A home assessment, or evaluation, is often a final and crucial step in discharging patients home safely and with adequate caregiver support. Occupational or Physical Therapy can perform this vital assessment and make skilled recommendations for environmental modifications, adaptive devices, and emergency plans. It should come as no surprise, that re-hospitalizations are beginning to impact both, the referring hospital and the long term care facility, financially when patients are readmitted to the hospital within 30 days of a discharge from the facility to home. Often, the readmission is due to a fall or lack of follow through with safety training taught in the gym. It is not translated into the home living environment via caregiver training and “real time” observation of the patient at the discharge location, whether that is assisted living or a private home.
Optimally, a home assessment should include a home safety check list and supply recommendations that would maximize patient independence and safety. It would include a review of the physical plant, i.e. steps to enter the home or apartment, navigation around obstacles such as furniture, rugs and pets, as well as observing transfers to and from the toilet, shower and bed. It would also include checking for adequate lighting, falls prevention strategies and food/meal preparation. There is much more to consider before qualifying the patient as “safe” to be discharged to an independent environment. Certainly medication management and caregiver support, community transportation and household responsibilities would need to be considered as well.
Barriers to a safe discharge can often be addressed with revision of therapeutic goals if the home assessment is completed early enough to incorporate needs into the current therapy plan of care. It is vital that, as clinicians, we do not skip this important part of the discharge and care planning process.