Issues Related to Planning for Home Care Before Discharge From the Hospital

A. Evaluating child, child’s family, home, and community
 1. Child
  a. Child is medically stable for home care
 2. Family
  a. Family desires to have child at home
  b. Family has learned the necessary skills
  c. Family has the resources (time, energy, and finances) to provide care
  d. Family has considered palliative care and end-of-life care options
 3. Home
  a. The home environment is adequate, safe, and accessible
   (1) Structure
   (2) Electrical (eg, 3-pronged plugs, 220-V line)a
   (3) Access (eg, bathroom and ramps)
   (4) Heat, hot water, clean water supply
   (5) Air conditioning
   (6) Driveway/road accessibility
   (7) Other (eg, snow removal)
   (8) Telephone accessb
 4. Community
  a. Community health nurse
  b. Home care nurses
  c. Therapists (eg, physical and occupational therapy)
  d. Ambulance/emergency medical services
  e. Specialty care
  f. Medical supply vendors
  g. Pharmacist
  h. School/early intervention program
  i. Counseling
  j. Support group(s)
  k. Palliative and hospice care where indicated
B. Finding a medical home
 1. PCP
 2. Roles and communication network
 3. Patient summary
  a. Plan for emergency care
  b. Medications
  c. Equipment
  d. Disposable supplies
  e. Advance care plan, out of hospital do-not-resuscitate order, where appropriate
C. Training the home caregivers
 1. Training schedule
 2. Actual care with supervision (trial home care)
D. Arranging home care nursing and developmental/educational services
 1. Nursing care coverage is outlined
 2. Alternative plans are made if nursing care is not available
 3. Arrangements with school or preschool programs for ongoing educational needs
E. Finding home care agencies for supplies and equipment
F. Insurance coverage
 1. Verify that adequate coverage will be provided
 2. Pursue alternative or additional coverage and benefits such as Medicaid waiver program and SSI
 3. Evaluate ability of family to pay for uncovered care (eg, transportation, electricity)
  • a Secondary power generators may be necessary; local power companies and emergency providers should be alerted on hospital discharge, to help prioritize responsiveness to emergencies.

  • b Arrangements should be made with telephone companies to ensure uninterrupted services. Internet services may also be required, especially for those parents who are hearing impaired and cannot easily communicate via telephone.