HSE 210 Final Project Guidelines and Rubric Overview The final project for this course requires you to analyze the provided case study to identify basic client inpatient and post-discharge needs. As you will see, the analysis of this case requires awareness of trauma and recovery and the fundamentals of ongoing care for neurological disorders and resultant paralysis, as well as sensitivity to health and lifestyle issues associated with aging. Based on the identified needs, you will develop a collaborative care guide, including several essential elements. To create this guide, you will assess research findings to identify goals and evidence-based strategies to address these needs or gaps in services for both inpatient and post-discharge care. You will identify the recommendations you will make during the multidisciplinary care planning session, while being sure to address any financial deficits that are identified for the patient. In your work, you will incorporate appropriate medical terminology to enhance comprehension of care plan objectives for all stakeholders. The project is divided into three milestones, each including elements of the final project. These milestones will be submitted at various points throughout the course to scaffold learning and ensure quality final submissions. Milestones will be submitted in Modules Three, Four, and Five. The final product will be submitted in Module Seven. In this assignment, you will demonstrate your mastery of the following course outcomes:      Illustrate the complexity of navigating the U.S. healthcare system for addressing its impact on patients Analyze the role of the human services worker and interdisciplinary teams for improving patient care and outcomes Apply best practices in the creation of inpatient and discharge care plans Develop basic strategies for addressing financial challenges faced by individual patients Analyze the forces that have influenced the evolution of the U.S. healthcare system Case Study Jean is an 87-year-old woman who was admitted to Manchester Community Hospital, in Manchester, New Hampshire, after having a debilitating stroke that paralyzed the left half of her body. She is a widow, and her three adult children live in different states. She needs assistance eating, transferring to her wheelchair, and most other activities of daily living. Her medical issues related to the stroke are quickly being resolved, and it is time to begin assessing her needs for discharge and post-discharge. It is important to note that Jean’s savings have been totally depleted and her medical bills are mounting since her healthcare insurance has proven to be inadequate to cover her medical expenses. Her limited pension and social security barely covered her living expenses prior to her stroke and are unlikely to cover the escalating expenses that she will undoubtedly encounter based on her medical condition. Moreover, Jean has been clinically diagnosed with PTSD after being raped by a neighbor in her home two years ago. She is still grappling with the effects of the trauma, even as the criminal case against the perpetrator slowly moves forward. Although her family modified the home to make it more secure and less vulnerable to intrusion, her current lack of mobility is weighing heavily on her psychologically. Despite her current issues, Jean derives great comfort from her faith as a devout Catholic. She typically has a wonderful sense of humor and is highly organized, having worked as an elementary school teacher during her earlier years. She participates regularly in the local garden club and on her neighborhood welcoming committee. She has a wide circle of friends with whom she interacts. Her children are currently staying in Manchester to oversee her care and to contribute to the development of her post-discharge care plan. It is unclear whether any of the children will stay on after her discharge to help care for Jean, but this seems unlikely unless considered essential by the medical team. An interdisciplinary team is being developed to design a comprehensive plan for Jean’s post-discharge care. Prompt Based on your analysis of the case study, develop a collaborative care guide in which you assess the client’s needs, make recommendations concerning the interdisciplinary team, and create a follow-up care plan. Remember to use healthcare terminology when appropriate. Specifically, the following critical elements must be addressed: I. Introduction A. Based on an analysis of the case study, research and select the most appropriate research-based strategies to use with this client. What are the most effective strategies used with this client population? Why? II. Inpatient Assessment A. In a narrative format, provide an overview—using a strengths-based focus—to identify the inpatient client needs represented in the context of the case. 1. What are the central physiological, emotional, social, and environmental issues facing this client? 2. How will her strengths help her make any needed transitions? 3. Does trauma impact this client? How? B. What potential complexities could the client encounter during her inpatient stay? How will these complexities impact the client? C. What types of strategies could you employ in this setting to ensure that the client is not re-traumatized? D. Develop effective strategies to address the client’s inpatient financial needs. How can you best facilitate access to recommended services? 1. What resources might be available in her community to fill unmet financial needs? 2. Are there state or federal resources available to assist this client? III. The Interdisciplinary Team A. Based on the case study, ideally who should serve on the interdisciplinary team tasked with developing the client’s care plan? Why? B. Analyze the role of each member of the interdisciplinary team in relation to the following: 1. Improving patient care. For instance, you might consider the role of a team member who would have day-to-day interaction with the client throughout the client’s hospital stay. 2. Improving patient outcomes. For instance, you might consider the role of a team member who would be responsible for developing cost-effective outcomes. C. What strategies should be implemented by the team to ensure the patient understands the terms and outcomes of the post-discharge plan? IV. Follow-Up Care Plan Based on all of the client’s needs, create a comprehensive follow-up care plan. Include the following: A. Applying best practices, explain the basic post-discharge client needs represented within the case study. B. Develop strategies to arrange provision of services to the client. C. Develop effective strategies to address the client’s post-discharge financial needs. What strategies will you use to ensure client access to recommended services? V. Conclusion A. Based on the case study, how would the difficulty of navigating the available resources for both inpatient and discharge needs impact the client? B. What long-term effects will the strategies you developed for addressing the client’s inpatient and post-discharge financial deficits potentially have? C. Describe the expected outcomes of this care plan. VI. Academic Reflection A. Reflect on your decisions and choices in the care plan based on the forces that have influenced the U.S. healthcare system. B. How has the evolution of the U.S. healthcare system positively impacted patients such as the one in this case? Negatively? Milestones Milestone One: Introduction (Section I) In Module Three, you will submit a draft of Section I of the final project. Based on your analysis of the case study, research and select the most appropriate research-based strategies to use with this client. What are the most effective strategies used with the client populations that Jean represents, including people who suffer the effects of stroke, those diagnosed with PTSD, and seniors who are gradually giving up some of their independence. Provide an overview, using a strengths-based focus, to identify client needs represented in the context of the case. This milestone will be graded with the Milestone One Rubric. Milestone Two: Inpatient Assessment and the Interdisciplinary Team (Sections II and III) In Module Four, you will submit a draft of Sections II and III of your final project, identifying the inpatient needs and the interdisciplinary team tasked with developing Jean’s care plan. This milestone will be graded with the Milestone Two Rubric. Milestone Three: Follow-Up Care Plan and Conclusion (Sections IV and V) In Module Five, you will submit a draft of Sections IV and V of your final project, creating a follow-up care plan and drawing conclusions about expected patient outcomes and the effects of navigating available resources. This milestone will be graded with the Milestone Three Rubric. Final Submission: Collaborative Care Guide In Module Seven, you will submit your final project. It should be a complete, polished artifact containing all of the critical elements of the final product. It should reflect the incorporation of feedback gained throughout the course. This submission will be graded with the Final Project Rubric. Deliverables Milestone Deliverable Module Due Grading One Introduction (Section I) Three Graded separately; Milestone One Rubric Two Inpatient Assessment and the Interdisciplinary Team (Sections II and III) Four Graded separately; Milestone Two Rubric Follow-Up Care Plan and Conclusion (Sections IV and V) Five Graded separately; Milestone Three Rubric Three Final Project Submission: Collaborative Care Guide Seven Graded separately; Final Project Rubric Final Project Rubric Guidelines for Submission: Your collaborative care guide should be 6 to 8 pages in length (plus a cover page and references) and must be written in APA format. Use double spacing, 12-point Times New Roman font, and one-inch margins. Critical Elements Introduction: Research-Based Strategies Exemplary (100%) Meets “Proficient” criteria and cites scholarly research that is aligned with claims Proficient (85%) Selects appropriate researchbased interventions and strategies, identifies effective strategies used with the client population, and explains why they are effective Inpatient Assessment: Inpatient Client Needs Meets “Proficient” criteria, and overview is well qualified with concrete examples Comprehensively assesses the inpatient client needs represented in the context of the case study Inpatient Assessment: Potential Complexities Meets “Proficient” criteria and offers a nuanced insight into the complexities of the healthcare system and its impact on patients Accurately identifies potential complexities and impacts on the client Inpatient Assessment: Strategies Meets “Proficient” criteria, and strategies are well qualified with concrete examples Describes strategies that could be employed in the setting to ensure the client is not retraumatized Inpatient Assessment: Inpatient Financial Needs Meets “Proficient” criteria and cites well-researched and viable sources of financial support to meet the client’s needs Develops effective strategies to address the client’s inpatient financial needs and makes appropriate recommendations to best facilitate access to services Needs Improvement (55%) Selects appropriate researchbased interventions and strategies but does not identify effective strategies used with the client population or does not explain why they are effective Assesses the inpatient client needs represented in the context of the case study but is not comprehensive or overlooks relevant factors Identifies potential complexities the client could encounter during her inpatient stay but does not address possible impact or lacks accuracy Describes strategies that could be employed in the setting to ensure the client is not retraumatized, but description lacks detail or is inaccurate Develops strategies to address the client’s inpatient financial needs but does not make appropriate recommendations to facilitate access to those services, or strategy is not effective Not Evident (0%) Does not select appropriate research-based interventions and strategies Value 5.7 Does not assess the inpatient client needs 5.7 Does not identify potential complexities 5.7 Does not describe strategies that could be employed to prevent retraumatization 5.7 Does not develop strategies to address the client’s inpatient financial needs 5.7 The Interdisciplinary Team: Who Should Serve Meets “Proficient” criteria, and justification is well supported with concrete examples Accurately describes and justifies who should serve on the interdisciplinary team tasked with developing the client’s care plan The Interdisciplinary Team: Role, Improving Patient Care Meets “Proficient” criteria and draws connections between member roles and success of patient care Analyzes the role of each member of the interdisciplinary team in relation to improving patient care The Interdisciplinary Team: Role, Improving Patient Outcomes Meets “Proficient” criteria and draws connections between member roles and success of patient outcomes Analyzes the role of each member of the interdisciplinary team in relation to improving patient outcomes The Interdisciplinary Team: Ensuring the Patient Understands Meets “Proficient” criteria and offers insight into why the identified strategies are appropriate in the context of the case Suggests appropriate strategies that should be implemented by the team to ensure the patient understands the terms and outcomes of the post-discharge plan Follow-Up Care Plan: Client Needs Meets “Proficient” criteria and corroborates the appropriateness of the postdischarge assessment by citing research Meets “Proficient” criteria and offers insight into why the identified strategies are appropriate in the context of the case Accurately explains the basic post-discharge client needs represented within the case study Follow-Up Care Plan: Provision of Services Develops effective strategies to arrange provision of services to the client Describes who should serve on the interdisciplinary team tasked with developing the client’s care plan but does not justify decision or overlooks relevant factors Analyzes the role of members of the interdisciplinary team in relation to improving patient care, but overlooks some members, or analysis lacks detail Analyzes the role of members of the interdisciplinary team in relation to improving patient outcomes but overlooks some members, or analysis lacks detail Suggests strategies that should be implemented by the team to ensure the patient understands the terms and outcomes of the post-discharge plan, but suggestions are not appropriate for this client Explains the basic postdischarge client needs represented within the case study, but explanation is not accurate or lacks detail Develops strategies to arrange provision of services to the client, but strategies are not effective Does not describe who should serve on the interdisciplinary team 5.7 Does not analyze the role of members of the interdisciplinary team in relation to improving patient care 5.7 Does not analyze the role of members of the interdisciplinary team in relation to improving patient outcomes 5.7 Does not suggest strategies the team should implement to ensure understanding 5.7 Does not explain the basic postdischarge client needs 5.7 Does not develop strategies to arrange provision of services 5.7 Follow-Up Care Plan: Post-Discharge Financial Needs Meets “Proficient” criteria and offers insight into why the identified strategies are appropriate in the context of the case Develops effective strategies to address post-discharge financial needs and ensure client has access to services Conclusion: Available Resources Meets “Proficient” criteria and offers a nuanced insight into the complexity of the healthcare system and its impact on patients Describes how the difficulty of navigating the available resources for both inpatient and discharge needs would impact the patient, based on the case study Conclusion: LongTerm Effects Meets “Proficient” criteria and uses concrete examples to substantiate claims Describes the potential longterm effects of the developed strategies for addressing the client’s inpatient and postdischarge financial deficits Conclusion: Expected Outcomes Meets “Proficient” criteria and uses concrete examples to substantiate claims Comprehensively describes the expected outcomes of the care plan Academic Reflection: Decisions and Choices Meets “Proficient” criteria and supports decisions and choices with specific, relevant examples Reflects on decisions and choices in the care plan based on the forces that have influenced the U.S. healthcare system Academic Reflection: Impact on Patients Meets “Proficient” criteria and uses scholarly research to illustrate claims Comprehensively explains how the evolution of the U.S. healthcare system positively and negatively impacted patients such as the one represented in the case Develops strategies to address the client’s post-discharge financial needs, but strategies are not effective, or does not give strategies to ensure that the client has access to those services Describes how the difficulty of navigating the available resources would impact a patient but does not relate description to the case study or neglects to describe both inpatient and discharge needs Describes the potential longterm effects of the developed strategies for addressing the client’s inpatient and postdischarge financial deficits, but description lacks detail or overlooks relevant factors Describes the expected outcomes of the care plan, but description is not comprehensive Reflects on decisions and choices in the care plan but does not base decisions and choices on the forces that have influenced of the U.S. healthcare system Explains how the evolution of the U.S. healthcare system positively and negatively impacted patients such as the one in the case, but explanation is not comprehensive or does not include both the positive and negative impacts Does not develop strategies to address the client’s postdischarge financial needs 5.7 Does not describe how the difficulty of navigating the available resources would impact the patient 5.7 Does not describe the potential long-term effects 5.7 Does not describe the expected outcomes 5.7 Does not reflect on decisions and choices 5.7 Does not explain how the evolution of the U.S. healthcare system positively and negatively impacted patients such as the one in the case 5.7 Articulation of Response Submission is free of errors related to citations, grammar, spelling, syntax, and organization and is presented in a professional and easy to read format Submission has no major errors related to citations, grammar, spelling, syntax, or organization Submission has major errors related to citations, grammar, spelling, syntax, or organization that negatively impact readability and articulation of main ideas Submission has critical errors related to citations, grammar, spelling, syntax, or organization that prevent understanding of ideas Total 3.1 100% HSE 210 Module One Worksheet Assignment Guidelines and Rubric For this assignment, you will use the case study about Jean, provided in the Final Project Guidelines and Rubric document. Like many people treated in the healthcare system, Jean has various conditions that need attention. Here is an opportunity to begin thinking about Jean’s experience and the professionals and settings that have been or will be part of her care. Using the case study, outline the different healthcare settings and people that have been and will be a part of Jean’s care, including the human services professional. Describe the types of services they may have provided to her. To complete this assignment, use the worksheet below. First, identify four conditions or issues that are part of Jean’s experience and may require attention in the healthcare system. For each condition, identify tasks to be completed by the human services professional and by one other professional. Then identify two settings where each condition may be engaged and the type of work likely to be completed in that setting. Jean’s Conditions Condition 1: Stroke / Paralyzed left side of her body Condition 2: Needs living assistance and home medical care Condition 3: Sexual assault, Rape, and PTSD Condition 4: Health Insurance and Medical costs Human Services Professional Tasks Social Worker and Counselors: Human service professionals give services to people in their communities and can recommend and set up Jean with home health care and physical rehabs. Home health care, Nurses, Physical therapists, and Doctors: Would help take care of Jean and her health. Would help with household and normal living stuff such as feeding, bathing, and help teach her how to live in her current condition. Mental health Counselor, Psychiatrists, and Law Enforcement: To help Jean with dealing with what her neighbor did and to help be able to get over her experience. Get with Law Enforcement to help with closure. Social Services: They can help get her on Medicaid to take care of medical expenses. DSS can also help with food stamps and other areas. Other Role and Tasks Counselors can help find support groups to help Jean. They can also help Home health care nurses and physical therapists can help take care of Jean and teach her how to possibly Rape Advocates or psychiatrists can help Jean learn to deal with emotional and mental Medicaid services can help make Jeans medical problems be easier to deal with and also allow better the family cope with the issues at hand. Setting 1 and Work Performed Counsel and help find treatment plans and help the family with counsel. Can help family find ways to deal with issues and potential issues. Help them understand issues and how to help situations. Setting 2 and Work Performed Hospital programs, physical rehabilitation and outpatient programs to help Jean transition out to her home life. Can make her more comfortable in her health condition. Also teach her how to make the best out of the situations she is struggling with. regain her health and independence again. issues due to the trauma she has been through. And also help mentally with the stroke stress. medical care. It will also help her with finances. Rubric Guidelines for Submission: Fill in the worksheet above and submit your assignment as a Word file. Critical Elements Proficient (100%) Needs Improvement (75%) Not Evident (0%) Value Identification of Four Conditions in Jean’s Experience Identifies four health-related conditions that are part of Jean’s experience Identifies health-related conditions but does not reach the threshold of four conditions that are part of Jean’s experience Does not identify relevant health-related experiences 15 Identification of Tasks Performed by the Human Service Professional Accurately identifies tasks performed by the human services professional engaging Jean’s conditions Identifies tasks, but they may not address Jean’s condition in each case or may not be suitably performed by the human services professional Does not identify relevant tasks performed by human services professional 25 Identification of Other Roles and Tasks Relevant to Condition Accurately identifies another healthcare professional who may engage Jean and examples of tasks this professional may perform Identifies professional and tasks, but they may not be appropriate for Jean’s experiences, or the tasks may not be those the selected professional would perform Does not identify another healthcare professional who will engage Jean 25 Identifies settings, but they may not be appropriate for Jean’s experiences, or the work performed may not match that performed at the setting Does not identify relevant healthcare settings or work performed 25 Submission may be unclear in places and has major errors related to grammar, spelling, syntax, or organization that negatively impact readability Submission is unclear or has critical errors related to grammar, spelling, syntax, or organization that prevent communication of ideas 10 Identification of Settings and Accurately identifies two settings where Work Performed Relevant to Jean may be treated for each condition Condition Articulation of Response Submission is clear and has no major errors related to grammar, spelling, syntax, or organization Total 100% MILESTONE 3 1 Milestone 3 Daniel McAlister SNHU MILESTONE 3 2 When concerned with engaging in service delivery, the Union Soccer agency is mandated to draft a feasible budget that would necessarily ensure that all the anticipated engagements are accomplished as per the developed schedule and plan. To guarantee the realizations of such undertakings, a budget must be drafted to aid in the usage of finances. Question a: The quality of service relayed to the public is significantly dependent on the amount of monetary allocation depicted by the budget. It is relatively vital that the proposed budget be maintained on the foundational tenets of the dominant ethical criterions. The act is justifiable by the fact that professionals within the human service department are continuously viewed by others to uphold higher standards which may encompass the expectations of them adhering to integrity, honesty and gives priority to people as well as the community. It is assertively explicit that in the process of developing a budget guided by ethical dogmata, there will be stringent accountability for all the monetary resources pumped into programs. These may regard the source alongside the destination of such finances; therefore, the agency is in the position to determine and identify individual subordinates who are in charge of relocating the said monies (Ebrahim, 2014). Hence through attributes as such, the agency is capable of remaining organized as it becomes more aware of its budgetary allocations meaning that smooth delivery of services to the community is realizable. As this act is assumable to be a responsibility towards the public or the society, the most appropriate standard is the standard number 11. It describes the existing professionals as persons who are considerably knowledgeable on their community and culture that they inherently practice hence conceiving them to be well MILESTONE 3 3 aware of multiculturalism within the societal realms and its unavoidable impact on individuals as well as the community as a whole. Question b: Within the frontier of employee retention, the decision to retain a portion of experienced personnel would mean that the agency is taking a step into nurturing its skilled workers thereby resulting in the improvement in efficiency alongside a total reduction in the learning costs. The outcome would be the existence of increment in quality of the services rendered by available professionals (Ebrahim, 2014). The decision to hire new members of the staff assertively provides the agency with the opportunity of introducing individuals who have different innovative ideologies that would enable the establishment to develop approaches which are quality centered. The agency’s budget is the optimal tool for determining the layout of every event aspired by the entity. As a result, it is fundamental to realize that when the budget is expanded, the establishment is optimally-placed to meet all its responsibilities amicably. Hence, it has the propensity to provide a program that is quality centered. Convincingly standard 13 that expresses the responsibility of professionals to the society and the public is best placed to address the influence as it highlights how the subordinates are enabled to fathom the overruling social criterions that communities and clients may deem as affecting their livelihood. Furthermore, these professionals are pictured as willing to share resolution-affiliated information with the affected communities, clientele and groups terming it as part of their work. Question c: Essentially, grants are expressible as non-repayable funds disbursed by one party better known as the grant maker which can be in the form of corporation, department of the government MILESTONE 3 4 or a foundation to a recipient that can be a non-profit firm, individual, business entity or educational establishment. Grant funding is assumable to have a direct relation to the actual delivery of services. It is ascertainable that for services meant for the public to be delivered efficiently, it is upon the management of the agency to secure finances that are usable in guaranteeing smooth operations between the subordinates accorded the role of disseminating endeavors to the intended target individuals. Ideally, a gap exists instances whereby the available monetary resources are incapable of meeting the allocations made on the developed budget. In typical periods, situations as such may require financial managers of agencies to revise their budgetary components so that it may balance at equilibrium with the available financial resources (Boyd-Barrett, 2013). Grants are vital as they enable an agency to fund its leading programs comfortably and thus it acts as a stepping stone unto which entities such as Union Soccer may have the muscle to see through their projects. It is tentative to note that one guiding regulations concerning grant compliance revolves around certification during occasions of federal funding. In this regard, the agency is exposed under the mandate to certify that its leading managerial team is not in any way barred from engaging in human service inclined programs. Question d With the looming implementation of the proposed changes within the Union Soccer, it is relatively clear that this agency should consider venturing into various sources of its funds. Ultimately, these may comprise but verily not limited to local as well as state funding; federal oriented funding; finances from existing foundations that do exist locally; and prevailing privateinclined companies (Boyd-Barrett, 2013). Since there is an expectation in the expansion of the MILESTONE 3 5 futuristic allocations and engagements, the budget is also probable to bulge meaning more funds should be sourced from the possible institutions. Nonetheless, the planned proposal would consequentially have a detrimental influence on the human service programs. Former trends guided by the agency’s culture shall be done away with. On the other hand, new trends like the collaboration between agencies would be more frequent in the endeavor that the public may experience the dissemination of services amply and appropriately. On the structure of workforce frontier, the proposal intends to abolish the former bureaucratic models where there was adherence to the chain of command. In its place, there is the plan to allow for modern tendencies such as blending of the staff members, the inclusion of millennials in the management team as well as embracing of the boomerang workers. The bottom line is that an inherent horizontal structure is the way to go as championed for by the proposal. MILESTONE 3 6 Reference Boyd-Barrett, O. (2013). Multinational news agencies. In Multinational Service Firms (RLE International Business) (pp. 123-147). Routledge. Ebrahim, A., & Rangan, V. K. (2014). What impact? A framework for measuring the scale and scope of social performance. California Management Review, 56(3), 118-141. Milestone 3 SNHU HSE210 Daniel McAlister 2 Milestone 3 VI. A. In this milestone, the assessment of Jean’s post-discharge needs is facilitated. Need or Description Concern Prevention and Although Jean's medical issues are under the resolution, she still suffers from wellness the stroke symptoms since she is incapable of moving, eating or performing her daily activities by herself due to the paralysis of her left body half. She, therefore, needs full recovery from the condition even after discharge. Emotional or Jean was diagnosed with PTSD after encountering rape case by a neighbor. mental health She is still struggling with trauma effects, and her real lack of movement concern weighs significantly on her mind. As a result, she needs assistance with the psychological problem. Personal Jean is a widow and needs help with her daily duties, home chores and during assistance her change in position since her current medical condition does not allow her. Her family is staying in various states, and it is uncertain whether they will live with their mother during her post-discharge care (Potthoff, Kane, & Franco, 1997). Financial advice Due to her medical issues, Jean's savings have been completely exhausted. or assistance Her clinical bills are accumulating because her healthcare insurance is now insufficient for covering the clinical expenses. Her small pension and social safety rarely covered costs before her stroke, and will still not cover for her mounting losses from the medical issues. 3 B. Strategies for arranging provision of services to the Jean Issue Strategy Prevention and wellness Provision of a social worker by the discharge planners who receives a referral from the health professional to PAC settings. The expert begins by helping the patient to navigate the healthcare system and operate towards wellness. They assess the client for psychosocial financial or social problems due to their medical conditions. Emotional or mental health Provision of a psychologist who will focus significantly on the concern psychotherapy and be curing the emotional and psychological suffering of Jean. Personal assistance Selecting the suitable PAC setting like the nursing home versus rehabilitation. Moreover, the hospital discharge location predictions for stroke patients like Jean are discharged to nursing homes if they are living alone, and have poorer pre-admission duties of daily living scores. Financial advice or assistance Referring to the Medicare for help. Medicare prospective payment system has created motivations to reduce hospital stays by allowing early discharge into the post-acute care, which is treated as the hospital referral. The attention is catered for by the Medicare throughout the treatment episode (Potthoff, Kane, & Franco, 1997). 4 V. Conclusion In conclusion, if the needs are not fully met, Jean's length of stay decreases in the hospital and is thus discharged when significantly physically and emotionally unstable (Potthoff, Kane, & Franco, 1997). Furthermore, if Jean continues to undergo the financial problem that interferes with her treatment process, physically, her state of immobility and inability to perform any personal care and daily activities will remain intact. Additionally, she will deteriorate psychologically and can end up developing acute mental disorders that originate from the traumatic event of raping from her neighbor. On the contrary, if she succeeds with the financial support issues, she continues to obtain therapies and can eventually gain her original condition due to stroke resolution. Discharges to PAC are considered as the hospital transfers in which the hospital like the Manchester Community Hospital becomes liable for the costs, which are then settled by the Medicare. Once the healthcare facilities have become fully accountable for the ongoing care of their discharged client like Jean, they are motivated to make right decisions, which thus ensure the greater stability in the physical and psychological condition of the patient when all discharge requirements are met. 5 Reference Potthoff, S., Kane, R. L., & Franco, S. J. (1997). Improving hospital discharge planning for elderly patients. Health Care Financing Review, 19(2), 47. Shi, L., & Singh, D. A. (2010). Essentials of the US health care system. Sudbury, Mass.: Jones and Bartlett. Milestone 2 SNHU HSE 210 Daniel McAlister The patient Jean is a 87-year-old female who has became paralyzed on the left side of her body due to a recent stroke. Jean needs care in all areas of medical specialists, professionals, nurses, including inpatient and outpatient care. Jean has three children, but all three children live out of state and though they are with her now. Hopefully they will help by being there for her everyday needs after Jean’s discharge. Jean also struggles with PTSD from a recent rape by her male neighbor, leaving her to feel helpless at home. Jean will also go through other mental issues like depression ect. due to the lack of now being independency that she now faces due her having a stroke and being paralyzed on her whole left side now. As Jean is over the age of 65 she is considered a senior entitled to Medicare, which will allow filling the gap of her helpless financial situation. In Jean’s diagnosis’, it would be great for her to have a specialty physician in this case would be a neurologist and psychiatrist. The specialty physicians will make the appropriate patient care plan that will be provided to Jean to get proper inpatient care needed. Jean’s inpatient care, she would be treated with a wide range of care, in all aspects of her health. Not only have the neurology team follow her but also having mental health psychiatry follow her. Jean’s emotional, mental, and security conditions will cause a big negative impact on her life. She lives alone and is undergoing a case of a traumatic rape case that was done by her neighbor in her own house. To add to all this, she just suffered a stroke, enabling her to not be ab use the left side of her body. Inpatient care is new to Jean and she has been independent to the most part. I think that Jean will be able to follow a discharge plan because she hopefully will now have her children with her and they have human service professionals and doctors as well as the care to allow Jean to have a smooth transition and recovery without too much worry. If Jean’s health was to worsen it would truly slow her recovery process. Like if her symptoms of paralysis never got better or got worse. She would not be able to possibly leave on her discharge care plan. Also, it would impact her to possibly never being able to live at home alone. While Jean is under care, she can be helped by a couple of different ways. She would need female personal hygiene care, of course from a female. I am sure after the trauma of PTSD from the rape of her neighbor she will suffer from trust issues with males and strangers in general. There are numerous programs to help with finances, there is state run agencies such as (DSS) Department of Social Services. Jean should be able to qualify for many different services they provide help with. These are some that can help her such as Medicare, Medicaid benefits, Medicare Advantage and Supplement Plans, and there is also some prescription assistance programs for the elderly. (https://www.eldercaredirectory.org/state-resources.htm) The team that should be involved with Jean will have doctors, specialists and home healthcare nurses. There will be more than one specialized doctor that will be involved in Jean’s care. For example, the neurologist, psychiatrist as well as her primary care doctor that will follow these doctor for long term. The neurologist would make sure the damages due to her stroke is under control and the proper medications are prescribed and follow patient care plan that is provided for patient to get proper therapy. Psychiatrist will help with emotional and her mental disorders like her PTSD and possible depression because of the stroke. Also, stability of nurses, who provide proper care both medication, hygiene and with helping her feel as independent and secure as possible. Social workers who will Social workers to recognize co-occurring diagnoses when evaluating clients for treatment and additional resources like finances. Human service professionals, who complete skills assessment of progression and what comes next after Jeans stay, and work on resources to keep Jean involved in actives for her mental and physical wellness. These teams should be working together in Jean’s life to help with her plans and observe her improvements or weaknesses. Also, the team of specialists should help Jean and her family, so they have the understanding and knowledge of her future care in the discharge plan. Making sure Jean’s questions are answered by both herself and her family and accommodations are made by human service professionals and doctors pair up for cost efficient after care plan. If Jean has any wishes of how her care plan may go, this should be taken into serious consideration to help her with her personal comfort and security. References: Shi L., & Singh, D.A, (2017). Essentials of the U.S. health care system. Burlington, Ma: Jones & Bartlett learning. https://www.eldercaredirectory.org/state-resources.htm Introduction Milestone 1 Daniel McAlister In this case, Jean is an 87 year old woman patient that has had a deliberating stroke that has paralyzed her whole left side of her body. This has led to lack of mobility, more mental health issues. All this to add on top of the PTSD she already has due to a violent attack and rape by her neighbor. In looking at this case there is one thing that stands out the most and that is all the issues she is going to have taking care of herself. With the lack of family living close and low income this can definitely take a toll mentally and physically. In my review of the issues that Jean have and will have to deal with she will need a lot of assistance. She will need to get help improving the quality of her life at home. She is going to need home healthcare and a nurse to come help her. Hopefully her conditions get better so they can help her feel more independent. This could also help with some of the mental strain caused from the depression ect. from the stroke. They would give out medicines, give therapy, do light housework, and also will need transportation to doctor visits. There is another serious aspect that has to be address and that is her mental illness. She has been already diagnosed with PTSD from the traumatic event she suffered. She is also going to more than likely struggle with more issues due to her stroke conditions. Jean will need to also have appointments to mental health in her town and also a psychiatrist. This will ensure she will be on the right medications to help her mental diagnoses. Most of this review is of course in the respect that Jean’s family doesn’t move close to help. If they don’t she may be better off in an assisted living center. This will all depend on the results of her impatient plan and to be considered when it is time to put together her discharge plan. The case study is for Jean who is an 87-year-old woman with issues of mobility, trauma, and who recently suffered a stroke and was hospitalized as a result. In reviewing the case study, Jean’s mobility issues have taken a toll on her, being that she is not able to perform daily activities and needs assistance. Her recent stroke paralyzed the left side of her body in which requires her to get help to eat, sleep, and other routine daily living tasks. In addition to her already complicated life she is struggling financially, and due to this stroke, her insurance is not willing to cover her medical expenses. In reviewing Jean’s case, there are two options that may help to improve her quality of life, which is Home Healthcare or Rehabilitation Center. Home care would bring health services to Jean’s home in which provides a least restrictive care and allows the patient to feel more independent. Home care includes nursing, changing dressings, monitor medications, therapy and homemaker services. This would benefit Jean create a better quality of living being that she has a beautiful sense of humor and likes to be with friends and community. The second option would be a Rehabilitation Hospital in which “specialize in intensive therapeutic services to restore the maximum level of functioning in patients who have suffered recent disability due to illness or accident.” (Shi & Singh, 2017). Rehabilitation hospitals serve those that have endured sports injuries, amputees, and stroke victims to name a few. The rehabilitation center caters to those that cannot be cured but help on how to live with the condition. The rehabilitation center consists of psychical, occupational, and speech-language therapists. This would also be suitable for Jean however due to the insurance issues Home healthcare would be the best fit for Jean. References Shi, L., & Singh, D. A. (2017). Essentials of the U.S. health care system (4th ed.). Burlington, MA: Jones & Bartlett Learning.
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