplish his activities of daily living and access to food, medications, and other vital resources. Medication safety is another major concern for this patient. Upon discharge the patient will be prescribed two new medications for newly diagnosed hypertension and noninsulin-dependent diabetes. The patient will need to be closely monitored for adverse drug events and possible drug interactions with the daily unidentified “vitamin pills” he consumes.
The second healthcare issue that must be addressed by the case manager is Mr. Trosack’s ability to care for his own needs and maintain a household at discharge. It is imperative the case management team thoroughly assess the elderly patient’s ability to care for himself and his living arrangements. Assessments regarding the patient’s ability to perform basic functional tasks such as bathing, dressing, toileting, and feeding are all aspects of care that need to be evaluated. Additionally, the capacity for Mr. Trosack to procure...