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Difficulty: EasyDisposition and Care Setting Transitions

An 82-year-old woman is evaluated for discharge planning following a 5-day hospitalization for a left femoral neck fracture, which was treated with surgical hemiarthroplasty. Prior to her fall, she lived alone in a single-family home and was independent with all activities of daily living. Currently, her postoperative pain is well-controlled on oral analgesics, her vital signs are normal, and her surgical incision is clean and intact. Physical therapy notes indicate that she requires moderate physical assistance for transferring from the bed to a chair and cannot yet ambulate safely with a walker. She has no family living nearby who can provide daily assistance. Which of the following is the most appropriate disposition for this patient?

  1. A
    Discharge home with scheduled home health physical therapy visits
  2. Discharge to a skilled nursing facility for short-term rehabilitationAnswer
  3. C
    Transfer to an inpatient hospice facility
  4. D
    Transfer to a long-term acute care hospital
  5. E
    Continuation of acute inpatient care until she can ambulate independently

Answer

Discharge to a skilled nursing facility for short-term rehabilitation.
The correct disposition is discharge to a skilled nursing facility (SNF) for short-term rehabilitation. This patient is medically stable, making continued acute care unnecessary, but she has significant new functional deficits (requiring assistance with transfers and an inability to ambulate) and lacks social support at home. An SNF will provide the necessary daily physical and occupational therapy, along with nursing assistance for activities of daily living, enabling her to safely regain her independence before returning to her home environment.

Step-by-Step Solution

1
Assess the patient's medical stability.
The patient is medically stable with well-controlled pain and normal vital signs.
Medical stability determines whether the patient still requires acute inpatient care or can be transitioned to a lower level of care.
2
Evaluate the patient's functional status and care needs.
The patient requires moderate physical assistance for transfers and cannot ambulate independently.
Functional status dictates the level of nursing and rehabilitative care required post-discharge.
3
Assess the patient's home environment and social support.
The patient lives alone and has no local family to provide daily assistance.
Lack of continuous home support combined with significant physical deficits precludes a safe discharge directly to home.
4
Determine the most appropriate post-acute care setting.
A skilled nursing facility is selected.
A skilled nursing facility provides the required daily physical therapy and assistance with activities of daily living until the patient is safe to return home.

Key Concept

Patients who are medically stable but have new functional impairments requiring assistance with basic activities of daily living, and who lack adequate home social support, should be discharged to a skilled nursing facility for short-term rehabilitation.
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Topics

Disposition and Care Setting Transitions

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