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PTA Blog Talk

Homeward Bound

Published September 28, 2011 6:44 PM by Jason Marketti

I have done home assessments for patients leaving a facility to determine whether they are safe enough to return to their environment. I have walked through fifth wheels, mobile homes, two-story mansions and a clapboard hut built by the owner. Most environments are safe for people to return to and usually it is an easy-to-fix item like new batteries in a fire alarm that ensures a safer return.

I do have a checklist that I go through as well as some questions that are not on the list but just as beneficial to my determining if a patient is safe before discharging back home. Based on my assessment and recommendations or adaptations of their home environment, patients can go home. When you think about it, this is a huge responsibility.

But when I think about the acute-care patients leaving a hospital or when a patient mysteriously gets a discharge order without any home environment assessment, what I do could very well save their lives. There are scores of patients who had not thought about the smoke detector, tightening the banister or using a high-rise commode and shower bench. Even a simple adaptation like moving a table or using a nightlight can reduce the risk of falls for some patients.

Where a patient sleeps seems to be an ongoing battle. My thinking is that patients have to get up and out of wherever they sleep as easily as possible. Some patients don't care. If a bed is too high or a recliner too low, that is how it is going to be. Provided they can get up and out and do so safely, they will not change it. Even a suggestion of sleeping in the room closer to the bathroom can be blasphemous. I never understand it.

Maybe we are setting our profession up for lawsuits if we do not consistently do more home assessments prior to discharge. Even with a checklist, there are multiple things that need to be seen in person. Is the house infested with vermin? Is there more than one exit in case of fire? Is their neighborhood safe for them to return to? Do they have a phone and does it work? And how often do we talk to patients about medical alert services prior to discharge? Or should we simply wave goodbye to them because they are on their own once they leave our facility?


Kudos on considering this very important part of the patient's transition! I believe it is integral to ensuring a safe discharge. I used to perform them regularly when I worked for a care management company in NYC.

Why don't people take our recommendations and thank us for them? Maybe because they are leaving a place where they have no control over anything. Maybe because they see their control slipping away every year and their house is their castle. Who are we really to tell someone how to do something? We suggest, we explain the risks and benefits and then we allow the patient the dignity of making their own informed choice. If they trip over the cat or extension cord in the dark on the way to the loo, it is because they made that choice.

One needs to ensure that all suggestions have been explained to the patient, that they voice understanding of them, and they understand the risks of not following them. Then our work is done.

Dean Metz September 28, 2011 2:35 PM

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About this Blog

    Jason J. Marketti
    Occupation: Physical Therapist Assistant
    Setting: San Jacinto, CA
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