What options does Diana have for Mr. Mitchell’s discharge plans? What are the potential risks and consequences of these options?

Question

While working as a medical social worker at Holland Community Hospital, Diana Howard, BSW, received a referral to coordinate home health services for patient Joshua Mitchell. Mr. Mitchell had been admitted to the hospital repeatedly after failing to make use of home health services set up for him in the past. In order for Mr. Mitchell to be released from the hospital he had to have a discharge plan from Diana. However, Diana was unsure what course to take as the medical staff pushed for his release and Diana searched for a way to provide services that Mr. Mitchell would use.

Answer 1

First, Diana may create a discharge plan for Mr. Mitchell that includes in?home services after he leaves the hospital. But she knows he will probably refuse the services, as he has done in the past. If he continues to refuse services, her referral will waste limited funds, the referral agencies (e.g., home health care, homemaker services) may refuse future referrals from the hospital, and Mr. Mitchell will likely end up back in the hospital.
Second, Diana may create a discharge plan for Mr. Mitchell that includes no in-home services, as he demanded. Because Mr. Mitchell is mentally competent Diana would need to outline the services she offered to the client and also document that he refused these services in the discharge plan. If she does this, however, she knows he will likely end up back in the hospital. In addition, Mr. Mitchell’s sister, Ms. Williams, is very concerned about his health and strongly believes he should be receiving services. Unless Mr. Mitchell is declared mentally incompetent, neither Ms. Williams nor Diana can force services upon him.
Third, Diana could encourage Mr. Mitchell to accept services from people who are part of his natural support system. Diana knew, for example, that he has received assistance from a fellow church member. Gaining this kind of information from Mr. Mitchell and the reason for his refusal of services may help Diana and the social work team coordinate services that would be most appropriate for Mr. Mitchell’s situation and unique needs.
Fourth, Diana could refuse to arrange a discharge that lacked adequate support services and instead explore and recommend housing with a relative (e.g., Ms. Williams) or a live-in caretaker. This option would give Mr. Mitchell a consistent caretaker and also allow him to receive care in a home he is familiar with (Ms. Williams) or in the comfort of his own home. Mr. Mitchell may, however, not favor this recommendation because he may believe it will limit his independence.
Fifth, Diana could also explore and recommend a long-term care facility placement. This option will also give Mr. Mitchell consistent care and not drain other resources he is refusing to use. Diana, however, must consider the expense this recommendation will create and also consider (and discuss with Mr. Mitchell) the loss of freedom and independence Mr. Mitchell would experience.