The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 22: Facilitating the Transitionserious and steady decline with wasting, disorientation and a cascade of other symptoms andinfections, it can be hard for the closest caregivers to see or admit what is going on. 12 It canmake a tremendous difference for physicians, nurses, therapists, social workers, and/or friendsand loved26 picasones to acknowledge the approach of death gently, but clearly.For a smooth transition to home-based care services, discharge planning should begin as earlyas possible. Evenings and holidays are inappropriate times to discharge a person to home-basedcare unless thorough arrangements have been made regarding access to ordered medications,equipment, supplies and agency personnel. Referrals to home nursing and palliative care servicesshould be made with much advance notice because it may require several days to secureall services for inpatient teaching and home equipment.ASSESSMENT FOR HOME CARE■ One of the most important practical questions facing the patient and team (whether theteam is inpatient staff, outpatient staff, or both) is “Can this patient and family live safely athome?” An assessment of the physical and emotional condition of the patient is necessary tounderstand what needs must be met. This is most often the responsibility of the nurse and/orphysician. However, a comprehensive assessment for home care must take an interdisciplinaryapproach in addressing several important issues (see Table 22-3):• The patient’s mental capacity to make decisions• The patient’s physical capacity to carry out activities of daily living andparticipate in care• The caregiver capacity to provide support in the homeTable 22-3: Assessment of the Home Environment1. Who in the home can assume primary responsibility as caregiver?2. What is the patient’s level of ability in activities of daily living?3. Are family members or caregiver able to read and understand medication labels?4. What is the family and patient’s understanding of, and adjustment to, the illness?5. What is the potential impact of disclosure by the patient of HIV status to familymembers and other people?6. Are there physical and mental health issues among other family members andcaregivers? (i.e., Is this patient’s partner or spouse also HIV-infected, addicted todrugs or alcohol, or physically or psychologically unable to meet the demands thatwill be placed upon him/her?)7. Are medications, especially pain medications, safe from theft or abuse by others inthe home?8. Do the family and caregiver have the capacity to maintain a stable homeenvironment?9. Will the patient be able to access outpatient care from home? Will the patient andfamily be able to obtain medications and supplies at home?458U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau