A registered nurse or therapist will conduct an initial visit to determine the patient’s needs and desired outcomes, and make sure the patient and family understand the services that will be provided, the benefits of home care and the availability of community resources. This information will also be communicated to your physician.
What exactly takes place during the assessment? Think of the assessment as the discovery phase, in which we gather lots of information about the patient’s needs so we can create an individualized plan of care. An experienced clinician conducts the assessment, documenting the patient’s condition:
- Head-to-toe assessment
- Medical diagnoses
- Current health conditions
- Overall nutrition and appetite
- Functional abilities/disabilities
- Ability to carry out daily living activities
The clinician and family also discuss the patient’s:
- Home environment
- Safety issues
- Mental and emotional health
- Social engagement
- Support network
We suggest that the family member(s) who will be most involved in the patient’s care attend the assessment. Once this process is complete, we coordinate with the patient’s primary care physician (PCP) to determine the frequency of visits and which services will best assist the patient to safely regain strength and independence at home.