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 TransitionUnanticipated barriers to home care, such as inadequate or unstable housing, substanceabuse or lack of insurance, may require that discharge from the hospital be postponed. Somehome situations are inappropriate for palliative care supported by home care or hospice services26 (see picas Table 22-5).Table 22-5: Persons for Whom Home Care May Be Inappropriate1. Persons with diarrhea who are housed in single-room occupancy hotels lacking aprivate bathroom or running water in the room.2. Persons with significant weight loss living in places lacking cooking and foodstorage facilities.3. Persons requiring intravenous therapy who have neither a telephone norrefrigeration.4. Persons who are non-ambulatory patients but live in buildings with stairs orbroken elevators.5. Persons living in high crime buildings or in homes where overt drug use andtrafficking takes place in the presence of home care staff. 136. Persons living in housing that is unstable, transient, or a “double up” situation.7. Persons with previously stable housing that is jeopardized by hospitalization anddisclosure of HIV status.8. Persons living in homes in which confused or intoxicated individuals have accessto weapons.If family members have unrealistic expectations of the course of the illness, they may expectthat the patient should not be discharged from the hospital until their health is improved. Conversely,the patient, family members and caregivers may be reluctant to have the patient returnhome from the hospital at all. Often this is due to specific fears that can be addressed in thetransition planning process (see Table 22-6). Some of these fears are real. Others can be amelioratedwith education and support.Table 22-6: Common Caregiver Fears1. That the health of the family or caregiver will suffer.2. That the patient will be readmitted to the hospital and thereby create a negativeperception of the family’s ability to provide care.3. That a crisis will occur at home when no trained professional is on site.4. That incontinence, sickness, or confusion will cause embarrassment.5. That the patient will be left out of discussions/decisions regarding care.6. That the loved one will die at home.7. That the illness will have negative impact on the family, especially children, yet thepatient’s desire to see them may be particularly strong at this time. 148. That a diagnosis of HIV/AIDS will be disclosed to others.460U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau