The goal for discharge planning is to make sure that the patient has everything in place to go home safely. Supplies and support need to be in place, and the patient and family need a good understanding of self-care skills and also know who to call if problems arise.
However, there are those situations where you know the family will be challenged by home care. You want to make sure they are as prepared as possible, but there is only so much you can do in the limited time you have. This is when you need to provide the family with appropriate resources for follow-up.
Early signs of dementia
One example of this is when a patient is hospitalized for a medical or surgical problem, but is also showing early signs of dementia. The family wants to care for the patient at home, rather than moving him or her to a care facility.
Dementia is a group of symptoms, not a disease. People with dementia may not be able to think well enough to independently manage their own activities of daily living, such as eating or getting dressed. They may no longer be able to solve problems or control their emotions. They may experience agitation, delusions, and hallucinations.
So at the time of discharge, the patient may be safe to go home, but you recognize that, in time, the patient’s condition will worsen and the family will need new skills and coping mechanisms to function well.
How do you help them prepare for the changes ahead?
Anticipatory guidance
In a situation where you know changes are coming, it is good to prepare the family with some tips on what to look for and a list of 
resources they can tap into when the time is right. For example, in the case of a patient with dementia, teach the family to look for signs that they are getting frustrated, such as a more frequent lack of patience or feeling the need to strike out. Feeling overwhelmed by the responsibility of caring for the patient is a sign more help is needed.
Offer the family a list of resources they can use if and when this moment comes. For example, for dementia care, there are several websites that can provide information, instruction, and additional resources:
Forgetfulness: Knowing When to Ask for Help
http://www.nia.nih.gov/HealthInformation/Publications/forgetfulness.htm
Challenging Behaviors: Special Issues for Family Care
The National Institute on Aging
http://www.nia.nih.gov/Alzheimers/Publications/challenging.htm
This Caring Home: Tips and tools to enhance home safety for persons with dementia.
www.thiscaringhome.org
As a staff nurse, you have a limited amount of time to prepare Dementia patients for discharge. Use the time you have well. Make sure they know how to recognize problems and know how to respond. Make sure they have a list of the resources available, so when they are ready to get more help, they know where to go.
Nurses, please leave a comment below sharing your thoughts on this article!
